Article
Seven steps to tackle industry challenges
Published
16 January 2024
The healthcare industry accounts for a significant share of the global net CO2 emissions. Furthermore, the industry is facing an increasing number of patients whose conditions are caused or worsened by air pollution. This situation calls for the implementation of specific measures to effectively address these challenges.
The healthcare industry occupies a distinctive position when it comes to the debate on greenhouse gas and climate change. It is an industry that is a significant emitter with a CO2 footprint exceeding four percent1 of global net emissions while facing an increasing number of patients whose conditions are caused or worsened by air pollution.
Unless the healthcare industry, including hospitals, acts and reduces their emissions now, reaching the goals of the Paris Agreement will require even more from other industries. An unlikely proposition.
Below are seven steps that hospitals can take to reduce their greenhouse gas emissions. The list is not exhaustive but is meant to inspire hospital and healthcare leaders to do their part in addressing challenges faced in the industry. They all contribute to the double bottom line and may even prevent healthy people from becoming patients in the future.
Seven steps hospitals can take to reduce greenhouse gas emissions
1. Demand that suppliers do their part
A hospital’s supply chain, hereunder medical equipment, supplies and pharmaceuticals, is the source of most of a hospital’s greenhouse gas emissions2. A simple first step is to use the procurement process to require that its vendors have a plan for sustainability, e.g. by showing proof of ISO 14001 certification or similar. Better yet, one may use the procurement process to define specific sustainability-related goals. For example, the Champalimaud Foundation used the procurement process to partner with Philips to reduce the carbon footprint of their imaging equipment by 50% over five years3
2. Reduce unnecessary testing and procedures
Studies have shown that as many as 40-60% of tests are unnecessary4, sometimes leading to unnecessary follow-up studies and procedures. Beyond being unnecessary, and sometimes even harmful, these contribute to greenhouse emissions – and increased financial strain. The ABIM Foundation’s Choosing Wisely campaign put the spotlight on some of these tests and treatments, but walking into most western hospitals and clinics one will still see activity that is either not clinically indicated or even contraindicated.
3. Examine consumable utilisation
Many who have spent time in hospitals have noticed the significant amount of garbage created. Having seen dozens of gloves being donned, doffed and discarded in a hospital – gloves that will go on to be incinerated – it can be difficult to fully buy into separating the cardboard from plastic spreadable butter containers to ready it for recycling, as expected in Copenhagen. While the use of gloves is crucial in hospitals, it does not imply that they are always required.
A fitting example is the NHS’ “Gloves Off” campaign, which reduced the annual consumption of plastic gloves by 3.7 million pairs, a full thirty-three percent reduction, and reported an overall improvement in hand hygiene5. This initiative saved eighteen tonnes of plastic in one year, corresponding to many more tonnes of CO2 given plastic’s footprint from production and disposal.
4. Accelerate the adoption of telemedicine solutions
During the pandemic, we saw a marked uptick in the utilisation of remote consultations6. Yet, we are nowhere near taking full advantage of the potential eHealth and telemedicine presents, whether in the form of remote consultations or specialist physicians supporting hospitals remotely. As patient travel and staff commute are other contributors to greenhouse gas emissions, adopting solutions that reduce the need for physical presence can have a positive impact.
5. Buy medical technology with sustainability in mind
Beyond looking at, for example, a medical device’s power consumption, one may look at other aspects relevant to greenhouse emissions. Take magnetic resonance imaging (MRI) equipment, for example: conventional machines require approximately 1,700 litres of helium per machine. Helium is not a greenhouse gas, but through production extraction and transport, it contributes to greenhouse emissions. In contrast, newer generations only require a single-digit number of litres, reducing their greenhouse emissions from helium by more than 99%.
6. Adjust energy use to activity levels
Most hospitals operate around the clock, but many hospital departments do not. In these departments, heating, cooling and lighting should be adjusted, as they should in any facility where humans gather.
In hospitals, large medical equipment often continues to draw power during off-hours. While an MRI should not be turned off completely, specific parts of the electronics may be turned off when the machine is not in use, following the manufacturer’s recommendations. CT scanners can be turned off completely, but some are kept in low-power mode overnight instead, quietly drawing power even when there are no plans to use the machine for emergencies.
7. Optimise sterile supply and surgical instrument usage
As with gloves, sterile supplies and surgical instruments are essential parts of running a hospital. Still, again, as with gloves, there is room for improvement. For example, surgical trays contain a range of instruments, and in many operating rooms, some of these instruments are never used but are included in a set just in case. Since these “extra” instruments need to be re-sterilised for each procedure, they both increase the workload for the sterile supply department, and they increase the use of the sterilising agent ethylene oxide (EtO). Although EtO is not a greenhouse gas, it is another compound that contributes to significant CO2 emissions during production.
An alternative to including the “just in case” instruments in the main set is to wrap them separately, eliminating exposure to a non-sterile environment, which in turn eliminates the need for re-sterilisation.
References
2Tennison I, Roschnik S, Ashby B et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021;5(2):e84-92.
4Koch C, Roberts K, Petruccelli C, Morgan DJ. The Frequency of Unnecessary Testing in Hospitalized Patients. Am J Med. 2018 May;131(5):500-503. doi: 10.1016/j.amjmed.2017.11.025. Epub 2017 Dec 7. PMID: 29224739; PMCID: PMC8628817.
6Johnsen T, Norberg B, Kristiansen E, Zanaboni P, Austad B, Krogh F, Getz L Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners J Med Internet Res 2021;23(2):e26433 URL: https://www.jmir.org/2021/2/e26433 DOI: 10.2196/26433