Handling 'carbon footprint' in orthopaedics

INTRODUCTION

The National Health Service contributes 4%-5% of England and Wales' greenhouse gases and a quarter of all public sector waste. Between 20% and 33% of healthcare waste originates from a hospital's operating room, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. The goal of this study was to quantify the amount and type of waste produced during a selection of common trauma and elective orthopaedic operations, and to calculate the carbon footprint of processing the waste.

METHODS

Waste generated for both elective and trauma procedures was separated primarily into clean and contaminated, paper or plastic, and then weighed. The annual carbon footprint for each operation at each site was subsequently calculated.

RESULTS

Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double-draping the patient contribute to increasing the quantity of waste. Over the procedures analysed, the mean total plastic waste at the hospital sites varied from 6 to 12kg. One hospital site undertook a pilot of switching disposable gowns for reusable ones with a subsequent reduction of 66% in the carbon footprint and a cost saving of £13,483.89.

CONCLUSIONS

This study sheds new light on the environmental impact of waste produced during trauma and elective orthopaedic procedures. Mitigating the environmental impact of the operating room requires a collective drive for a culture change to sustainability and social responsibility. Each clinician can have an impact upon the carbon footprint of their operating theatre.

Can the UK meet the World Health Organization PM2.5 interim target of 10 μg m-3 by 2030?

The recent United Kingdom (UK) Environment Act consultation had the intention of setting two targets for PM2.5 (particles with an aerodynamic diameter less than 2.5 μm), one related to meeting an annual average concentration and the second to reducing population exposure. As part of the consultation, predictions of PM2.5 concentrations in 2030 were made by combining European Union (EU) and UK government's emissions forecasts, with the Climate Change Committee's (CCC) Net Zero vehicle forecasts, and in London with the addition of local policies based on the London Environment Strategy (LES). Predictions in 2018 showed 6.4% of the UK's area and 82.6% of London's area had PM2.5 concentrations above the World Health Organization (WHO) interim target of 10 μg m-3, but by 2030, over 99% of the UK's area was predicted to be below it. However, kerbside concentrations in London and other major cities were still at risk of exceeding 10 μg m-3. With local action on PM2.5 in London, population weighted concentrations showed full compliance with the WHO interim target of 10 μg m-3 in 2030. However, predicting future PM2.5 concentrations and interpreting the results will always be difficult and uncertain for many reasons, such as imperfect models and the difficulty in estimating future emissions. To help understand the sensitivity of the model's PM2.5 predictions in 2030, current uncertainty was quantified using PM2.5 measurements and showed large areas in the UK that were still at risk of exceeding the WHO interim target despite the model predictions being below 10 μg m-3. Our results do however point to the benefits that policy at EU, UK and city level can have on achieving the WHO interim target of 10 μg m-3. These results were submitted to the UK Environment Act consultation. Nevertheless, the issues addressed here could be applicable to other European cities.

Nutrient recovery and pollutant removal during renewable fuel production: opportunities and challenges

Stimulated by the desire to achieve a Net Zero energy economy, the demand for renewable fuels is growing rapidly. The production of toxic waste streams that accompanies the transition from fossil fuels to renewable fuels is often overlooked. These waste streams include, among others, thiols and ammonia, and benzene, toluene, and xylene (BTX). When suitable treatment technologies are available, these compounds can be converted to valuable nutrients. In this opinion article, we provide an overview of expected waste streams and their characteristics. We indicate future challenges for associated waste streams, such as the lag in developing resource recovery technologies. Furthermore, we discuss unexploited opportunities to recover valuable nutrients from these waste streams.