Sustainability
Greening the surgical process: key strategies
Kate Woodhead RGN DMS discusses some of the strategies that could help operating theatre teams to reduce their impact on the environment and to maximise their contribution towards achieving the NHS’s Net Zero target.
The greatest challenge of our life is with us now and that is climate change. The association of rising temperatures, uncertain weather and climate effects causing fires, floods and many storms, together with the spread of different vector-borne diseases, increases the risks of harm to society. As responsible professionals and citizens, we need to ensure that our work environment is able to make as much difference as we do at home to contribute towards the Net Zero target. The World Health Organization says that the climate crisis is a major threat to human health. Delivery of healthcare is also part of the problem – so what can we do to assist? Health systems are thought to contribute
4.4% of global emissions in comparison to 2.5% from aviation. Surgical practice is one of the largest single causes of resource use in health systems, which in England accounts for around 27% of the financial spend and an estimated 5.7 million tonnes of CO2
per year.1 This author is wanting to contribute to a
greater level of information available on the topic, so that individuals can make their own assessments of where they can reduce or
reuse. This will be a short series of articles, as the Green Surgery Report is long with many facts and recommendations and hundreds of references for teams, individuals, hospital leadership and governments to help towards the reduction in harmful emissions. The Green Surgery Study is the result of a two-year effort to reduce the impact of surgical care, headed by the UK Health Alliance on Climate Change, Brighton and Sussex Medical School, and The Centre for Sustainable Healthcare. The project was carried out with a range of different stakeholders representing every stage of the surgical pathway. Initially, we will review the need for sustainability in healthcare and then focus further on surgery.
Establishing the need for sustainability Healthcare without Harm estimated that the healthcare sector is responsible for 4.4% of global net emissions and that if healthcare were a country, it would be the fifth largest emitter2
That is shocking enough, but add to
this fact that the NHS in England generates an estimated 25 million tonnes of CO2
each year,
which includes three ‘scopes’ of greenhouse gas emissions (GHG).3 It seems that the areas where greatest effort should be made for reduction of GHGs is in the supply chain for healthcare. In addition, nitrous oxide and halogenated anaesthetic gases, such as isoflurane, contribute to ozone depletion. Detailed analysis will be made in a future article, particularly regarding the supply chain issues. However, it is clear from Table 1 that there is much work to do, not only to increase awareness, but also to make changes to the delivery of healthcare, where it is known to be harming the planet and contributing to ill health.
Reducing the need for surgery Reducing the need for surgery is a huge challenge, which unless more professionals are aware of the actions we must make, will not be met. Before COVID interrupted normal service, the volume of surgical procedures in the world were increasing and were estimated, in 2012, to be 313 million procedures.4
The reasons for this
were largely down to increasing trauma and cancers in the global south, in the developing world, as well as demand from an elderly demographic in the developed healthcare systems. One of the principles of sustainable surgery, identified by Rizan and colleagues, and devised by the Centre for Sustainable Healthcare’s four principles of clinical practice,5
suggests that
society needs to get a great deal better at disease prevention and this includes ’surgical’ disorders. There is already considerable emphasis on healthy behaviours in the media, but little serious evidence that it is having a huge impact on reducing red meat eating, more exercise, less alcohol and smoking, which may affect population health. Checking compliance with medications is as well as medication rationalisation
also cited,6
to reduce interventions, with the potential to reduce the need for surgery. Reducing unnecessary visits to outpatients and the GP has already changed in some areas as telemedicine
June 2024 I
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