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Desterbecq C, Harrison M, Tubeuf S. What are the Revealed and Stated Population Preferences for Environmental Sustainability in Healthcare? A Scoping Review. PHARMACOECONOMICS 2025:10.1007/s40273-025-01479-y. [PMID: 40106196 DOI: 10.1007/s40273-025-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVE Collective changes in healthcare practices are required to ensure real environmental gains. As patient-centred care is increasingly considered to enhance the ability of health systems to meet the expectations of the population, it is crucial for policymakers and health professionals to account for the preferences of the wider public regarding environmentally friendly healthcare. This article synthesises and appraises evidence from empirical studies to understand how people value environmental concerns when making decisions within medical-related or pharmaceutical sectors. METHODS We conducted electronic searches of the PubMed, Scopus, and Embase literature databases. Studies were eligible if they conducted a quantitative experiment to understand participants' preferences regarding sustainability and green initiatives in the medical sector or for pharmaceuticals. RESULTS Of the 1138 documents identified, 32 studies were deemed eligible. More than 60% were published since 2020. Different methods were used to elicit the revealed and/or stated preferences of participants. In most studies, respondents valued the environment positively and were willing to change their behaviour or practices to support sustainability. However, concerns such as disease severity or clinical effectiveness of medicines or medical interventions were often prioritised over environmental considerations. The wide heterogeneity in study participants emphasises the need to involve all stakeholders to achieve the transition to a greener and sustainable healthcare system. CONCLUSION The identified studies used various methods but were consistent in finding broad support for environmental considerations within the healthcare sector.
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Affiliation(s)
- Charlotte Desterbecq
- Institute of Health and Society (IRSS), Université catholique de Louvain (UClouvain), Brussels, Belgium.
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, Canada
| | - Sandy Tubeuf
- Institute of Health and Society (IRSS), Institute of Economic and Social Research (IRES), Université catholique de Louvain (UClouvain), Brussels, Belgium
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Masters C, Wu C, Gleeson D, Serafica M, Thomas JL, Ickovics JR. Scoping review of climate drivers on maternal health: current evidence and clinical implications. AJOG GLOBAL REPORTS 2025; 5:100444. [PMID: 40027476 PMCID: PMC11869044 DOI: 10.1016/j.xagr.2025.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2025] Open
Abstract
Objective To systematically review the literature on associations between climate drivers and health outcomes among pregnant people. This review fills a gap by synthesizing evidence for a clinician audience. Data Sources Systematic scoping review of articles published in PubMed and clinicaltrials.gov from January 2010 through December 2023. Study Eligibility Criteria Empirical studies published in English-language peer-reviewed journals, assessing associations between select climate drivers and adverse maternal and birth outcomes. The review included studies examining heat, storms, sea level rise, flooding, drought, wildfires, and other climate-related factors. Health outcomes included preterm birth, low birthweight, small for gestational age, gestational diabetes, pre-eclampsia/eclampsia, miscarriage/stillbirth and maternal mortality. Study Appraisal and Synthesis Methods The scoping review protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410004, January 3, 2024) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted by 2 authors; quality and risk of bias was assessed independently. Results Total of 966 references were screened; 16.35% (k=158) met inclusion criteria. The majority of studies (146/158; 92.4%) documented statistically significant and clinically meaningful associations between climate drivers and adverse perinatal health outcomes, including risk of preterm birth, low birthweight, and stillbirth as well as preeclampsia, gestational diabetes, miscarriage, and maternal death. Among the most durable findings: extreme heat exposure in early and late pregnancy were associated with increased risk of preterm birth and stillbirth. Driven in part by large (often population-based) studies and objective outcomes from surveillance data or medical record reviews, studies in this scoping review were evaluated as high quality (scoring 7-9 on the Newcastle-Ottawa Scale). Risk of bias was generally low. Conclusions Climate drivers are consistently associated with adverse health outcomes for pregnant people. Continuing education for clinicians, and clinician-patient communications should be expanded to address risks of climate change and extreme weather exposure, especially risks of extreme heat in late-pregnancy. Results from this review should inform multilevel interventions to address adverse health effects of climate during pregnancy as well as practice advisories, protocols, checklists, and clinical guidelines in obstetrics.
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Affiliation(s)
- Claire Masters
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (Masters)
- Department of Environmental, Occupational, and Geospatial Health Sciences, City University of New York, New York City, NY (Masters)
| | - Chuhan Wu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (Wu)
| | - Dara Gleeson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT (Gleeson, Ickovics)
| | | | - Jordan L. Thomas
- Department of Psychology, University of California, Los Angeles, CA (Thomas)
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT (Gleeson, Ickovics)
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Woods N, Melnyk AI, Moalli P. Waste not want not: the story of surgical trash. Curr Opin Obstet Gynecol 2024; 36:444-449. [PMID: 39361335 DOI: 10.1097/gco.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2024]
Abstract
PURPOSE OF REVIEW Our escalating reliance on disposable products in the operating room has generated a large amount of waste, cost, and environmental pollution. Heath damages from the pollution caused by the US healthcare industry cause as much harm, as measured by disability-adjusted life years, as total medical errors. Our response to our own environmental impact should be proportional to that harm. Understanding the waste streams we create and the factors that contribute to our large waste generation in the operating room can help us target solutions to our most harmful practices. RECENT FINDINGS Recent studies within the field of medical waste in ObGyn have included a systematic review analyzing most effective practices for waste reduction and environmental life cycle analyses of specific medical procedures. SUMMARY Operating room waste includes regulated medical waste, pathologic waste/chemotherapy, sharps, general municipal waste, recycling, linens, and anesthetic gases. The most effective way to reduce the environmental impact from medical waste is to reduce our use of disposable supplies in favor of durable reusable materials. Other important interventions include eliminating 'overage' of unused supplies, optimizing use of anesthetic gas, custom pack scale backs, and proper waste segregation. This review of operative waste is intended to aid healthcare facilities in understanding and addressing their own environmental impact.
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Affiliation(s)
- Noe Woods
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra I Melnyk
- OB/GYN & Women's Health Institute, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Pamela Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh
- Magee Womens Research Institute Pittsburgh, Pennsylvania, USA
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Lodhia S, Pegna V, Abrams R, Jackson D, Rockall TA, Rizan C. Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers. Ann Surg 2024; 280:954-959. [PMID: 38726670 DOI: 10.1097/sla.0000000000006337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
OBJECTIVE To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres. BACKGROUND Global health care sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within health care. METHODS Three databases were searched (Web of Science, Ovid, and PubMed), last checked January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis. RESULTS A total of 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics and Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, United States, United Kingdom, and Ireland). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive. CONCLUSIONS This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. In addition, implementation studies should be carried out to examine whether barriers do change in practice.
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Affiliation(s)
- Siya Lodhia
- University of Surrey, Stag Hill, Guildford, UK
- Royal Surrey County Hospital, Guildford, UK
| | | | - Ruth Abrams
- University of Surrey, Stag Hill, Guildford, UK
| | | | | | - Chantelle Rizan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Martins FP, Paschoalotto MAC, Closs J, Bukowski M, Veras MM. The Double Burden: Climate Change Challenges for Health Systems. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241298789. [PMID: 39575137 PMCID: PMC11580064 DOI: 10.1177/11786302241298789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/19/2024] [Indexed: 11/24/2024]
Abstract
Climate change presents significant challenges to human health and health systems, and there is a critical need for health systems to adapt and become more resilient in order to effectively mediate the impacts of climate change on population health. This paper analyzes existing academic literature to identify key themes, trends, and research gaps at the intersection of climate change and health systems. Utilizing a scoping review of 179 studies, we explore how health systems can enhance their resilience through effective governance, sustainable financing, resource generation, and adaptive service delivery. Our findings emphasize the importance of integrating climate considerations into health system governance, mobilizing innovative financial resources, and adapting infrastructure and workforce capacities to address climate-related health challenges. The study highlights the need for continued interdisciplinary research and targeted interventions to ensure health systems are equipped to promote equity and protect vulnerable populations in the face of climate change. These insights contribute to the development of climate-resilient health systems and identify crucial areas for future research.
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Affiliation(s)
| | - Marco Antonio Catussi Paschoalotto
- Research Center in Political Science (CICP), School of Economics, Management and Political Science, University of Minho, Braga, Portugal
- UNU-EGOV, United Nations University Operating Unit on Policy-Driven Electronic Governance, Guimarães, Portugal
| | - Jose Closs
- Laboratory of Environmental and Experimental Pathology—Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Meike Bukowski
- Department of Geography and Geology, University of Salzburg, Salzburg, Austria
| | - Mariana M Veras
- Laboratory of Environmental and Experimental Pathology—Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Sao Paulo, Brazil
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Swiecki-Sikora AL, Becker MV, Harbin LM, Knapp E, Nair RT, Guzman MI, Atwood DA, Ali SZ, Dietrich CS. Environmental sustainability in gynecologic oncology. Gynecol Oncol Rep 2024; 55:101499. [PMID: 39308902 PMCID: PMC11416650 DOI: 10.1016/j.gore.2024.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/27/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024] Open
Abstract
Climate change is a complex, global issue that is impacting human health in various ways, with healthcare being a significant contributor to carbon emissions in the United States. This review discusses the environmental impact of important aspects of gynecologic oncology care, including surgery, anesthesia care, radiology, chemotherapy, and radiation oncology. Operating room energy and material use is highlighted, with a focus on the environmental impact of robotic surgery. The contribution of certain anesthetic gases in increasing greenhouse gas emissions is addressed. Additionally, the environmental impacts of radiologic imaging, chemotherapy, and radiation oncology are also discussed. Despite the complexity of climate change, there are multiple strategies on the individual and institutional level that can help mitigate the environmental impact of gynecologic oncology care. Individual efforts include practicing red bag stewardship, limiting single use-supplies, decreasing the use of potentially deleterious anesthetics, and supporting research into alternative dosing for chemotherapy and radiation which requires less patient travel. Institutional strategies include investing in efficient HVAC systems, utilizing reusable and reprocessed materials and devices, and purchasing renewable energy sources. Both individuals and institutions can advocate with industry and government at all levels for practices and policies that support lower carbon emissions. By recognizing our role in reducing carbon emissions, we can work towards improving the well-being of our patients and the larger community.
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Affiliation(s)
- Allison L. Swiecki-Sikora
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Mariel V. Becker
- Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Laura M. Harbin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Elizabeth Knapp
- Office of Technology Commercialization, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Rashmi T. Nair
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Marcelo I. Guzman
- Department of Chemistry, University of Kentucky, 506 Library Dr., Lexington, KY 40536, United States
| | - David A. Atwood
- Department of Chemistry, University of Kentucky, 506 Library Dr., Lexington, KY 40536, United States
| | - Syed Z. Ali
- Department of Anesthesiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
| | - Charles S. Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States
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Sathe TS, Alseidi A, Bellato V, Ganjouei AA, Foroutani L, Hall RP, Potapov O, Bello RJ, Johnson SM, Marconi S, Francis N, Barach P, Sanchez-Casalongue M, Nijhawan S, Oslock WM, Miller B, Samreen S, Chung J, Marfo N, Huo B, Lim RB, Vandeberg J, Alimi YR, Pietrabissa A, Arezzo A, Frountzas M, Rems M, Eussen MMM, Bouvy ND, Sylla P. Perspectives on sustainability among surgeons: findings from the SAGES-EAES sustainability in surgical practice task force survey. Surg Endosc 2024; 38:5803-5814. [PMID: 39160314 PMCID: PMC11458713 DOI: 10.1007/s00464-024-11137-7] [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: 05/12/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Surgical care significantly contributes to healthcare-associated greenhouse gas emissions (GHG). Surgeon attitudes about mitigation of the impact of surgical practice on environmental sustainability remains poorly understood. To better understand surgeon perspectives globally, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery established a joint Sustainability in Surgical Practice (SSP) Task Force and distributed a survey on sustainability. METHODS Our survey asked about (1) surgeon attitudes toward sustainability, (2) ability to estimate the carbon footprint of surgical procedures and supplies, (3) concerns about the negative impacts of sustainable interventions, (4) willingness to change specific practices, and (5) preferred educational topics and modalities. Questions were primarily written in Likert-scale format. A clustering analysis was performed to determine whether survey respondents could be grouped into distinct subsets to inform future outreach and education efforts. RESULTS We received 1024 responses, predominantly from North America and Europe. The study revealed that while 63% of respondents were motivated to enhance the sustainability of their practice, less than 10% could accurately estimate the carbon footprint of surgical activities. Most were not concerned that sustainability efforts would negatively impact their practice and showed readiness to adopt proposed sustainable practices. Online webinars and modules were the preferred educational methods. A clustering analysis identified a group particularly concerned yet willing to adopt sustainable changes. CONCLUSION Surgeons believe that operating room waste is a critical issue and are willing to change practice to improve it. However, there exists a gap in understanding the environmental impact of surgical procedures and supplies, and a sizable minority have some degree of concern about potential adverse consequences of implementing sustainable policies. This study uniquely provides an international, multidisciplinary snapshot of surgeons' attitudes, knowledge, concerns, willingness, and preferred educational modalities related to mitigating the environmental impact of surgical practice.
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Affiliation(s)
- Tejas S Sathe
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Vittoria Bellato
- Department of Minimally Invasive Surgery, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Amir Ashraf Ganjouei
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Laleh Foroutani
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Ryan P Hall
- Department of Surgery, Tufts Medical Center, Boston, USA
| | - Oleksii Potapov
- Department of General Surgery, College of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ricardo J Bello
- Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Shaneeta M Johnson
- Department of Surgery, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Paul Barach
- Thomas Jefferson University School of Medicine, Philadelphia, USA
- Department of General Surgery, Imperial College London, London, UK
| | | | - Sheetal Nijhawan
- Department of Surgery, Sharon Regional Medical Center, Sharon, PA, USA
| | - Wendelyn M Oslock
- Department of Surgery, University of Alabama Birmingham, Birmingham, AL, USA
- Department of Quality, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Sarah Samreen
- Division of Minimally Invasive Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Jimmy Chung
- Adventus Health Partners, Cincinnati, OH, USA
| | - Nana Marfo
- Ross University School of Medicine, Miramar, FL, USA
| | - Bright Huo
- Department of General Surgery, McMaster University, Ontario, CA, USA
| | - Robert B Lim
- Department of Surgery, Atrium Carolinas Medical Center, Wake Forest University, Charlotte, NC, USA
| | | | - Yewande R Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Miran Rems
- Department of General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA
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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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van Nieuwenhuizen KE, Both IGIA, Porte PJ, van der Eijk AC, Jansen FW. Environmental sustainability and gynaecological surgery: Which factors influence behaviour? An interview study. BJOG 2024; 131:716-724. [PMID: 37973607 DOI: 10.1111/1471-0528.17709] [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: 07/24/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the various factors that influence environmentally sustainable behaviour in gynaecological surgery and examine the differences between gynaecologists and residents. DESIGN An interview study. SETTING Academic and non-academic hospitals in the Netherlands. POPULATION Gynaecologists (n = 10) and residents (n = 6). METHODS Thematic analysis of semi-structured interviews to determine the various factors that influence environmentally sustainable behaviour in gynaecological surgery and to examine the differences between gynaecologists and residents. By using the Desmond framework and the COM-B BCW, both organisational and individual factors related to behaviour were considered. MAIN OUTCOME MEASURES Factors that influence environmentally sustainable behaviour. RESULTS Awareness is increasing but practical knowledge is insufficient. It is crucial to integrate education on the environmental impact of everyday decisions for residents and gynaecologists. Gynaecologists make their own choices but residents' autonomy is limited. There is the necessity to provide environmentally sustainable surgical equipment without compromising other standards. There is a need for a societal change that encourages safe and open communication about environmental sustainability. To transition to environmentally sustainable practices, leadership, time, collaboration with the industry and supportive regulatory changes are essential. CONCLUSION This study lays the groundwork for promoting more environmentally sustainable behaviour in gynaecological surgery. The key recommendations, addressing hospital regulations, leadership, policy revisions, collaboration with the industry, guideline development and education, offer practical steps towards a more sustainable healthcare system. Encouraging environmentally sustainable practices should be embraced to enhance the well-being of both our planet and our population, driving us closer to a more environmentally sustainable future in healthcare.
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Affiliation(s)
| | - Ingena G I A Both
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Petra J Porte
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anne C van der Eijk
- Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
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10
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [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: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Almukhtar A, Batcup C, Bowman M, Winter-Beatty J, Leff D, Demirel P, Porat T, Judah G. Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. Int J Surg 2024; 110:554-568. [PMID: 37889570 PMCID: PMC10793789 DOI: 10.1097/js9.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF). MATERIALS AND METHODS Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. RESULTS Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: 'knowledge' ( N =18), for example knowledge of sustainable practices; 'environmental context and resources' ( N =16) for example personnel shortage and workload and inadequate recycling facilities; 'social influences' ( N =9) for example lack of leadership/organisational mandate or support; 'beliefs about consequences' ( N =9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it. CONCLUSIONS Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs.
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Affiliation(s)
- Aws Almukhtar
- Department of General Surgery, Imperial College Healthcare NHS Trust
- Department of Surgery and Cancer, St Mary’s Hospital
| | - Carys Batcup
- Dyson School of Design Engineering, Imperial College London
| | - Miranda Bowman
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Daniel Leff
- Department of Surgery and Cancer, St Mary’s Hospital
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Pelin Demirel
- Dyson School of Design Engineering, Imperial College London
| | - Talya Porat
- Dyson School of Design Engineering, Imperial College London
| | - Gaby Judah
- Department of Surgery and Cancer, St Mary’s Hospital
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12
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Emont J, Wang M, Wright K. Health system decarbonization on obstetric and newborn units. Semin Perinatol 2023; 47:151844. [PMID: 37852893 DOI: 10.1016/j.semperi.2023.151844] [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] [Indexed: 10/20/2023]
Abstract
The healthcare industry makes up 4.6 % of greenhouse gas (GHS) emissions worldwide. Although it is not known what proportion of GHGs come from obstetric and newborn units, newborns and pregnant individuals are likely to face some of the largest consequences from climate change. We review the literature in the areas of decarbonization on labor and delivery (L&D) and neonatal units and describe innovations from the fields of surgery and anesthesia. Best practices for L&D include refining disposable equipment packs, decreasing the use of single-use medical devices, adequately triaging waste, and decreasing the use of potent anesthetic gases such as nitrous oxide and desflurane. In neonatal settings, similarly triaging waste and decreasing the use of plastics containing endocrine disrupting chemicals can lower the carbon and environmental footprint and improve neonatal health. Additionally, avoiding unnecessary cesarean deliveries and increasing breastfeeding practices are also likely to improve the carbon footprint of L&D and neonatal units.
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Affiliation(s)
- Jordan Emont
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA.
| | - Melissa Wang
- Department of Obstetrics and Gynecology, Columbia University Medical Center - New York Presbyterian Hospital, 622 W 168th St, New York, NY 10032, USA
| | - Kelly Wright
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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13
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Sullivan GA, Reiter AJ, Smith C, Glick RD, Skarda DE, Le HD, Gow KW, Rich BS, Raval MV. Pediatric Surgeon Perceptions on Operating Room Environmental Stewardship and Current Institutional Climate-Smart Actions. J Pediatr Surg 2023; 58:2278-2285. [PMID: 37468347 DOI: 10.1016/j.jpedsurg.2023.06.013] [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: 04/13/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Operating rooms generate significant greenhouse gas emissions. Our objective was to assess current institutional climate-smart actions and pediatric surgeon perceptions regarding environmental stewardship efforts in the operating room. METHODS A survey was distributed to members of the American Pediatric Surgical Association in June 2022. The survey was piloted among ten general surgery residents and two professional society cohorts of pediatric surgeons. Comparisons were made by demographic and practice characteristics. RESULTS Survey response rate was 15.9% (n = 160/1009) and included surgeons predominantly from urban (n = 93/122, 76.2%) and academic (n = 84/122, 68.9%) institutions. Only 9.8% (n = 12/122) of pediatric surgeons were currently involved in operating room environmental initiatives. The most common climate-smart actions were reusable materials and equipment (n = 120/159, 75.5%) and reprocessing of medical devices (n = 111/160, 69.4%). Most surgeons either strongly agreed (n = 48/121, 39.7%) or agreed (n = 62/121, 51.2%) that incorporation of environmental stewardship practices at work was important. Surgeons identified reusable materials/equipment (extremely important: n = 61/129, 47.3%, important: n = 38/129, 29.5%) and recycling (extremely important: n = 68/129, 52.7%, important: n = 29/129, 22.5%) as the most important climate-smart actions. Commonly perceived barriers were financial (extremely likely: n = 47/123, 38.2%, likely: n = 50/123, 40.7%) and staff resistance to change (extremely likely: n = 29/123, 23.6%, likely: n = 60/123, 48.8%). Regional differences included low adoption of energy efficiency strategies among respondents from southern states (n = 0/26, p = 0.01) despite high perceived importance relative to other regions (median: 5, IQR: 4-5 vs median: 4, IQR 4-5, p = 0.04). CONCLUSIONS While most pediatric surgeons agreed that environmental stewardship was important, less than 10% are currently involved in initiatives at their institutions. Opportunities exist for surgical leadership surrounding implementation of climate-smart actions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Charesa Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - David E Skarda
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Health Care, Salt Lake City, UT, USA
| | - Hau D Le
- Division of Pediatric Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kenneth W Gow
- Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Department of Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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14
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Melnyk AI, Niino C, Wright KN. Addressing Sustainability in the Operating Room. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:719-724. [PMID: 37493260 DOI: 10.1097/spv.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
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15
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Melnyk AI, Woods N, Moalli P. Going green in gynecology: a call to action. Am J Obstet Gynecol 2023; 229:269-274. [PMID: 37116823 DOI: 10.1016/j.ajog.2023.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
The climate change crisis poses a central threat to public health. The health outcomes of this crisis are well known, but lesser known to medical professionals is the role that healthcare delivery plays in worsening this crisis. The United States healthcare system is responsible for producing 10% of the total greenhouse gases. The adverse health outcomes caused by the overall healthcare system emissions in the United States is estimated to be 470,000 disability-adjusted life years lost, which is commensurate with the 44,000 to 98,000 people who die in hospitals each year in the United States as a consequence of preventable medical errors. Factors that contribute to healthcare greenhouse gas emissions include emissions from our facilities and from the purchase, transport, and use of supplies and waste. In the purview of obstetrics and gynecology, providers should minimize their use of disposable supplies, replace single-use specula with stainless steel specula, and educate themselves and operating room staff about best waste disposal practices. In addition, they can use their individual and collective voice to advocate for sustainable energy and supply practices. A transformation in the way we supply and power our hospitals is needed, and providers should be early adopters of this transformational change. Physician buy-in is essential to decrease the carbon footprint of our care. This narrative is a call to action for obstetricians and gynecologists to reduce our carbon footprint as a public health measure to uphold the quality of care we provide to women.
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Affiliation(s)
- Alexandra I Melnyk
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center Medical Education, Pittsburgh, PA; Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Noe Woods
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Pamela Moalli
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
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16
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Chan KS, Lo HY, Shelat VG. Carbon footprints in minimally invasive surgery: Good patient outcomes, but costly for the environment. World J Gastrointest Surg 2023; 15:1277-1285. [PMID: 37555111 PMCID: PMC10405111 DOI: 10.4240/wjgs.v15.i7.1277] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 07/21/2023] Open
Abstract
Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery (MIS). Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and mortality. MIS has become the first-line surgical intervention for some types of gastrointestinal surgery, such as laparoscopic cholecystectomy and appendicectomy. Carbon dioxide (CO2) is the main gas used for insufflation in MIS. CO2 contributes 9%-26% of the greenhouse effect, resulting in global warming. The rise in global CO2 concentration since 2000 is about 20 ppm per decade, up to 10 times faster than any sustained rise in CO2 during the past 800000 years. Since 1970, there has been a steady yet worrying increase in average global temperature by 1.7 °C per century. A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO2 emission per surgery, with higher CO2 emission following robotic compared to laparoscopic surgery. However, with superior benefits of MIS over open surgery, this poses an ethical dilemma to surgeons. A recent survey in the United Kingdom of 130 surgeons showed that the majority (94%) were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental sustainability. Given the deleterious environmental effects of MIS, this study aims to summarize the trends of MIS and its carbon footprint, awareness and attitudes towards this issue, and efforts and challenges to ensuring environmental sustainability.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Hong Yee Lo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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17
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Galvão DM, Cezar-Vaz MR, Xavier DM, Penha JGM, Lourenção LG. Hospital sustainability indicators and reduction of socio-environmental impacts: a scoping review. Rev Esc Enferm USP 2023; 57:e20220364. [PMID: 37366602 PMCID: PMC10294698 DOI: 10.1590/1980-220x-reeusp-2022-0364en] [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: 09/15/2022] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact. METHOD Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included. RESULTS A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability. CONCLUSION The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved.
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18
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Zeng Y, Li W, Zhao M, Li J, Liu X, Shi L, Yang X, Xia H, Yang S, Yang L. The association between ambient temperature and antimicrobial resistance of Klebsiella pneumoniae in China: a difference-in-differences analysis. Front Public Health 2023; 11:1158762. [PMID: 37361142 PMCID: PMC10285064 DOI: 10.3389/fpubh.2023.1158762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Antimicrobial resistance (AMR) of Klebsiella pneumoniae (K. pneumoniae) poses a significant global public health threat and is responsible for a high prevalence of infections and mortality. However, knowledge about how ambient temperature influences the AMR of K. pneumoniae is limited in the context of global warming. Methods AMR data of 31 Chinese provinces was collected from the China Antimicrobial Resistance Surveillance System (CARSS) between 2014 and 2020. Socioeconomic and meteorological data were collected from the China Statistical Yearbook during the same period. A modified difference-in-differences (DID) approach was applied to estimate the association between ambient temperature and third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and carbapenem-resistant K. pneumoniae (CRKP). Furthermore, moderating effects of socioeconomic factors were also evaluated. Results Every 1°C increase in annual average temperature was associated with a 4.7% (relative risk (RR):1.047, 95% confidence intervals (CI): 1.031-1.082) increase in the detection rate of 3GCRKP, and a 10.7% (RR:1.107, 95% CI: 1.011-1.211) increase in the detection rate of CRKP. The relationships between ambient temperature and 3GCRKP and CRKP were found to be moderated by socioeconomic status (GDP per capita, income per capita, and consumption per capita; the interaction p-values <0.05), where higher economic status was found to strengthen the effects of temperature on the detection rate of 3GCRKP and weaken the effects on the detection rate of CRKP. Discussion Ambient temperature was found to be positively associated with AMR of K. pneumoniae, and this association was moderated by socioeconomic status. Policymakers should consider the impact of global warming and high temperatures on the spread of 3GCRKP and CRKP when developing strategies for the containment of AMR.
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Affiliation(s)
- Yingchao Zeng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weibin Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Manzhi Zhao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu Liu
- Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Lin Shi
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinyi Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haohai Xia
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shifang Yang
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, China
| | - Lianping Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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19
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Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2023; 20:399-410. [PMID: 36481812 PMCID: PMC9735025 DOI: 10.1038/s41575-022-00716-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.
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Affiliation(s)
- Miguel F Cunha
- Colorectal Surgery group - General Surgery Department, Algarve University Centre, Portimão, Portugal.
- Algarve Biomedical Centre, Portimão, Portugal.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
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20
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Quitmann C, Sauerborn R, Danquah I, Herrmann A. 'Climate change mitigation is a hot topic, but not when it comes to hospitals': a qualitative study on hospital stakeholders' perception and sense of responsibility for greenhouse gas emissions. JOURNAL OF MEDICAL ETHICS 2023; 49:204-210. [PMID: 35459742 PMCID: PMC9985738 DOI: 10.1136/medethics-2021-107971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/11/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Physical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of 'do no harm' imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders' perceptions of hospitals' GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital. METHODS We conducted 29 semistructured qualitative expert interviews at one of Germany's largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical and 12 administrative employees on different levels were selected using purposive maximum variation sampling. Interviews were transcribed verbatim and analysed using the framework approach. RESULTS Concerning GHG emissions, hospital stakeholders perceived energy and waste as most relevant emission sources followed by mobility. Climate change mitigation in general was considered as important. However, in their role as patients or employees, hospital stakeholders felt less responsible for climate change mitigation. They saw providing best possible medical care to be the top priority in hospitals and were often concerned that patients' health could be jeopardised by climate change mitigation measures. CONCLUSION Perceptions of most important emission sources did not coincide with those in literature, highlighting the need to inform stakeholders, for instance, about pharmaceuticals as important emission source. A frequently perceived conflict between reducing emissions and providing high-quality medical care could be eased, if reducing emissions would not only be justified as a contribution to mitigation, but also as a contribution to preventing ill health-a basic principle of medical ethics.
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Affiliation(s)
- Claudia Quitmann
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Alina Herrmann
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
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21
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Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
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Slutzman JE, Bockius H, Gordon IO, Greene HC, Hsu S, Huang Y, Lam MH, Roberts T, Thiel CL. Waste audits in healthcare: A systematic review and description of best practices. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:3-17. [PMID: 35652693 PMCID: PMC9925917 DOI: 10.1177/0734242x221101531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.
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Affiliation(s)
- Jonathan E Slutzman
- Center for the Environment and
Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Hannah Bockius
- Department of Biomedical
Engineering, University of Delaware, Newark, DE, USA
| | - Ilyssa O Gordon
- Robert J. Tomsich Pathology &
Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
| | - Hannah C Greene
- Department of Biology, New York
University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Hsu
- Warren Alpert Medical School,
Brown University, Providence, RI, USA
| | | | - Michelle H Lam
- Department of Chemical and
Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY,
USA
| | - Timothy Roberts
- Health Sciences Library, NYU
Langone Health, Grossman School of Medicine, New York University, New York,
NY, USA
| | - Cassandra L Thiel
- Grossman School of Medicine,
Wagner Graduate School of Public Service, Tandon School of Engineering, New
York University, New York, NY, USA
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23
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Mashallahi A, Ardalan A, Nejati A, Ostadtaghizadeh A. Climate adaptive hospital: A systematic review of determinants and actions. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:983-1013. [PMID: 36406601 PMCID: PMC9672300 DOI: 10.1007/s40201-022-00810-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/01/2022] [Indexed: 06/11/2023]
Abstract
Introduction Climate change is among the most renowned concerns of the current century, endangering the lives of millions of people worldwide. To comply with the United Nations Climate Change Conference (COP21), hospitals should be on track to reduce greenhouse gas emissions. Although hospitals contribute to climate change by emitting greenhouse gases, they are also affected by the health consequences of climate change. Despite all the guidance provided, hospitals need more radical measures to confront climate change. The current study was carried out to examine the components of hospitals' adaptation to climate change and to review measures to confront climate change in hospitals. Method This systematic review was designed and carried out in 2020. The required information was collected from international electronic databases including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar. Moreover, Iranian datasets such as Scientific Database (SID), Irandoc, Magiran, and IranMedex were reviewed. No restriction was considered in the methodology of the study. For the relevant thesis, the ProQuest database was also explored. The related sources were examined and the Snowball method was applied to find additional related studies. The research team also reviewed other accessible electronic resources, such as international guidelines and academic websites. The checklist of the Joanna Briggs Institute (JBI, 2017) was employed in order to evaluate the quality of the included papers. The studies published until June1, 2020, were included in the study. Results Of 11,680 published documents in the initial search, the full-texts of 140 were read after evaluating the titles and abstracts, of which 114 were excluded due to lack of sufficient information related to countermeasures in hospitals. Finally, the full-texts of 26 studies were reviewed to extract the required components. Two strategies were found, including climate change mitigation and climate change adaptation, with 13 components including water, wastewater, energy, waste, green buildings, food, transportation, green purchasing policy, medicines, chemicals and toxins, technology, sustainable care models, and leadership in hospitals were identified as affecting these measures and strategies. Conclusion Considering the significance of climate change and strategies to confront it as one of the current challenges and priorities in the world, it is necessary to develop a framework and model to reduce the effects of climate change and adapt to climate changes in hospitals and other health centers. The identification and classification of the measures and components, influencing hospital adaptability and solutions for reducing the climate change impacts could be the first stage in developing this strategy. This is because it is impossible to create this framework without identifying these factors and their mutual impacts at the first. In the present study, through a systematic review using a comprehensive approach, the related components were explored and divided into two categories, including measures to reduce the effects and measures to adapt to climate change. The results of this study can be useful in developing a comprehensive action model to reduce greenhouse gas emissions and adapt hospitals to climate change.
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Affiliation(s)
- Alireza Mashallahi
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Ghods Ave, Tehran, Iran
- Institute for Environmental Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Ghods Ave, Tehran, Iran
- Institute for Environmental Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Nejati
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Ghods Ave, Tehran, Iran
- Associate Professor of Emergency Medicine, Pre-Hospital and Hospital Emergency Research Center, Department of Emergency Medicine, Imam Khomeini Hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Ghods Ave, Tehran, Iran
- Institute for Environmental Health Research, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Qods Street, Enqelab Square, Tehran, Iran
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Cichosz S, Masek A, Piotrowska M. Characterization of the UV-aging and antimicrobial resistance of cellulose / ethylene-norbornene composites. Carbohydr Polym 2022; 289:119459. [DOI: 10.1016/j.carbpol.2022.119459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
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Thiel C, Richie C. Carbon Emissions from Overuse of U.S. Health Care: Medical and Ethical Problems. Hastings Cent Rep 2022; 52:10-16. [PMID: 35993105 DOI: 10.1002/hast.1404] [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] [Indexed: 11/06/2022]
Abstract
The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to "green" health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health care industry, with structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions-and the paucity of attention to the carbon of hospital care and clinical services-this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data-driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States.
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Talking about Climate Change and Environmental Degradation with Patients in Primary Care: A Cross-Sectional Survey on Knowledge, Potential Domains of Action and Points of View of General Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084901. [PMID: 35457768 PMCID: PMC9029888 DOI: 10.3390/ijerph19084901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023]
Abstract
Purpose: General practitioners (GPs) could play a role in mitigating climate change by raising awareness of its impact on human health and implementing changes to improve population health and decreasing environmental footprints. The aim of this study was to assess GPs’ knowledge and perspectives about the health impacts of climate change. Method: A questionnaire was sent to 1972 GPs in the French-speaking part of Switzerland. Knowledge of the impact of environmental degradations and climate change on health and willingness to address climate change with patients, to be exemplary and to act as role models were surveyed as well as demographic characteristics of GPs. Results: Respondents (N = 497) expressed a high level of self-reported knowledge regarding climate change, although it was lower for more specific topics, such as planetary health or health–environment co-benefits. Participants mostly agreed that it is necessary to adapt clinical practice to the health impacts of climate change and that they have a role in providing information on climate change and its links to human health. Conclusion: Most of the GPs were concerned about environmental and climate degradation. However, this study revealed a gap between the willingness of GPs to integrate the impact of climate change on health into their clinical activities and their lack of overall knowledge and scientific evidence on effective interventions. A promising way forward may be to develop co-benefit interventions adapted to the clinical setting on diet, active mobility and connecting with nature.
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28
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Wu S, Cerceo E. Sustainability Initiatives in the Operating Room. Jt Comm J Qual Patient Saf 2021; 47:663-672. [PMID: 34344594 DOI: 10.1016/j.jcjq.2021.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Operating rooms (ORs) contribute up to 30% of a hospital's waste, are very resource-intensive, and thus provide an opportunity for improvement. METHODS A narrative review was conducted, searching MEDLINE, EMBASE, and ProQuest databases. The study included 78 of the 108 published articles. RESULTS The researchers identified and categorized articles according to the following major themes: Committee and Leadership; Waste Reduction; Segregating OR waste; Minimizing unnecessary devices and packaging; Reducing energy consumption; Choosing anesthetic gases; Education; Reducing water consumption; Different surgical venues; Donating medical supplies. Formation of an OR committee or a hospital Green Team dedicated to environmentally sustainable initiatives can significantly improve health care's impact on the environment while saving money. Changes in supply chain with preferences for reusable devices, effective recycling, repurposing instruments, and donating items can all be effective means of diverting waste away from landfills. Reducing unnecessary packaging and instruments would eliminate excess in the waste stream. Curtailing energy and water usage results in cost and environmental savings. Surgical venue (inpatient vs. outpatient surgical center) can also contribute to waste. Transitioning away from certain inhaled anesthetics can minimize greenhouse gas impact. Education to all levels in the health care system is important to drive change and maintain change. CONCLUSION Optimizing efficiency and decreasing waste generation can have a positive impact on the environment and can be accompanied by cost reduction. Because the field of sustainability in health care is young but burgeoning, increased research is needed to support evidence-based approaches.
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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: 1.6] [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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30
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Ryan EC, Dubrow R, Sherman JD. Medical, nursing, and physician assistant student knowledge and attitudes toward climate change, pollution, and resource conservation in health care. BMC MEDICAL EDUCATION 2020; 20:200. [PMID: 32576175 PMCID: PMC7310528 DOI: 10.1186/s12909-020-02099-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/29/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Climate change and pollution generated by the health care sector impose significant public health burdens. This study aimed to assess medical, nursing and physician assistant student knowledge and attitudes regarding climate change, pollution from the health care sector, and responsibility for resource conservation within professional practice. METHODS In February-March, 2018, medical, nursing, and physician assistant students at Yale University (1011 potential respondents) were sent a 17-question online Qualtrics survey. Data analysis included descriptive statistics, as well as Fisher's exact test and logistic regression to assess associations between variables of interest and the personal characteristics of gender, age, geographic place of origin, school, and year in school (among medical students). RESULTS The response rate was 28% (280 respondents). 90% felt that physicians, nurses, and physician assistants have a responsibility to conserve resources and prevent pollution within their professional practice. 63% agreed or strongly agreed that the relationship between pollution, climate change, and health should be covered in the classroom and should be reinforced in the clinical setting. 57% preferred or strongly preferred reusable devices. 91% felt lack of time and production pressure, and 85% believed that lack of education on disease burden stemming from health care pollution, were barriers to taking responsibility for resource conservation and pollution prevention. Women and physician assistant students exhibited a greater commitment than men and medical students, respectively, to address pollution, climate change, and resource conservation in patient care and professional practice. CONCLUSION We found that health professional students are engaged with the concept of environmental stewardship in clinical practice and would like to see pollution, climate change, and health covered in their curriculum. In order for this education to be most impactful, more research and industry transparency regarding the environmental footprint of health care materials and specific clinician resource consumption patterns will be required.
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Affiliation(s)
- Emma C Ryan
- Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Robert Dubrow
- Environmental Health Sciences, Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Jodi D Sherman
- Anesthesiology, Environmental Health Sciences, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
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31
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Affiliation(s)
- Cassandra Thiel
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York
- NYU Robert F. Wagner Graduate School of Public Service, New York, New York
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
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Namburar S, Pillai M, Varghese G, Thiel C, Robin AL. Waste generated during glaucoma surgery: A comparison of two global facilities. Am J Ophthalmol Case Rep 2018; 12:87-90. [PMID: 30364583 PMCID: PMC6197147 DOI: 10.1016/j.ajoc.2018.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose We measured waste from glaucoma surgeries at an eye care facility in Southern India and compared these results to a community hospital in the United States. Methods The waste produced in the glaucoma operating room at Aravind Eye Hospital, Madurai, India from June 22 to July 15, 2015 was weighed and compared to the waste produced in the glaucoma surgical clinic in a Baltimore-area community hospital from one day of surgeries in August 2015. Results The average waste produced per trabeculectomy at Aravind was 0.5 ± 0.2 kg, compared to an average of 1.4 ± 0.4 kg per trabeculectomy (p < 0.05) at the Baltimore-area hospital. Waste from device surgeries and trabeculectomy with phacoemulsification was also quantified at Aravind, with averages of 0.4 ± 0.2 kg and 0.7 ± 0.2 kg respectively. Conclusions and importance The amount of waste per trabeculectomy at the Aravind Eye Hospital was significantly lower than the waste per trabeculectomy in the Baltimore-area hospital, even though the used and the apparent complication rates between Aravind and American eye hospital are comparable. Given efforts to decrease the environmental impact of health care, it is necessary to examine the waste produced from surgeries to determine if policy and legal changes in the United States could decrease surgical waste while not affecting the surgical complication rate.
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Affiliation(s)
| | | | | | | | - Alan L Robin
- Johns Hopkins University, Baltimore, MD, USA.,Kellogg Eye Institute University of Michigan, Ann Arbor, MI, USA
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