Greening Our Hospitals: Meet The Environmental Sustainability Working Group

 “You cannot get through a single day without having an impact on the world around you. What you do makes a difference and you have to decide what kind of difference you want to make.” - Jane Goodall

Each year, on April 22, we honour Earth Day by raising awareness of the need to protect our environment for future generations. 

Like all industries, the health-care sector impacts our planet. Research on health care and climate change has found that the sector generates 4.6% of Canada’s total greenhouse gas emissions, as well as approximately  200,000 tons of other pollutants. (In comparison, the United Kingdom’s health-care system accounts for 3%-4% of emissions.) Unfortunately, this positions Canada in the top 10 worst polluters per capita when it comes to the percentage of emissions from health care. 

In early 2022, Ontario’s Anesthesiologists decided that we wanted to make a difference in this area. This led to the formation of the Environmental Sustainability Working Group (ESWG), which brought together a small group of Ontario anesthesiologists to take action. Led by Dr. Anita Rao, an anesthesiologist at Trillium Health Partners, this group has grown to include over two dozen members who are working collaboratively  to make our health-care system greener.

  

This video, created by the Canadian Coalition for Green Health Care, features several ESWG members.

The ESWG is working towards this goal in a number of different ways. One is a focus on reducing the large amount of waste hospitals create. The 2019 Green Hospital Scorecard, which featured input from 83 hospitals from across Canada, found that its participants generated 101,898 metric tonnes of waste (in comparison, in 2018, Canada as a whole generated just over 25 million metric tonnes of waste). Somewhere between 20% and 33% of that waste is generated in the operating room.

Thankfully, operating rooms are ripe with opportunities to swap waste-creating single-use products for safe, efficient reusable alternatives that contribute to what’s known as a circular economy. Explains the ESWG, “Health care must move towards a circular economy model where supplies are maintained and reused in a high-quality state for as long as possible and then refurbished, repurposed or recycled. Such a model maximizes resource productivity while minimizing waste, which can lower costs and reduce negative downstream health effects.” 

Advocating for greener supplies is the key goal of the PEACH (Partnerships for Environmental Action by Clinicians and Communities for Healthcare Facilities) Health Ontario Sustainability in Procurement Working Group, of which the ESWG is a vocal member. This organization, made up of major group purchasing organizations from across the Ontario health-care sector, emphasizes buying equipment that can be reused, repaired and/or recycled. 

For example, most operating room health-care teams use disposable surgical gowns that are thrown out following every surgery, leading to a tremendous amount of garbage. One case study from a single large American surgical unit found that they were throwing out over 1,000 gowns a day! After switching to reusable gowns—which they were safely cleaning and reusing up to 100 times—that hospital found that over three years, it had diverted 297 tons of waste and saved over a million dollars.

With figures like that, it’s clear why the ESWG and its partners in PEACH are advocating for the purchase of reusable gowns.

Swapping Disposable Plastic surgical trays for metal reusable trays is ANother opportunity to reduce or waste

Another key focus of the ESWG is greening one of an anesthesiologist’s key tools: Anesthetic gases. Administering general anesthesia, which induces unconsciousness in a patient, is one of an anesthesiologist’s primary tasks. It requires the use of anesthetic gases, some of which have staggeringly high carbon footprints. One anesthetic gas that has a particularly elevated carbon footprint is called desflurane. Using it for just one hour has the same carbon footprint as driving a gasoline-powered car for 320 kilometres! Since most operating rooms use anesthetic gases for at least seven hours a day, desflurane’s carbon output quickly adds up. In comparison, using sevoflurane, a comparable anesthetic gas, for one hour generates the same carbon footprint as driving that same car for just 6.5 kilometres.

There is a worldwide push to eliminate desflurane. The European Union is aiming to have it banned by 2026 and Scotland has already done away with it, “cutting emissions equal to powering 1,700 homes a year.” Here in Ontario, the ESWG is advocating for the removal of desflurane from all operating rooms in the province. Several Ontario health facilities have already replaced it with alternatives that are just as safe and effective.

Members of the ESWG tour Blue Zone Technologies, an Ontario company that captures Used Anesthetic Gases before they are released into the air

The ESWG also has several other initiatives on the go, including working directly with physicians and hospitals from across Ontario who want to green their practices. We hope to share some of those success stories in a future blog post (and if you’re a health-care professional who wants to green your operating rooms, please contact us).

We’re thrilled to note that the ESWG is already having an impact on the practice of anesthesiology at a national level by contributing to “playbooks” developed by CASCADES, a Canada-wide organization that’s helping to green health care.

And earlier this year, the Canadian Anesthesiologists’ Society released its updated Guidelines to the Practice of Anesthesia, which provides high-level guidance for our specialty. New to this edition is a section entitled, “Guidelines for Environmental Sustainability,” which was developed with input from the ESWG.

Ontario’s Anesthesiologists is extremely proud of the progress the Environmental Sustainability Working Group has made in such a short time and and we look forward to continuing to make a difference.

Special thanks to Dr. Anita Rao and Dr. David Ohrling for their input into this blog post.