Carbon footprint evaluation of routine anatomic pathology practices using eco-audit: Current status and mitigation strategies

Recycled formalin: a new tool to mitigate the environmental impact of surgical pathology in routine practice

Formalin is universally acknowledged as the gold standard for tissue fixation. However, it is a dangerous toxic chemical without any realistic substitute. Therefore, decreasing its use seems to be the only way to reduce its environmental impact. We assessed the feasibility of an innovative formalin recycling circuit based on the reuse of formalin following biopsy removal and paper filtration. We also assessed the efficiency of a policy of less formalin use in routine practice without compromising work quality and security. The recycled formalin was equivalent to new formalin in terms of its chemical and molecular properties, as well as the fixation, analysis, and storage of tissue samples. Moreover, its use for fixation did not affect molecular analyses. We calculate that our process would have decreased the total consumption of formalin in 2022 by 26% compared to 2021. This corresponds to financial savings of €4620, a 2434 kg CO2 equivalent reduction in greenhouse gases, and substantial decreases in toxicity to humans and freshwater. Our recycled formalin circuit is a simple, easy-to-implement, efficient way to mitigate the environmental impact of formalin in surgical pathology without compromising the quality of analysis and the safety of the pathology staff.

Surgical pathology and sustainable development: international landscape and prospects

The healthcare sector significantly contributes to global greenhouse gas emissions, with surgical pathology (SP) playing a notable role. This review explores the ecological transformation of SP, offering a global overview of existing challenges and sustainable initiatives worldwide.While some countries, such as the UK and France, have developed national strategies to reduce the carbon footprint of healthcare, including SP, many regions remain at an early stage of implementing green practices. Several studies have assessed the carbon footprint of SP, focusing on key aspects such as laboratory operations, pathology procedures and functional units, highlighting materials and transportation as major contributors to emissions. The integration of digital pathology and artificial intelligence (AI) presents opportunities to enhance efficiency and address medical deserts but also poses challenges due to the associated energy consumption.Local initiatives such as the 'Transformation Ecologique en Anatomie et Cytologie Pathologiques' (Ecological transformation in SP) or TEAP collective in France, Belgium's 'Green Team' and sustainable practices in Tunisia and New Zealand demonstrate the global effort to reduce the environmental impact of SP. Key strategies discussed include ecodesign of care, circular economy practices, green AI and partnerships with industry. However, achieving meaningful reductions in SP's environmental impact requires international cooperation and support from national health policies. This review emphasises the importance of collaborative efforts to implement sustainable solutions without compromising the quality and safety of healthcare services.

[Medical education in ecology and environmental health: A sustainable tool for action]

Global warming and the disruption in ecosystems have been identified as the greatest threats to human health in the 21st century. Today, the French healthcare system accounts for 6.6% to 10% of overall greenhouse gas emissions in France. This system is currently not resilient and totally dependent on fossil fuels. Therefore, a transformation of the current system is needed in order to reduce the deterioration of populations' health. Medical education and pedagogy have been identified as a major solution for the ecological transformation of the healthcare system. The introduction of early education on ecology and environmental health in the first and second cycles of medical studies is a major lever for action. From the third cycle of medical studies, and more specifically in pathology, it is essential to teach this topic to residents and experienced pathologists, whether in "theoretical teaching" or "applied to the medical specialty". The aim of this review is to identify the educational programs and training currently available in the medical courses and at the post-graduate level, regarding ecology/environmental health and the consequences on human health. Then, we will detail more specifically the pedagogical perspectives and training opportunities for pathology residents and pathologists.

[The environmental impact of digital technology and artificial intelligence, in the era of digital pathology]

While digitization and artificial intelligence represent the future of our specialty, future is also constrained by global warming and overstepping of planetary limits, threatening human health and the functioning of the healthcare system. The report by the Délégation ministérielle du numérique en santé and the French government's ecological planning of the healthcare system confirm the need to control the environmental impact of digital technology. Indeed, despite the promises of dematerialization, digital technology is a very material industry, generating greenhouse gas emissions, problematic consumption of water and mineral resources, and social impacts. The digital sector is impacting at every stage: (i) manufacture of equipment; (ii) use; and (iii) end-of-life of equipment, which, when recycled, can only be recycled to a very limited extent. This is a fast-growing sector, and the digitization of our specialty is part of its acceleration and its impact. Understanding the consequences of digitalization and artificial intelligence, and phenomena such as the rebound effect, is an essential prerequisite for the implementation of a sober, responsible, and sustainable digital pathology. The aim of this update is to help pathologists better understand the environmental impact of digital technology. As healthcare professionals, we have a responsibility to combine technological advances with an awareness of their impact, within a systemic vision of human health.

[In the face of climate change, is a relevant and sustainable eco-pathology in France possible?]

INTRODUCTION

The healthcare sector is a major contributor to greenhouse gas emissions, accounting for 8 % of annual French emissions. Eco-design in healthcare, which provides care with equal quality, safety, and relevance but with a lower environmental impact, is therefore a crucial lever for sustainable medical practice. This article explores the application of eco-design in anatomical and cytopathological practices (ACP) in France, in response to the country's decarbonization goals.

OBJECTIVES

After demonstrating that decarbonization is possible through the chosen eco-design of care and practices in ACP, we describe the barriers to these changes and the potential real-world solutions.

DISCUSSION

We examine the challenges and solutions for integrating eco-design principles into daily ACP practice, highlighting the importance of the relevance of medical procedures to reduce unnecessary practices. We discuss the technical and human barriers in ACP, as well as the solutions: raising awareness among laboratory personnel, industrial stakeholders, research and innovation, the involvement of scientific societies, and initiatives from the collective for Ecological Transformation in ACP (TEAP). Finally, we propose financial incentives to make eco-friendly practices economically viable in ACP.

CONCLUSION

Eco-design in ACP practices is essential to address the climate challenge and ensure the sustainability of the healthcare system.

The carbon footprint of a surgical pathology laboratory in France

OBJECTIVES

The health sector contributes to climate disruption through greenhouse gas (GHG) emissions. It accounts for 8% to 10% of France's GHG emissions. Although the medical community has been alerted to the problem, more data are needed. This study aimed to determine the carbon footprint of a surgical pathology laboratory.

METHODS

The study was conducted in the surgical pathology laboratory at Saint Vincent hospital (Lille) in 2021. It represented 17,242 patient cases corresponding to 54,124 paraffin blocks. The 17 staff members performed cytology, immunohistochemistry, and in situ hybridization. The study included all inputs, capital equipment, freight, travel, energy consumption, and waste. Carbon emission factors were based on the French Agence De l'Environnement et de la Maîtrise de l'Energie database.

RESULTS

In 2021, the pathology laboratory's carbon footprint was 117 tons of CO2 equivalent (t CO2e), corresponding to 0.5% of Saint Vincent hospital's total emissions. The most significant emissions categories were inputs (60 t CO2e; 51%), freight associated with inputs (24 t CO2e; 20%), and travel (14 t CO2e; 12%). Waste and energy generated 10 t CO2e (9%) and 9 t CO2e (8%), respectively.

CONCLUSIONS

The pathology laboratory's carbon footprint was equivalent to the yearly carbon impact of 11 French inhabitants. This footprint is dominated by inputs and associated freight. This suggests an urgent need to develop ecodesign and self-sufficiency in our routine practices.