Environmental issues in hospitals

Health care sector’s role in environmental issues has become more known due to the increased environmental awareness, more strict environmental regulations and the need for cutting costs of public expenditure (Karlsson & Öhman, 2005). Such as other public actors, also hospitals have a responsibility to act as an example in activities against climate change. The responsibility is even more highlighted, when the complex and major environmental impacts of health care sector are considered; hospitals have an extensive carbon footprint but also complex waste streams containing for example, infectious, hazardous, radioactive and solid waste. (Cosford, 2009; Zimmer &

McKinley, 2008) The overall goal of health care sector is to improve human health, but often the personnel and CEOs of hospitals do not consider the impacts of their own waste and emissions on human health. However, the most significant motivators to reduce pollution and waste have been concerns about personnel’s and patients’ health as well as hazardous waste regulations and cots. (Zimmer & McKinley, 2008)

In order to prevent the climate change, hospitals should reduce their carbon footprint and first of all start by measuring it. It is essential to have a wide view on the issue;

instead of measuring only energy use, hospitals should also consider transport, procurement, waste and building design. (Cosford, 2009) Especially waste management plays a central role and many of the hospitals’ environmental issues are related to the waste generation and disposal methods. In addition, it is essential that hospitals do not only reduce the amount of waste but also the toxicity of the waste, which has directly negative impacts on human health. Disposal of hospital’s waste and products results pollutants such as mercury and dioxin that are greatly adverse for human health.

Because of the large amount of solid and toxic waste, healthcare sector is responsible for the generation of these adverse pollutants. (Kaiser, Eagan & Shaner, 2001)

The impacts of hospital waste disposal on human health and environment are often indirect since the waste does not contain immediate hazards. These indirect impacts cause also indirect costs. That is why analyzing the life cycle of the product is useful for hospitals, because it takes into account all the environmental impacts that occur during the life-cycle. It is a way to observe indirect impacts and costs caused not only by the disposal but also manufacturing, distribution and use of the product. (Kaiser et al., 2001)

Therefore, primary tasks for hospitals to reduce negative environmental impacts include consideration of waste disposal methods and also implementation of green procurement that contains an environmental screening of the products. This screening can be done by utilizing the life cycle assessment and including environmental criteria into purchasing processes. (Kaiser et al., 2001) In order to take into account environmental aspects in purchasing, purchasers need precise information about the environmental aspects of specific products within the whole supply chain. In addition, the scoring used in the purchasing process should be improved and define the relative significance of environmental criteria. (Oruezabala & Rico, 2012)

However, there are many barriers against the implementation of environmental procurement in health care sector. The prioritization and main values in health care are patient and personnel safety, quality and clinical performance, which are so important that they often reduce and postpone the efforts towards reducing negative environmental impacts. (Karlsson & Öhman, 2005; Walker & Brammer, 2009) Nevertheless, as mentioned earlier, negative environmental impacts caused by health care sector have also often negative impacts on human health, which is against health care sector’s general goals (Zimmer & McKinley, 2008). The lack of possibilities to prioritize environmental issues is also related to the strict budgets, the perception that more environmental friendly products are more expensive and lack of the amount of personnel, especially environmentally aware personnel. In some cases hospitals do not have enough time and resources to concentrate on environmental issues. In addition, a general and significant problem is the lack of knowledge of environmental impacts of medical products. This issue hinders the implementation of green procurement policies

in public hospitals. (Kaiser et al., 2001; Zimmer & McKinley, 2008; Walker &

Brammer, 2009)

Even though operating rooms (OR) represent relatively small physical area in hospitals, the waste they generate is about 20-33% of all waste produced in hospitals (Kagoma, Stall, Rubinstein & Naudie, 2012; ref. Goldberg, Vekeman, Torjman et al., 1996;

Tieszen & Gruenberg, 1992). ORs are also consuming greatly energy, because of the circulation, humidity, lightning and temperature requirements (Kagoma et al., 2012).

Moreover, the use of anesthetic gases significantly contributes to the global warming (Kagoma et al., 2012; McGain, Story, Kayak, Kashima & McAlister, 2012b).

The amount and costs of hospital waste produced in operating rooms is increasing.

According to McGain, Mossenson & Story (2012a) anesthesiologists’ attitudes towards recycling play a central role in improving the recycling in OR. Their study results that anesthesiologists find recycling in OR important, but still only 1 out of 9 respondents agreed that they recycle in their ORs. There occurs three main barriers towards OR recycling; insufficient facilities for recycling, insufficient information and know-how, and staff attitudes. By contrast, costs, lack of time, lack of space, and safety issues were found to be insignificant barriers. In order to increase OR recycling greater support from hospital administration is needed. (McGain et al., 2012a)

Plastic packaging is one major source of OR waste; surgical products are often double-wrapped and packaged in big containers (Kagoma et al., 2012) and another major source is single-use equipment (McGain et al., 2012a). It is estimated that even 80% of OR waste is produced before the actual surgery (Kagoma et al., 2012; ref. Donaldson, 2000). Even though recycling in the OR is important, even more important is to reduce packaging and single-use equipment (McGain et al., 2012a).

In addition to the amount of waste, another significant environmental issue is the use of anesthetic gases. The global warming potential (GWP) of anesthetic gases is even 2000 times that of carbon dioxide (Kagoma et al., 2012, Doyle, Byrick, Filipovic et al., ref.

Canadian Centre for Pollution Prevention, 2005). For example, during one working day the amount of N2O or desflurane (anesthetic gases) one anesthesiologist administrates produces an amount of CO2 that is comparable to more than 1000km of car driving (McGain et al., 2012b; Ryan & Nielsen, 2010; Ishizawa, 2011). McGain et al. (2012b)

have made a list of recommendations on how to improve environmental sustainability of anesthesia practices. First, they recommend the use of low flow anesthesia, which does not contribute only to the emission reduction, but also reduces purchase costs of anesthetic agents. In addition, turning off or assessing a “stand-by” mode in anesthesia machines and monitors would possibly contribute in energy and cost savings. Also reduction of waste is important, for example by reducing package material. All these actions require cooperation with suppliers.

Above all, hospitals must ensure the patient safety and quality of care. Nevertheless, the current technology development can enable the consideration of greener practices without compromising safety or quality. Nowadays there are different technology and material alternatives available, which would improve the sustainable practices in OR and should be considered, when police-makers are searching for strategies to save money. (Kagoma et al., 2012)