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Operating Rooms and Climate Change

Blog_climate_change_hospitals_02_26Image: Piron Guillaume

The United States medical industry produces about 8% of climate change-causing greenhouse gas emissions.[1] Healthcare providers have long embraced the mandate “do no harm.”  Increasingly, hospitals are considering the environmental impact of medical practice when following this mandate.

One specific venue that is paramount to health care but problematic for climate change is the operating room. The operating room accumulates some of the largest hospital costs for supplies, equipment, and personnel, and it also makes a major contribution to greenhouse gas emissions and waste.[2] Pollutants from the operating room can also exacerbate illnesses caused by poor air quality.[3] Making a few changes in the operating room could reduce greenhouse gases, waste, and environmental health disparities.

Let’s focus on one procedure’s health and environmental outcomes – a Cesarean Section, or “C-section.” This can begin with the use of nitrous oxide, an inhaled anesthetic gas which helps to control neural pathways. As a pain management aid, it can be used during the stages of labor and in post-delivery procedures. But if improperly managed, nitrous oxide, a greenhouse gas, can escape into the atmosphere. It can also have an adverse impact on indoor air quality.

In addition to greenhouse gas emissions, operating rooms can produce between 20% and 33% percent of a hospital’s total solid waste.[4] This waste might be from one-time use surgery kits, plastic tubing lined with eroding chemicals, or pharmaceuticals.[5] Mishandled waste from operating procedures ends up in landfills and incinerators, which pose environmental health threats to the surrounding communities.

To address these concerns, the healthcare industry is taking steps to build environmental stewardship into medical practice. For example, UC San Francisco (UCSF) Medical Center has developed educational brochures that connect climate change and health, explaining how higher temperatures and air pollution affect cardiovascular disease, asthma, and other conditions. These brochures encourage hospital staff and faculty to promote holistic health that doesn’t stop at hospital treatments, but also includes preventive care. Each brochure includes information about how personal steps to be healthier, such as taking the stairs, also combat greenhouse gas emissions.[6]

Other environmentally-minded hospitals have joined the Practice GreenHealth Alliance. Practice GreenHealth serves the healthcare industry by advising on environmental improvements for hospitals’ workers and surrounding communities. Their online series “Greening the Operating Room” highlights the connection between climate change and the health industry’s adaptation and mitigation policies for greenhouse gases.[7] For example, Kaiser Permanente is “Greening the Operating Room” by reprocessing: unused or slightly used items from the operating room  (according to FDA regulations) can be donated to nonprofits who reprocess these items in international settings, as well as re-use them in certain medical procedures. [8]

At Yale New Haven Hospital, physicians and stakeholders are teaming up to decrease waste by “Greening the Operating Room” through proper management of anesthetic gases and surgery kit uses. Most surgery kits are pre-packaged and contain items that are not used in all surgeries, ultimately creating excess waste. Yale is focusing on fitting kits to each procedure, reducing surgical waste.[9]

More and more hospitals are embracing environmental advocacy, taking a stand to decrease pollutants and waste from not only the operating rooms, but from the entire healthcare industry. Along with the connections that health providers are making between human health and climate change, we can be hopeful that the medical industry will reduce its own contributions to waste generation and greenhouse gas emissions.

[1] Kagoma, Y., Stall, N., Rubinstein, E., & Naudie, D. (2012). People, planet and profits: the case for greening operating rooms. CMAJ : Canadian Medical Association Journal, 184(17),1905–1911.

[2] Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. HealthCare System and Effects on Public Health. PLOS ONE 11(6): e0157014

[3] Axelrod, Deb, et al. “Greening the Operating Room and Perioperative Arena.”Environmental Sustainability for Anesthesia Practice, vol. 1, Oct. 2015, pp. 4–25.,Task Force on Environmental Sustainability Committee on Equipment and Facilities.

[4] Kagoma, Y., Stall, N., Rubinstein, E., & Naudie, D. (2012). People, planet and profits: the case for greening operating rooms. CMAJ : Canadian Medical Association Journal, 184(17),1905–1911.

[5] Stall, N. M., Kagoma, Y. K., Bondy, J. N., & Naudie, D. (2013). Surgical waste audit of 5 total  knee arthroplasties. Canadian Journal of Surgery, 56(2), 97–102.