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Masud FN, Sasangohar F, Ratnani I, Fatima S, Hernandez MA, Riley T, Fischer J, Dhala A, Gooch ME, Keeling-Johnson K, Moon J, Vincent JL. Past, present, and future of sustainable intensive care: narrative review and a large hospital system experience. Crit Care 2024; 28:154. [PMID: 38725060 PMCID: PMC11080308 DOI: 10.1186/s13054-024-04937-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Healthcare systems are large contributors to global emissions, and intensive care units (ICUs) are a complex and resource-intensive component of these systems. Recent global movements in sustainability initiatives, led mostly by Europe and Oceania, have tried to mitigate ICUs' notable environmental impact with varying success. However, there exists a significant gap in the U.S. knowledge and published literature related to sustainability in the ICU. After a narrative review of the literature and related industry standards, we share our experience with a Green ICU initiative at a large hospital system in Texas. Our process has led to a 3-step pathway to inform similar initiatives for sustainable (green) critical care. This pathway involves (1) establishing a baseline by quantifying the status quo carbon footprint of the affected ICU as well as the cumulative footprint of all the ICUs in the healthcare system; (2) forming alliances and partnerships to target each major source of these pollutants and implement specific intervention programs that reduce the ICU-related greenhouse gas emissions and solid waste; and (3) finally to implement a systemwide Green ICU which requires the creation of multiple parallel pathways that marshal the resources at the grass-roots level to engage the ICU staff and institutionalize a mindset that recognizes and respects the impact of ICU functions on our environment. It is expected that such a systems-based multi-stakeholder approach would pave the way for improved sustainability in critical care.
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Affiliation(s)
- Faisal N Masud
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA.
| | - Farzan Sasangohar
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Iqbal Ratnani
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Sahar Fatima
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | | | - Teal Riley
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Jason Fischer
- Office of Sustainability, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Megan E Gooch
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Konya Keeling-Johnson
- Center for Critical Care, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Jukrin Moon
- Center for Health Data Science and Analytics, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Jean-Louis Vincent
- Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Gaetani M, Uleryk E, Halgren C, Maratta C. The carbon footprint of critical care: a systematic review. Intensive Care Med 2024; 50:731-745. [PMID: 38416200 DOI: 10.1007/s00134-023-07307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE The provision of healthcare is a substantial global contributor to greenhouse gas (GHG) emissions. Several medical specialties and national health systems have begun evaluating their carbon emission contributions. The aim of this review is to summarise and describe the carbon footprint resulting from the provision of adult, paediatric and neonatal critical care. METHODS A systematic search of Embase, Cochrane and Web of Science was performed in January 2023. Studies reporting any assessment of the carbon footprint of critical care were included. No language restrictions were applied. GHG emissions from life cycle assessments (LCA) were reported, in addition to waste, electricity and water use. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. RESULTS In total, 13 studies assessing and describing the environmental impact of 36 adult or paediatric intensive care units (ICUs) were included. Two studies described full LCAs, seven reported waste only, two provided audits of unused medical supplies, one reported electricity use, and one study described a Material Flow Analysis. The estimated carbon emissions from critical care range between 88 kg CO2e/patient/day and 178 kg CO2e/patient/day. The two predominant sources of carbon emissions in critical care originate from electricity and gas use, as well as consumables. Waste production ranged from 1.1 to 13.7 kg/patient/day in the 6 studies where mean waste could be calculated. CONCLUSION There is a significant carbon footprint that results from intensive care provision. Consumables and waste constitute important, measurable, and modifiable components of anthropogenic emissions. There remains uncertainty due to a lack of literature, several unstudied areas of carbon emissions from critical care units, and within measured areas, measurement and reporting of carbon emissions are inconsistent.
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Affiliation(s)
- Melany Gaetani
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Camilla Halgren
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christina Maratta
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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Sonaiya S, Marino R, Agollari K, Sharma P, Desai M. Environmentally sustainable gastroenterology practice: Review of current state and future goals. Dig Endosc 2024; 36:406-420. [PMID: 37723605 DOI: 10.1111/den.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. METHODS A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. RESULTS This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. CONCLUSION Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented.
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Affiliation(s)
- Sneh Sonaiya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Richard Marino
- Kansas City University School of Medicine, Kansas City, USA
| | - Klea Agollari
- Kansas City University School of Medicine, Kansas City, USA
| | | | - Madhav Desai
- Center for Interventional Gastroenterology, UTHealth McGovern Medical School, Houston, USA
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Garcia Borrega J, Hermes C, König V, Kitz V, Möller S, Stark D, Janssens U, Mager D, Kochanek M. [Sustainability in intensive and emergency care : A nationwide survey by the German Society of Medical Intensive Care and Emergency Medicine]. Med Klin Intensivmed Notfmed 2024; 119:108-115. [PMID: 37341751 PMCID: PMC10901941 DOI: 10.1007/s00063-023-01039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The impact of climate change on humans is well known. However, the health care system is also a relevant contributor, accounting for up to 5-7% of global greenhouse gas emissions, and work should be adapted to be more sustainable. AIM The survey investigated whether sustainability plays a role in hospitals and specifically in the field of emergency and intensive care. Concrete measures and which hurdles are already recognized were also inquired. MATERIALS AND METHODS The "AG Nachhaltigkeit" (working group on sustainability) of the "Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin" (DGIIN) conducted an electronic survey among the staff of intensive care units, emergency rooms, and ambulance services in Germany. RESULTS In all, 218 survey results were included in the analysis: 108 (50%) participants were from the nursing sector and 98 (45%) belonged to the medical staff. The majority of participants work in an intensive care unit (181 [83%]) followed by intermediate care unit (52 [24%]). A total of 104 (47%) participants indicated that their workplace had already implemented sustainability measures. However, when asked whether decision-makers in the workplaces incorporate sustainability into their decisions, management scored highest with only 20%. Potential for improvement is seen in energy and waste management, among others. CONCLUSION The survey results show that (1) employees are highly motivated to address the issue of sustainability and to implement measures, (2) the potential to establish a resource-saving and environmentally friendly hospital is far from being exhausted, and (3) it must become a priority that decision-makers in the hospital propagate sustainability, make processes transparent, and support the motivation of employees on the subject of sustainability. In addition, this process must be supported by politicians and health insurance companies.
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Affiliation(s)
- Jorge Garcia Borrega
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Carsten Hermes
- Hochschule für angewandte Wissenschaften (HAW), Hamburg, Deutschland
- Akkon Hochschule für Humanwissenschaften, Berlin, Deutschland
| | | | - Valery Kitz
- Interdisziplinäre Intensivstation, Pflegeentwicklung, Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Deutschland
| | - Sverrir Möller
- Interdisziplinäre konservative Intensivstation, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Dominik Stark
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Uwe Janssens
- Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - David Mager
- Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Murthy S, Bernat M, Perner A. Attributable climate emissions: an important public- and patient-centered outcome for intensive care trials. Intensive Care Med 2024; 50:144-146. [PMID: 38112770 DOI: 10.1007/s00134-023-07283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Matthieu Bernat
- Service d'anesthésie et de Réanimation Hôpital Nord Assistance, Publique Hôpitaux Universitaires de Marseille, Aix, Marseille Université, Marseille, France
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Affiliation(s)
- Heather Baid
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Eleanor Damm
- Intensive Care Medicine and Anaesthesia, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Louise Trent
- Hawke's Bay Hospital, Te Matau a Māui, Te Whatu Ora, New Zealand
| | - Forbes McGain
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Australia
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Bein T. [The CO 2 footprint of intensive care medicine-let's go green]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01012-z. [PMID: 37119258 DOI: 10.1007/s00063-023-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/01/2023]
Abstract
Climate change and global warming are facts, and actually they are a hot topic for politics, economics, and societies. Global healthcare contributes approximately 5% of worldwide anthropogenic emissions, and this fact might produce an ethical dilemma between the Hippocratic principles of 'beneficence' (promotion of health) and of 'non-maleficence' (avoiding reinforcement of the climate crisis). Intensive care medicine has continuous high staff activity, resource use, and energy demands, and it is clear that intensive care medicine must become green to commence with practical measures to reduce their intensive care unit (ICU) carbon footprint. In this article several strategies are introduced, beginning with the creation of green teams on the ICUs from the bottom. Furthermore, systematic recycle programs, and the assessment and control of energy use are required to make ICUs more sustainable. Strategies for avoiding futile treatment combined with a choose wisely philosophy might contribute to such projects. Immediate engagement of all healthcare staff, particularly those who work in the ICU, is necessary to join the 'race to zero carbon emissions'.
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Affiliation(s)
- Thomas Bein
- Deutsche Allianz Klimawandel und Gesundheit, Fakultät für Medizin, Universität Regensburg, 93042, Regensburg, Deutschland.
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8
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Drinhaus H, Schumacher C, Drinhaus J, Wetsch WA. W(h)at(t) counts in electricity consumption in the intensive care unit. Intensive Care Med 2023; 49:437-439. [PMID: 36952015 PMCID: PMC10119198 DOI: 10.1007/s00134-023-07013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christine Schumacher
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Wolfgang A Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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9
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Halpern NA, Scruth E, Rausen M, Anderson D. Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future. Crit Care Clin 2023; 39:577-602. [DOI: 10.1016/j.ccc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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10
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Using Residual Blood from the Arterial Blood Gas Test to Perform Therapeutic Drug Monitoring of Vancomycin: An Example of Good Clinical Practice Moving towards a Sustainable Intensive Care Unit. Crit Care Res Pract 2022; 2022:9107591. [PMID: 36605032 PMCID: PMC9810402 DOI: 10.1155/2022/9107591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022] Open
Abstract
Background Regarding sustainability in the intensive care unit (ICU), there is increasing interest in reducing material waste and avoiding unnecessary procedures. Therapeutic drug monitoring (TDM) of vancomycin, using a dedicated tube, is standard clinical care during treatment with vancomycin. Furthermore, in the ICU, on a daily basis, arterial blood gas (ABG) tests are frequently performed throughout the day. After analysis, a variable volume of blood is discarded. Lithium heparin (LiHep) syringes for ABG tests differ from normally used dipotassium ethylenediaminetetraacetic acid (K2EDTA) tubes. The primary objective was to compare both containers and validate the use of LiHep syringes. Secondary objectives were to evaluate the potential impact on saving materials, nursing time, and costs when implementing vancomycin TDM via LiHep syringes. Methods Vancomycin analysis from sampling in lithium heparin (LiHep) syringes for ABG tests was validated and compared with the concentrations from conventional sampling in K2EDTA tubes. For method comparison, a Bland-Altman plot and Deming regression analysis were performed. The method was validated for inter- and intra-day precision and accuracy. Vancomycin was analyzed by means of the validated method using a particle-enhanced turbidimetric inhibition immunoassay (PETINIA) autoanalyzer. Furthermore, an analysis was conducted to evaluate the potential impact of implementing vancomycin sampling via ABG tests on savings in materials, nursing time, and costs. Results From 18 patients, 24 plasma samples in both K2EDTA tubes and LiHep syringes were obtained and compared. The mean relative difference between the two containers was -2.0% (-3.0 to -0.93%). Both the Deming regression analysis and the Bland-Altman plot met the acceptance criteria. Potentially, over 1000 blood draws and accompanying materials and packaging can be saved when vancomycin samples are obtained by means of scavenged LiHep syringes. The vancomycin analysis for LiHep syringes showed a total interday precision of 1.95% and an accuracy of 99.7%. The total intraday precision was 2.22%, and the accuracy was 99.2%. Accuracy and precision values were within the acceptance criteria of recovery 85 to 115% and ≤15%, respectively. Conclusion No significant differences were found in vancomycin concentration between the two analyses, and the LiHep analysis was validated for further implementation in clinical care. Residual blood from ABG test samples can be used for TDM of vancomycin, resulting in a potential reduction of materials used and the number of blood draws. These results will contribute to a more sustainable TDM process with benefits for the patient.
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Vali M, Salimifard K, Gandomi AH, Chaussalet TJ. Application of job shop scheduling approach in green patient flow optimization using a hybrid swarm intelligence. COMPUTERS & INDUSTRIAL ENGINEERING 2022; 172:108603. [PMID: 36061977 PMCID: PMC9420315 DOI: 10.1016/j.cie.2022.108603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 07/21/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
With the increasing demand for hospital services amidst the COVID-19 pandemic, allocation of limited public resources and management of healthcare services are of paramount importance. In the field of patient flow scheduling, previous research primarily focused on classical-based objective functions, while ignoring environmental-based objective functions. This study presents a flexible job shop scheduling problem to optimize patient flow and, thereby, minimize the total carbon footprint, as the sustainability-based objective function. Since flexible job shop scheduling is an NP-hard problem, a metaheuristic optimization algorithm, called Chaotic Salp Swarm Algorithm Enhanced with Opposition-Based Learning and Sine Cosine (CSSAOS), was developed. The proposed algorithm integrates the Salp Swarm Algorithm (SSA) with chaotic maps to update the position of followers, the sine cosine algorithm to update the leader position, and opposition-based learning for a better exploration of the search space. generating more accurate solutions. The proposed method was successfully applied in a real-world case study and demonstrated better performance than other well-known metaheuristic algorithms, including differential evolution, genetic algorithm, grasshopper optimization algorithm, SSA based on opposition-based learning, quantum evolutionary SSA, and whale optimization algorithm. In addition, it was found that the proposed method is scalable to different sizes and complexities.
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Affiliation(s)
- Masoumeh Vali
- Computational Intelligence & Intelligent Research Group, Business & Economics School, Persian Gulf University, Bushehr 75168, Iran
| | - Khodakaram Salimifard
- Computational Intelligence & Intelligent Research Group, Business & Economics School, Persian Gulf University, Bushehr 75168, Iran
| | - Amir H Gandomi
- Faculty of Engineering & Information Technology, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Thierry J Chaussalet
- Health and Social Care Modelling Group, School of Computer Science and Engineering, University of Westminster, London W1W 6UW, UK
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12
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Richie C. Environmental sustainability and the carbon emissions of pharmaceuticals. JOURNAL OF MEDICAL ETHICS 2022; 48:334-337. [PMID: 33853877 DOI: 10.1136/medethics-2020-106842] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/09/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions of pharmaceuticals since they are consistently calculated to be among the top contributors to healthcare carbon and assess the factors that contribute to pharmaceutical carbon emissions. Specifically, overprescription, pharmaceutical waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle prescriptions, and drugs given due to a lack of preventive healthcare will be identified. Prescribing practices have environmental ramifications. Carbon reduction, when focused on pharmaceuticals, can lead to cleaner, more sustainable healthcare.
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Affiliation(s)
- Cristina Richie
- Philosophy and Ethics of Technology, Technische Universiteit Delft, Delft 2628, The Netherlands
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13
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Milford K, Rickard M, Chua M, Tomczyk K, Gatley-Dewing A, Lorenzo AJ. Medical conferences in the era of environmental conscientiousness and a global health crisis: The carbon footprint of presenter flights to pre-COVID pediatric urology conferences and a consideration of future options. J Pediatr Surg 2021; 56:1312-1316. [PMID: 32782130 PMCID: PMC7364154 DOI: 10.1016/j.jpedsurg.2020.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Medical conferences are integral to academic medicine, with academic posters being a well-established medium for presenting research. However, conferences carry an ecological footprint due to greenhouse gas emissions. Furthermore, traditional conference formats have recently not been possible due to the COVID-19 pandemic. Herein we examine the carbon footprint associated with travel by presenting delegates to the Fall SPU conferences from 2013 to 2019, and the 2015 ESPU conference. METHODS Online programs for the targeted SPU Fall meetings and the 2015 ESPU Annual Meeting were retrospectively reviewed. Variables collected included meeting location and presenter home base. Distance traveled by the presenter, and likely CO2e of this return trip were estimated using online calculators. Analysis was performed using the Kruskal-Wallis-H test with pairwise comparisons to detect differences in round trip distances and CO2e between meeting locations. RESULTS Six Fall SPU conferences and one ESPU conference were reviewed. The majority of presenters were from the region (North America and Europe, respectively), for both SPU and ESPU. The median round trip distance was 2596.34 miles (IQR 1420.96-4438.30), and the median CO2e 0.61 metric tons (IQR 0.36-1.02). We found that the distances traveled to conferences in the Western USA and Europe were slightly further than those to conferences in Central Canada and the Southern US. The difference in CO2e between these locations did not achieve statistical significance. CONCLUSION Presenter travel to and from pediatric urological conferences generates an important carbon footprint and may not be possible in the medium-term future due to a global pandemic. We should explore strategies to allow meetings and knowledge exchange to continue whilst reducing the need for travel and the ecological burden of conferences. LEVEL OF EVIDENCE Level III: Most comparative level of evidence.
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Affiliation(s)
- Karen Milford
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada.
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Michael Chua
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Kristine Tomczyk
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Amber Gatley-Dewing
- The University of Cape Town, The Faculty of Medicine, Cape Town, South Africa
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
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Nagai K, Barraclough K, Ueda A, Itsubo N. Sustainability in dialysis therapy: Japanese local and global challenge. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00360-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractHuman-induced climate change is considered the greatest health threat of the 21st century. The health effects of climate change are becoming increasingly apparent, and there is substantial evidence indicating increased risk of kidney injury due to heat illness and other climate change-related meteorological abnormalities. On the other hand, healthcare itself is responsible for environmental burdens and has been estimated to generate between 3 and 10% of total national CO2 equivalent emissions. Dialysis has been estimated as one of the major contributors to healthcare’s carbon footprint. Especially in Australia and the UK, nations that have high awareness regarding environmental research, “Green Nephrology” has emerged as a new discipline. From both of these countries, a series of papers have been produced outlining the carbon footprint of hemodialysis, the results of surveys of specialists’ awareness of environmental issues, and proposals for how to save resources in dialysis therapy. Following on from this, several national and international nephrology societies have committed themselves to a range of initiatives aiming at “greening” the kidney sector. In Japan, where water and electricity supplies currently are stable, we occasionally are reminded of the potential for shortages of water and energy and of waste disposal problems. These issues particularly come to the fore in times of disasters, when hemodialysis patients need to be evacuated to distant dialysis facilities. Irrespective of the current state of resource availability, however, continuous efforts and the establishment of resource-saving procedures as a part of Japanese culture are highly desirable and would contribute to environmentally friendly healthcare. Japan needs to build awareness of these issues before the country faces a catastrophic situation of resource shortages. This review is intended as a call to action regarding environmental sustainability in kidney healthcare in Japan and the world.
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Bein T, Koch S, Schulz C. What's new in intensive care: environmental sustainability. Intensive Care Med 2021; 47:903-905. [PMID: 34145473 PMCID: PMC8313467 DOI: 10.1007/s00134-021-06455-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas Bein
- Faculty of Medicine, University of Regensburg, 93042, Regensburg, Germany. .,KLUG-Deutsche Allianz Klimawandel und Gesundheit e.V., Berlin, Germany.
| | - Susanne Koch
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Schulz
- Climate Change Working Group, Department of Anesthesiology and Intensive Care, Technical University of Munich School of Medicine, Munich, Germany.,KLUG-Deutsche Allianz Klimawandel und Gesundheit e.V., Berlin, Germany
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16
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Baid H, Damm E. Reducing critical care's carbon footprint with financial and social co-benefits. Intensive Crit Care Nurs 2021; 64:103030. [PMID: 33745781 DOI: 10.1016/j.iccn.2021.103030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Heather Baid
- School of Health Sciences, University of Brighton, Village Way, Westlain House, Falmer, Brighton BN1 9PH, UK.
| | - Eleanor Damm
- Shrewsbury and Telford Hospitals NHS Trust, Mytton Oak Road, Shrewsbury SY3 8XQ, UK; Intensive Care Society - Environmental Sustainability Workgroup, UK
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17
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Richie C. Can United States Healthcare Become Environmentally Sustainable? Towards Green Healthcare Reform. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:643-652. [PMID: 33404336 DOI: 10.1177/1073110520979371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care - as a business reliant on fossil fuels for transportation, energy, and operational functioning - is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care - not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.
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Affiliation(s)
- Cristina Richie
- Cristina Richie, Ph.D., is a Fellow at the Institute for Advanced Studies in the Humanities at the University of Edinburgh and a Lecturer in Philosophy and Ethics of Technology at Delft University of Technology
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18
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McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125:680-692. [PMID: 32798068 PMCID: PMC7421303 DOI: 10.1016/j.bja.2020.06.055] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 01/17/2023] Open
Abstract
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
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Affiliation(s)
| | - Jane Muret
- French Society of Anaesthesia and Intensive Care (SFAR), Institut Curie PSL Research University, Paris, France
| | - Cathy Lawson
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England, UK
| | - Jodi D. Sherman
- Department of Anesthesiology, Yale School of Medicine, Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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19
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Affiliation(s)
- Renee N Salas
- Harvard Global Health Institute, Cambridge, MA, USA
- Center for Climate, Health, and the Global Environment, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Maibach
- Center for Climate Change Communication, George Mason University, Fairfax, VA, USA
| | - David Pencheon
- Medical and Health School, University of Exeter, Exeter, UK
| | - Nick Watts
- Lancet Countdown: Tracking Progress on Health and Climate Change, London, UK
| | - Howard Frumkin
- University of Washington School of Public Health, Seattle, WA, USA
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20
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Richie C. Guest Editorial: Sustainability and bioethics: where we have been, where we are, where we are going. New Bioeth 2020; 26:82-90. [PMID: 32584209 DOI: 10.1080/20502877.2020.1767920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Cristina Richie
- Bioethics and Interdisciplinary Studies Department, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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21
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Wooldridge G, Murthy S. Pediatric Critical Care and the Climate Emergency: Our Responsibilities and a Call for Change. Front Pediatr 2020; 8:472. [PMID: 32974244 PMCID: PMC7468581 DOI: 10.3389/fped.2020.00472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023] Open
Abstract
Critical care is perhaps one of the most "climate-intensive" divisions of health care. As greenhouse gas emissions continue to rise, the unprecedented threat of climate change has belatedly prompted an increased awareness of critical care's environmental impact. Within our role as pediatric critical care providers, we have a dual responsibility not only to care for children at their most vulnerable, but also to advocate on their behalf. There are clear, demonstrable effects of our worsening climate on the health of children, with the resultant increased burden of pediatric critical illness and disruption to health care systems. From increasing wildfires and their effect on lung health, to the spread of vector-borne diseases such as dengue, and the increased migration of children due to a changing climate, the effects of a changing climate are here, and we are beginning to see the changing epidemiology of pediatric critical illness. Ensuring that the effects of ongoing changes are minimized, including its future effects on child health, requires a multifaceted approach. As part of this review, we will use the Lancet Countdown on Climate Change indicators to explore the impact of pediatric critical care on climate change and the inevitable influence climate change will have on the future practice of pediatric critical care globally.
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Affiliation(s)
- Gavin Wooldridge
- St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Srinivas Murthy
- Pediatric Critical Care, BC Children's Hospital, Vancouver, BC, Canada
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22
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Baid H, Richardson J, Scholes J, Hebron C. Sustainability in critical care practice: A grounded theory study. Nurs Crit Care 2019; 26:20-27. [PMID: 31828900 DOI: 10.1111/nicc.12493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/01/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sustaining high-quality, critical care practice is challenging because of current limits to financial, environmental, and social resources. The National Health Service in England intends to be more sustainable, although there is minimal research into what sustainability means to people working in critical care, and a theoretical framework is lacking that explains the social processes influencing sustainability in critical care. AIMS AND OBJECTIVES This study aimed to explain the concept of sustainability from the perspective of practitioners caring for critically ill patients. DESIGN The qualitative research followed a Charmazian constructivist grounded theory approach, including concurrent data collection and interpretation through constant comparison analysis. METHODS In-depth interviews were conducted online or by telephone with 11 health care professionals working in critical care in the South of England (8 nurses, 2 physiotherapists, and 1 technician). Schatzman's dimensional analysis and Straussian grounded theory techniques supplemented the data analysis. RESULTS Sustainability was defined as maintaining financial, environmental, and social resources throughout the micro, meso, and macro systems of critical care practice. The most pertinent social process enabling sustainability of critical care was satisficing (satisfaction of achieving a goal of quality care while sufficing within the limits of available resources). Increased satisficing enabled practitioners to fulfil their sense of normative, responsible, sustainable, and flourishing practice. Satisficing was bounded by the cognitive and environmental influences on decisions and an ethical imperative to ensure resources were used wisely through stewarding. CONCLUSIONS An explanation of the concept of sustainability and significant social processes, in relation to critical care, are presented in a theoretical framework, with implications for how financial, environmental, and social resources for critical care practice can be maintained. RELEVANCE TO CLINICAL PRACTICE This theory offers clinicians, managers, educators, and researchers a definition of sustainability in critical care practice and provides a structured approach to addressing critical care sustainability issues.
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Affiliation(s)
- Heather Baid
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Janet Richardson
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Julie Scholes
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Eastbourne, UK
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23
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Life cycle assessment as decision support tool for environmental management in hospitals: A literature review. Health Care Manage Rev 2019; 46:12-24. [PMID: 31116121 DOI: 10.1097/hmr.0000000000000248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life cycle assessment (LCA) is an environmental accounting tool aimed at determining environmental impacts of products, processes, or organizational activities over the entire life cycle. Although this technique already provides decision-makers in other sectors with valuable information, its application in the health care setting has not yet been examined. PURPOSE The aim of this study was to provide a comprehensive overview of scientific research on the application of LCA in hospitals and its contribution to management decision-making. METHOD We perform a systematic literature review by searching a range of databases with synonyms of "LCA" in combination with the term "hospital" in order to identify peer-reviewed studies. The final sample of 43 studies were then subjected to a content analysis. RESULTS We categorize existing research and show that single and multi-indicator LCA approaches are used to examine several products and processes in hospitals. The various approaches are favored by different scientific communities. Whereas researchers from environmental sciences perform complex multi-indicator LCA studies, researchers from health care sciences focus on footprints. The studies compare alternatives and identify environmental impacts and harmful hotspots. PRACTICE IMPLICATIONS LCA results can support health care managers' traditional decision-making by providing environmental information. With this additional information regarding the environmental impacts of products and processes, managers can implement organizational changes to improve their environmental performance. Furthermore, they can influence upstream and downstream activities. However, we recommend more transdisciplinary cooperation for LCA studies and to place more focus on actionable recommendations when publishing the results.
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24
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Taylor T, Mackie P. Carbon footprinting in health systems: one small step towards planetary health. Lancet Planet Health 2017; 1:e357-e358. [PMID: 29851647 DOI: 10.1016/s2542-5196(17)30158-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Tim Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, RCH Treliske, Truro, UK.
| | - Phil Mackie
- Scottish Public Health Network/Scottish Managed Sustainable Health Network, Edinburgh, UK
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