Environmental sustainability resources: Overview

Abstract in English, French
Purpose: Anesthesia contributes up to 25% of operating room (OR) waste. We sought to conduct a quality improvement project to initiate soft plastic recycling, aiming to recycle 1,000 g per day of soft plastic.

Methods: In this single-centre, anesthesiology resident-led quality improvement initiative in British Columbia, Canada, we started a soft plastics recycling collection program in a single operating room (OR) and expanded it to 12 ORs through a series of Plan-Do-Study-Act cycles. The outcome measure was the daily weight of soft plastics recycled. We tracked the number of mistakes as a balancing measure. We collected data eight months after the conclusion of the project to assess sustained changes. We visualized data with Shewhart control charts.

Results: One OR resulted in a mean (standard deviation [SD]) of 194 (157) g of soft plastics collected daily. Once we expanded to all ORs, a mean (SD) of 1,524 (708) g of waste was collected daily. A mean (SD) of 1,284 (613) g was recycled daily during the eight-month follow-up. There was a median [interquartile range (IQR)] of 0 [0-2] mistakes per day with only one OR, which increased to a median [IQR] of 2 [1-4] mistakes per day upon expansion, and remained low at eight months, with a median [IQR] of 1 [0-3] mistake per day. E-mail reminders and signage improved the error rate.

Conclusions: We successfully introduced and sustained a soft plastics collection program in our centre's OR suite with the aim to stream it for recycling. Monitoring and education were helpful in growing the program and reducing errors.

Abstract
Nitrous oxide (N2O) is a greenhouse gas that is a significant contributor to the carbon dioxide-equivalent emissions of health services. We aimed to obtain information about N2O usage and knowledge of its environmental effects among clinical staff at an Australian metropolitan public health network. We distributed an anonymised survey to doctors, nurses and midwives working in anaesthesia, birthing, adult and paediatric emergency medicine, and paediatrics. We analysed 403 of 1320 (31%) responses; 117 of 198 (59%) from anaesthesia, 102 of 368 (27%) from birthing, 137 of 643 (21%) from adult and paediatric emergency medicine and 40 of 111 (36%) from paediatrics. Descriptive statistics were used, and statistical analyses performed on questions regarding environmental knowledge. Of those who currently used N2O, the majority indicated there were alternative therapies (184/239, 77%), which they would (137/239, 57%) or could (90/239, 38%) be willing to use. Approximately half (219/385, 57%) of respondents correctly identified N2O as a greenhouse gas, but only 70/382 (18%) identified its global warming potential as hundreds of times that of carbon dioxide. Almost half (180/383, 47%) answered that N2O is ozone depleting. For anaesthetists, 96% (45/47) knew that N2O was a greenhouse gas, compared with 41% (32/79) of midwives. This survey demonstrated that frequency of use and reason for use of N2O varies between clinical groups, and that a significant proportion of staff that use N2O do not know its harmful environmental characteristics. Our results provide data to inform future research on interventions to minimise clinical use of N2O, and suggest that educational programs should form part of these efforts.