Can We Save Patients and Protect the Planet? Environmental Sustainability in the Intensive Care Unit

In our personal lives, we make conscious decisions to help protect our natural environment. We recycle, we garden, we drive electric vehicles. Yet, in our professional lives, we often fail to recognize the negative impact of our clinical practice on the planet.

The US healthcare sector is responsible for 8.5% of the nation’s carbon emissions¹. In comparison, the entire US commercial aviation industry only produces 2%. In terms of absolute numbers, if the global health sector was a country, it would be the 5^th largest emitter on the planet, behind the US, China, India and the collective European Union².

Within hospitals, certain carbon “hotspots” have been identified and intensive care is one of them, due to our high acuity and resource utilization. ICU patients generate 50% more solid waste and 200% more greenhouse gas emissions than floor patients³. Left unchecked, the carbon emissions we emit and the waste we produce will further exacerbate climate change, ultimately hurting the patients we diligently aim to protect.

We are all in this field because we care, and we want to keep children safe and well. A healthy environment is essential for healthy children.

The first step toward meaningful change is awareness. The second is to explore the negative environmental impact of our clinical care. One only needs to look around the room after a resuscitation to see the mountains of trash that were produced. I always hoped in those moments that my eco-sins would be forgiven because I was busy trying to save a life, but I have come to realize that saving a life and protecting the planet do not have to be mutually exclusive. As part of the global pollution and carbon emissions problem, we can also be part of the solution.

Here are some educational tidbits that may pique your curiosity to become more involved in hospital environmental sustainability action:

Desflurane

• What we know: The inhaled anesthetic agent Desflurane is a super pollutant, with the highest global warming potential of any inhaled agent. The greenhouse gas effect of one hour of desflurane anesthesia is equivalent to driving in a modern car for 235 miles (as compared to 30 miles for sevoflurane)⁴.
• What we can do: If we made a choice to use less environmentally toxic anesthetic agents, imagine the cumulative effect, as more than 50 million inpatient surgeries are performed annually in the US alone.

Ventilators and ICU patient monitors

• What we know: Medical devices such as ventilators and ICU patient monitors use almost the same amount of electricity when they are in stand-by mode versus fully functioning mode⁵.
• What we can do: The simple action of keeping equipment powered off as long as possible is an easy way to reduce energy expenditure and cost.

Hospital Waste

• What we know: An estimated 50-70% of normal waste is inadvertently disposed of as biohazardous (also referred to as regulated medical waste). Exploring the reasons why, often uncovers a knowledge gap, with staff unsure which items require special disposal or misconceptions that all waste is infectious⁶. Biohazardous waste must be incinerated, which increases the environmental and financial price tag.
• What we can do: Educational sessions and proper signage regarding what should be thrown into which bin, can result reduced carbon emissions and financial savings⁷.

If you believed one person’s actions didn’t make a difference, you wouldn’t be in this field… and neither would I. We are a community of healthcare professionals, leaders in our communities, and we have a wide sphere of influence. Join this journey to promote environmental sustainability in our intensive care units. There is no admission pre-requisite, you don’t have to drive a Tesla to arrive in support. Everyone is welcome, and everyone is needed.

We are all agents of change

A toolkit on how to start sustainability initiatives in your intensive care unit from the Australian and New Zealand Intensive Care Society is easily accessible⁷. Also, coming soon is the first publication from the Society of Critical Care Medicine’s Environmental Sustainability Task Force.

References:

1. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The United States: An Update. Health Aff (Millwood). Dec 2020; 39(12):2071-2079
2. https://global.noharm.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
3. Prasad PA, Joshi D, Lighter J, et al. Environmental footprint of regular and intensive inpatient care in a large US hospital. The International Journal of Life Cycle Assessment. Jan 2022; 27(1):38-49
4. Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010 Jul; 111(1):92-8
5. Drinhaus H, Schumacher C, Drinhaus J, Wetsch WA. W(h)at(t) counts in electricity consumption in the intensive care unit. Intensive Care Med. Apr 2023; 49(4):437-439
6. Hames K. Healthcare waste disposal: an analysis of the effect of education on improving waste disposal. Healthcare infection. 2013;18(3):110-114.
7. A Beginners Guide to Sustainability in the ICU. 2022