Environmental sustainability: Overview

Abstract
A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists' perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability-opportunity-motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July-September 2021). Participants' age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability-opportunity-motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare.

Abstract
Objective: During the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs.

Design: This is a prospective cross-sectional point prevalence study, as part of the 2021 ANZICS Point Prevalence Program. Specific questions related to waste and sustainability practices were asked at the site and patient level.

Setting and participants: ANZ adult ICUs and their patients on the day of the study.

Main outcome measures: Amount of single use items disposed of per shift, as well as the engagement of the site with sustainability and recycling practices.

Results: In total, 712 patients (median number of patients per ICU = 17, IQR 11-30) from 51 ICUs across ANZ were included in our study; 55% of hospitals had a sustainability officer, and recycling paper (86%) and plastics (65%) were frequent, but metal recycling was limited (27%). Per patient bed space per 12-h shift there was recycling of less than 40% paper, glass, intravenous fluid bags, medication cups and metal instruments. A median of 10 gowns (IQR 3-19.5), 10 syringes (4.5-18) and gloves 30 (18-49) were disposed of per bed space, per 12-h shift. These numbers increased significantly when comparing patients with and without infection control precautions in place.

Conclusions: In ANZ ICUs, we found utilisation of common ICU consumables to be high and associated with low recycling rates. Interventions to abate resource utilisation and augment recycling are required to improve environmental sustainability in intensive care units.

Abstract
There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce pollution from clinical practice. Inhaled anaesthetics is a particular research area of interest for two reasons. First, several gases are potent greenhouse gases, and waste gas is mostly emitted directly to the environment. Second, there are options to reduce gas waste and substitute medications and procedures with fewer embodied emissions while delivering high-quality care. Performance improvements are contingent on a proper understanding of the emission estimates and climate metrics used to ensure consistent application in guiding mitigation strategies and accounting at various scales. We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs: desflurane, sevoflurane, isoflurane, methoxyflurane, and nitrous oxide.