Think Global, Act Local - ESAIC leading the world in Sustainable Health Care

The world is on the brink of a climate catastrophe, with the Intergovernmental Panel on Climate Change (IPCC) Special Report stating that we have less than 10 years to dramatically reduce greenhouse gas emissions to avoid global warming beyond ¹.5C. Everyone across all sectors has a role to play in avoiding this disaster, and the healthcare sector is no different.  

Anaesthesia and theatres are major contributors to greenhouse gases and global warming through the use of volatiles and other drugs and waste generation. The ESAIC has recognised this and launched a coordinated response to this global crisis. 

2023 saw the ESAIC and its Sustainiac Committee co-ordinate with anaesthetic societies and governments across Europe with several key initiatives culminating with the Dear Green Place global village and Glasgow Declaration on Sustainability at Euroanaesthesia in June and the publication of the European Society of Anaesthesia and Intensive Care Consensus Document on Sustainability: 4 Scopes to achieve more sustainable practice this month. 

The “Dear Green Place” initiative was an area within the congress where delegates, industry and experts could all meet and share ideas and innovations. There were 5 “islands” within the space, each focusing on a different aspect of sustainable healthcare: creating networks, drugs and gases, energy efficiency, waste and recycling, and “beyond anaesthesia” (which looked at moving sustainability out of theatres to the wider hospitals and universities). Each island had an expert member of Scotland’s Green Anaesthesia Group (GAS) who would host talks and highlight the Scottish national programme, which has co-ordinated nationwide elimination of Desflurane, decommissioning of nitrous pipelines and a national green theatres project to provide guidance and support innovation in sustainability. The Dear Green Place also offered the industry the opportunity to show off the latest in volatile capture technology, minimum waste consumables, and other new products and hosted research from delegates for ESAIC’s first sustainability poster sessions. 

Central within the Dear Green Place was the “Glasgow Declaration”¹– ESAIC’s commitment to sustainable healthcare in the future. Signed by the outgoing and incoming Presidents and the Chair of the Sustainiac group, the Glasgow Declaration focuses on 3 key areas of anaesthetic care: medicine use, energy use and circularity in process and waste. It recognises the contribution of anaesthesia to environmental pollution and commits to reducing this in line with the European Union’s commitment to climate neutrality by 2050. Though there are no quick solutions, the declaration at its heart emphasises a pragmatic approach that individuals, departments and societies can follow with recommendations which emphasise the importance of selecting anaesthetics with the lowest global warming potential, optimising energy consumption in operating rooms, adopting renewable energy sources, minimising waste generation, and implementing strategies to mitigate pharmaceutical pollution in sewage water. 

As part of the Glasgow Declaration, ESAIC will publish its consensus document on sustainability² this month. This comprehensive guidance will empower practitioners to be able to reflect on their practice and draw on expert advice to improve sustainability in their own areas. Broad reaching and comprehensive, the guidance has 4 scopes recognising the need for a multi-faceted approach to addressing healthcare generated pollution., examining direct emission, energy optimisation, waste and supply chain management, and well-being and self-care. At its heart, though, its principles can be summarised with the “5R’s”:  

REJECT products where there is a more sustainable and equally good alternative and avoid using unnecessary devices or products, particularly if they generate extra waste. 

REDUCE waste by maximising product use and avoiding discarding unused items where possible. 

REUSE products when it is safe to do so in line with local policies and avoid single-use items if there is a safe, reusable alternative. 

RECYCLE whenever it is possible to do so. 

REPAIR whenever possible (and ensure that you have a post-manufacture maintenance service for devices). 

A problem as vast as climate change can seem unsurmountable, but the key to solving this global issue relies on local change, and as anaesthetists, there are certain things within our power that we can change ourselves today. Anaesthetic gases represent 5% of all of the healthcare carbon footprint, and the NHS accounts for 50% of all hospital gas pollution. Theatres account for a large proportion of hospital energy use and waste. We may become focused on new technologies, but each anaesthetist and their department can take simple individual steps. When giving a volatile anaesthetic, use the one with the least global warming potential and avoid nitrous where possible. Use low-flow anaesthesia and speak to your estates and medical physics teams to see whether the scavenging and hospital ventilation systems can be turned off out of ours (or set back to low power modes) out of hours in non-emergency theatres. When buying anaesthetic equipment, inquire whether parts of it can be reused or sterilised- is there a reusable alternative? Find out what happens to the waste packaging in theatres- is it recycled? Do you segregate your waste so that only contaminated items are sent for incineration? With simple steps, meaningful change is possible, or perhaps more fittingly, from little acorns, mighty oaks grow. 

Scotland has embraced sustainable practices and now has a government-endorsed and sponsored National Green Theatres Programme (NGTP)³. What is remarkable, though, is that this has not come from the government itself; rather, it has been driven by individual clinicians recognising the problems and working together to create a network that has gone from a WhatsApp group between several individuals to a national programme. The term “grassroots” has never been better (or more suitably) used, and it shows the power of cooperation between clinicians.  

The NGTP has identified multiple areas where sustainability can be improved, all achievable at individual, local and ultimately national levels. So far, the project has eliminated the use of Desflurane from practice, decommissioned nitrous pipeline systems across the country, reserved nitrous use for areas where there are no alternatives, worked to decrease the use of IV paracetamol when the oral route is available, helped turn off or set back theatre ventilation and anaesthetic scavenging systems in non-emergency areas overnight, implement recycling and waste separation schemes into theatre areas and the use of reusable suction devices. The next projects being rolled out will be decreasing the use of fluid warming kits (with the use of warming cabinets to pre-warm fluids) and “rubbing, not scrubbing” for handwashing for sterile procedures. 

There is no one solution to climate change; rather, we must all work to make marginal gains, which together will translate into meaningful change. Everyone has a role to play. However, a change in thought, thinking, and culture is required. Sustainable practice cannot simply be thought of as an individual project or even a movement. It must be a revolution- something that keeps turning and gaining momentum because, with enough momentum, we might just change the world… 

References

1. https://www.esaic.org/esa-news/european-society-of-anaesthesiology-and-intensive-care-esaic-tackling-the-climate-emergency-the-esaic-glasgow-declaration-on-anaesthesiology-and-intensive-care-addresses-the-importance-of/ 
2. https://pubmed.ncbi.nlm.nih.gov/38235604/ 
3. https://www.nhscfsd.co.uk/our-work/national-green-theatres-programme/green-theatre-actions/#:~:text=The%20National%20Green%20Theatres%20Programme,will%20be%20released%20in%20bundles. 

Authors

• Dr. Paul McConnell (MB ChB LLM FRCA FFICM EDIC) – Past Chair of ESAIC Ethics Forum and member of Green Anaesthesia Scotland