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MacNeill AJ, Hopf H, Khanuja A, Alizamir S, Bilec M, Eckelman MJ, Hernandez L, McGain F, Simonsen K, Thiel C, Young S, Lagasse R, Sherman JD. Transforming The Medical Device Industry: Road Map To A Circular Economy. Health Aff (Millwood) 2020; 39:2088-2097. [PMID: 33284689 DOI: 10.1377/hlthaff.2020.01118] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy- and market-driven solutions are needed to encourage systemic transformation.
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Affiliation(s)
- Andrea J MacNeill
- Andrea J. MacNeill is a clinical associate professor in the Department of Surgery at the University of British Columbia, in Vancouver, British Columbia, Canada
| | - Harriet Hopf
- Harriet Hopf is a professor of anesthesiology in the Department of Anesthesiology at the University of Utah, in Salt Lake City, Utah
| | - Aman Khanuja
- Aman Khanuja is an MPH/MBA candidate in the Yale School of Management and the Yale School of Public Health at Yale University, in New Haven, Connecticut
| | - Saed Alizamir
- Saed Alizamir is an associate professor of operations management in the School of Management at Yale University
| | - Melissa Bilec
- Melissa Bilec is an associate professor in the Department of Civil and Environmental Engineering at the University of Pittsburgh, in Pittsburgh, Pennsylvania
| | - Matthew J Eckelman
- Matthew J. Eckelman is an associate professor in the Department of Civil and Environmental Engineering at Northeastern University, in Boston, Massachusetts
| | - Lyndon Hernandez
- Lyndon Hernandez is an adjunct clinical faculty member at the Medical College of Wisconsin, in Milwaukee, Wisconsin
| | - Forbes McGain
- Forbes McGain is an associate professor in the Centre for Integrated Critical Care at the University of Melbourne, in Melbourne, Victoria, Australia
| | - Kari Simonsen
- Kari Simonsen is a professor in the Division of Pediatric Infectious Diseases at the University of Nebraska Medical Center, in Omaha, Nebraska
| | - Cassandra Thiel
- Cassandra Thiel is an assistant professor at the NYU Langone Health School of Medicine, the Robert F. Wagner Graduate School of Public Service, and the NYU Tandon School of Engineering at New York University, in New York, New York
| | - Steven Young
- Steven Young is an associate professor in the School of Environment, Enterprise, and Development at the University of Waterloo, in Waterloo, Ontario, Canada
| | - Robert Lagasse
- Robert Lagasse is a professor and vice chair for quality and regulatory affairs, Department of Anesthesiology, Yale School of Medicine, Yale University
| | - Jodi D Sherman
- Jodi D. Sherman is an associate professor of anesthesiology in the Yale School of Medicine and the Yale School of Public Health, Yale University
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102
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Weber B, Weber J, Eberhart L, Knoth S. Fokus – NarCO2se und Umwelt. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:720-730. [PMID: 33242905 DOI: 10.1055/a-1084-9925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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103
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McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125:680-692. [PMID: 32798068 PMCID: PMC7421303 DOI: 10.1016/j.bja.2020.06.055] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 01/17/2023] Open
Abstract
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
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Affiliation(s)
| | - Jane Muret
- French Society of Anaesthesia and Intensive Care (SFAR), Institut Curie PSL Research University, Paris, France
| | - Cathy Lawson
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England, UK
| | - Jodi D. Sherman
- Department of Anesthesiology, Yale School of Medicine, Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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104
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Abstract
Climate change will be the defining health crisis of the twenty-first century, and environmental health is directly linked with human health. The health sector should lead the sustainability effort by greening itself and reducing its ecological footprint to improve global health and the health of the planet. Anesthesiology has an oversized role in production of greenhouse gases and waste, and thus its impact on affecting change is also oversized. Decreasing the waste of volatile anesthetic agents, medications, and anesthesia equipment is a powerful start to the many sustainability changes needed in health care.
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Affiliation(s)
- Diane Gordon
- Department of Anesthesiology, University of Colorado School of Medicine, 13123 East 16th Avenue B 090, Aurora, CO 80045, USA.
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105
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Hsu S, Thiel CL, Mello MJ, Slutzman JE. Dumpster Diving in the Emergency Department. West J Emerg Med 2020; 21:1211-1217. [PMID: 32970577 PMCID: PMC7514403 DOI: 10.5811/westjem.2020.6.47900] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/25/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals' waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction. METHODS We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. All waste generated in the ED during the study period was collected, manually sorted into separate categories based on its predominant material, and weighed. We tracked deviations from hospital waste policy using the hospital's Infection Control Manual, state regulations, and Health Insurance Portability and Accountability Act standards. Lastly, we calculated direct pollutant emissions from ED waste disposal activities using the M+WasteCare Calculator. RESULTS The ED generated 671.8 kilograms (kg) total waste during a 24-hour collection period. On a per-patient basis, the ED generated 1.99 kg of total waste per encounter. The majority was plastic (64.6%), with paper-derived products (18.4%) the next largest category. Only 14.9% of waste disposed of in red bags met the criteria for regulated medical waste. We identified several deviations from waste policy, including loose sharps not placed in sharps containers, as well as re-processable items and protected health information thrown in medical and solid waste. We also identified over 200 unused items. Pollutant emissions resulting per day from ED waste disposal include 3110 kg carbon dioxide equivalent and 576 grams of other criteria pollutants, heavy metals, and toxins. CONCLUSION The ED generates significant amounts of waste. Current ED waste disposal practices reveal several opportunities to reduce total waste generated, increase adherence to waste policy, and reduce environmental impact. While our results will likely be similar to other urban tertiary EDs that serve as Level I trauma centers, future studies are needed to compare results across EDs with different patient volumes or waste generation rates.
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Affiliation(s)
- Sarah Hsu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cassandra L Thiel
- New York University Grossman School of Medicine, Department of Population Health, New York, New York
| | - Michael J Mello
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Jonathan E Slutzman
- Massachusetts General Hospital and Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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106
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The Climate-Smart Emergency Department: A Primer. Ann Emerg Med 2020; 76:155-167. [DOI: 10.1016/j.annemergmed.2019.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
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107
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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: 9] [Impact Index Per Article: 2.3] [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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108
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Anesthesia environmental sustainability programs-a survey of Canadian department chiefs and residency program directors. Can J Anaesth 2020; 67:1190-1200. [PMID: 32529472 DOI: 10.1007/s12630-020-01738-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/19/2020] [Accepted: 06/03/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Anesthesia-related activities contribute to operating room waste impacting climate change. The aim of this study was to ascertain 1) the current existence and scope of department and education programs concerned with anesthesia "green" practice; and 2) perceived barriers to environmental sustainability efforts among Canadian anesthesia department chiefs and residency program directors. METHODS Association of Canadian University Departments of Anesthesia-affiliated anesthesiology department chiefs (n = 113) were invited to complete an online survey ascertaining current efforts in, and barriers to, environmentally sustainable anesthesia practice. Similarly, Canadian anesthesiology residency program directors (n = 17) were invited to complete an online survey delineating current educational programs on environmental sustainability and identifying interest in, and barriers to, developing a Canada-wide curriculum. RESULTS The response rates for department chiefs and program directors were 23% (26/113) and 41% (7/17), respectively. Department chiefs indicated that their departments participate in sustainability efforts such as donating medical equipment (65%) and recycling (58%). Despite interest in environmental sustainability, department chiefs identified inadequate funding (72%), lack of a mandate (64%), and inadequate knowledge (60%) as barriers to implementing environmentally sustainable practices. Only 29% of responding Canadian anesthesiology programs include environmental sustainability in their curriculum. Responding residency program directors believe residents would benefit from more teaching on the topic (86%) but identified barriers including a lack of faculty expertise (100%) and time constraints (71%). Respondents (71%) also indicated an interest in developing a Canadian curriculum on the topic. CONCLUSION Our results highlight current attitudes, gaps, and barriers to environmentally sustainable anesthesiology practice among departmental and educational leadership. Furthermore, this study identifies potential opportunities to develop cross-Canada collaborative educational programs in this field.
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109
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Petre MA, Malherbe S. Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice. Can J Anaesth 2020; 67:1044-1063. [DOI: 10.1007/s12630-020-01726-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/03/2019] [Accepted: 01/30/2020] [Indexed: 12/14/2022] Open
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Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The Carbon Footprint of Surgical Operations. Ann Surg 2020; 272:986-995. [DOI: 10.1097/sla.0000000000003951] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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111
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Glick DB. The Costs and Costing of Regulatory Compliance. Anesth Analg 2019; 127:331-332. [PMID: 30028383 DOI: 10.1213/ane.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David B Glick
- From the Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois
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112
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113
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Surface contamination in the operating room: use of adenosine triphosphate monitoring. J Anesth 2018; 33:85-89. [PMID: 30539274 DOI: 10.1007/s00540-018-2590-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. METHODS ORs with high case volumes were selected for the study. Ten sites in each OR were swabbed using the AccuPoint® HC ATP Sanitation Monitoring device, which provided a numerical measure of contamination (relative light units, RLUs). According to the manufacturer, surfaces are considered clean at ≤ 400 RLUs. AM measurements were taken before the start of surgical cases and PM measurements were taken after cases were completed. RESULTS Eighty morning and 70 afternoon samples were obtained from 8 ORs. Apart from the OR floor, laryngoscope handles had the highest level of morning contamination (1204 RLUs, interquartile range 345, 2603), with 75% of AM samples and 100% of PM samples exceeding 400 RLUs. This contamination was comparable to hospital toilet seats (87% of samples exceeding 400 RLUs). No sites showed statistically significant increases in contamination from AM to PM. CONCLUSION Apart from the OR floors, laryngoscope handles emerged as a key OR site where improved cleaning practices may reduce cross-contamination risk. While some sites showed increased contamination over the course of the day, none of these met statistical significance thereby offering tentative evidence that current cleaning practices during case turnover are effective for most sites.
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114
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Sherman JD, Hopf HW. Balancing Infection Control and Environmental Protection as a Matter of Patient Safety. Anesth Analg 2018; 127:576-579. [DOI: 10.1213/ane.0000000000002759] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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115
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Reprocessed single-use devices in laparoscopy: assessment of cost, environmental impact, and patient safety. Surg Endosc 2018; 32:4310-4313. [DOI: 10.1007/s00464-018-6275-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
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