Greening the operating room

Identify and mitigate environmental pollution created by surgery in one of the largest hospitals in The Netherlands
Greening the operating room

Climate change is a threat to human health. As such, health care professionals should be aiming at mitigating the impact of their work. To set the example, we set up a 'green team' on the operating room of our own hospital. Our goals are to minimise waste, save energy and prevent the emission of toxic pollutants associated with surgery.

Climate change is the most important threat to human health in the 21st century. Yet, the health care industry itself is responsible for 10% of global green house gas emissions. This leads to an important paradox for health care professionals: caring for individual patients is at odds with public health.   

We set out to mitigate the environmental impact of surgery at our own hospital "Amsterdam UMC", now one of the largest hospitals in The Netherlands. Our multidisciplinary team consists of an anaesthesiologist (chair), an anaesthesia nurse,  a scrub nurse and a recovery nurse working together on implementing strategies to comply with the Dutch 'green deal 2.0' for health care.

Volatile (gaseous) anaesthetics are potent green house gasses that enter the atmosphere unchanged after they have been exhaled by patients. Intravenous anaesthetics are available as alternative and can be used without compromising patient safety, or increasing health care cost. Life cycle analysis have shown that using intravenous rather than volatile anaesthetics can reduce the carbon footprint of anaesthetic drugs with 99%. We have implemented a program to increase awareness among anaesthesia care providers to avoid volatile anaesthetics whenever possible. Additionally, when volatiles are used, we implemented software modifications in our anaesthesia machine to use these agents more efficiently.

A second major source of greenhouse gas emissions on the operating room is the use of electricity in the operating theatre. Operating rooms consume 3-6 times more energy per m2 than other hospital departments. Strikingly, 90-99% of total energy consumption is used for heating, ventilation and air conditioning units in the operating room. In our hospital, these units were operational 24/7 on all operating rooms, whereas the majority of the operating rooms was in use only during working hours. A project to switch off these units on most operating rooms during the night has now saved up to 500.000 kWh on a yearly basis. We are currently working on optimising these systems during working hours in order to realise even more energy savings, and even improve patient safety.

Thirdly, the use of disposable materials generates enormous amounts of (biohazard) waste that was incinerated. A single operating is estimated to generate 10-14 kg of residual waste. Interestingly, studies have shown a recycling potential of around 60% that is currently neglected. As a first objective, we are now implementing two strategies where we intend to recycle all metal in the biohazard waste stream. Additionally, we aim at separating clean and biohazardous waste to be able to offer the clean stream to recycling companies.

Finally, we felt it was necessary to extend our scope beyond the operating theatre alone and started collaborating with procurement as well as waste management managers. This has been a successful step forward and increased the efficiency of our process tremendously. Moreover, in working with these people, it has been great fun and very rewarding to see how quickly things can change when the right people take up this gauntlet.

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