Environmental sustainability resources: Overview

Abstract
Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified. 30 strategies were identified across six topics: external purchasing (two strategies); internal purchasing (seven strategies); incentivisation and standardised environmental decision making (three strategies); successful practical introduction of reusable devices (five strategies); identification of goals and facilitation of leadership (two strategies); and a community of practice and knowledge building (11 strategies). We present these 30 implementation strategies, from the individual to the policy level, which consist of evidence-based behaviour change techniques aimed at addressing the identified barriers to replacing single-use devices with reusable alternatives.

Abstract
Globally, more than 1.2 billion inhalers are purchased for asthma and chronic obstructive pulmonary disease (COPD) annually. In Australia and New Zealand, pressurized metered dose inhalers (pMDIs) are the leading delivery device prescribed and pMDI salbutamol can be purchased over the counter in Australia. These inhalers are a major contributor to healthcare related greenhouse gases. This is due to the propellants that they currently contain which have extremely high global warming potential (GWP). In this position paper, we report the findings of a Thoracic Society of Australia and New Zealand (TSANZ) working group on the environmental impact of inhaled respiratory medicines. We reviewed the use of inhaled medicines in Australia and New Zealand and their contribution to climate change and other environmental degradation. We propose strategies for health professionals and consumers to reduce environmental impact in the management of airway diseases. These include accurate diagnosis to avoid unnecessary treatment, better disease control to minimize the need for reliever therapy and actively choosing inhaler devices with lower environmental impacts when clinically appropriate. Inhaler selection should be tailored to the individual, aiming to achieve the best possible clinical outcome. Choosing an appropriate inhaler for an individual involves consideration of factors such as dexterity, inspiratory capacity and cost. In our current climate emergency and with the availability of lower carbon alternatives, health professionals should also consider environmental impact.

Abstract
In today's era of modern healthcare, the intersection between medical practices and environmental responsibility has gained significant attention. One such area of focus is the practice of anesthesia, which plays a crucial role in various surgical procedures. Anesthetics such as nitrous oxide and volatile halogenated ethers (desflurane, isoflurane, sevoflurane) are examples of medical gases that are strong greenhouse gases that contribute to global warming. During medical procedures, most of these anesthetic agents are released into the atmosphere, which exacerbates their influence on the environment. Also anesthesia delivery systems have traditionally utilized high flow rates of gases, leading to not only excessive consumption but also a considerable environmental impact in terms of greenhouse gas emissions. However, the emergence of low-flow anesthesia (LFA) presents a promising solution for achieving emission reduction and cost savings, thereby aligning healthcare practices with sustainability goals. Understanding LFA involves the administration of anesthetic gases to patients at reduced flow rates compared to conventional high-flow methods. This practice requires precision in gas delivery, often incorporating advanced monitoring and control systems. By optimizing gas flow to match the patient's requirements, LFA minimizes wastage and excessive gas release into the environment, subsequently curbing the carbon footprint associated with healthcare operations. Decreasing volatile anesthetic delivery provides safe and effective strategies for anesthesia providers to decrease costs and reduce environmental pollution. Current literature support in favor of LFA represents an area of cost containment and an opportunity to lessen the environmental impact of anesthesia. This article will cover the concept of LFA, the distinctions between low flow and minimal flow, and the potential advantages of LFA, such as those related to patient safety, the environment, and the economy.