The green hospital 

To improve the health of the community, healthcare must prioritize waste reduction, recycling, and reuse of materials. Hospitals contribute to over six tons of waste daily, with upwards of 70% generated in the operating room (OR). Furthermore, 60% of that waste can be recycled; however, inefficient sorting and workflow barriers often cause these products to be discarded.  

Hospitals can reduce their carbon footprint in many ways, including improving energy efficiency, water conservation, and waste reduction and recycling. To reduce energy consumption, hospitals can install energy-efficient lighting, implementing timers and initiatives to turn lights off when not in use, and utilize energy efficient vehicles within the supply chain and during patient transport. Outfitting hospitals with solar panels and implementing conservative water systems that recycle water used in equipment sterilization can significantly reduce freshwater usage. Lastly, waste recycling and reduction, including implementing food composting programs can reduce the carbon footprint of healthcare institutions. 

As an anesthesiologist, I’m focused on the effects that OR waste and anesthesia, specifically volatile anesthetics, have on the environment. In the U.S., a total of 8.5% of greenhouse gases (GHG) comes from hospitals, with major contributions from the anesthesia gases used during surgery. These gases are toxic to the environment, with Desflurane having over 2500 times more global warming potential (GWP) then carbon dioxide (CO2). That’s equivalent to one million cars or one coal plant production for one year! Nitrous oxide (N2O) is also a potent GHG, with 265 times the GWP of CO2, ozone depletion effects, and a lifespan of over 100 years in the atmosphere. Interestingly, it’s estimated that 95% of N2O is leaked into the atmosphere from centralized tanks prior to reaching the patient. Lastly, drug wasting is a huge problem in the OR, with an estimated 20-50% of prepared medications going unused and discarded.   

What can you do to reduce your environmental impact? 

1. Eliminate Desflurane from clinical practice.

Equivalent volatile anesthetics without Desflurane’s negative environmental footprint exist. 

2. Switch to nitrous oxide e-cylinders.   

E-cylinders don’t have pressure-release valves venting into the atmosphere. 

3. Optimize workflow to improve waste sorting.

Use of colored containers, with placards showing specific products used in that clinical setting, can improve sorting and proper disposal. 

4. Switch to reusable equipment.   

5. Only draw up medications you will use.   

Adopting sustainable practices now will allow clinicians to improve the health of our community extending outside the walls of the OR and operating rooms. 

To learn more: 

Mathew T Ryan, Jonathan Malmrose, Charles A Riley, Anthony M Tolisano, Operating Room Waste Generated Across Otolaryngology Cases, Military Medicine, Volume 188, Issue 7-8, July/August 2023, Pages e1697–e1700. 

Sherman J, Le C, Lamers V, et al. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg. 2012; 114:1086–90. 

Barbariol F, Deana C, Lucchese F, Cataldi G, Bassi F, Bove T, Vetrugno L, De Monte A. Evaluation of Drug Wastage in the Operating Rooms and Intensive Care Units of a Regional Health Service. Anesth Analg. 2021 May 1;132(5):1450-1456.

Ravishankara AR, Daniel JS, Portmann RW. Nitrous Oxide (N2O): The dominant ozone-depleting substance emitted in the 21st century. Science. 2009;326 (5949):123-5. 

Herr M, Outterson R, Aggarwal S. Lost in the ether: The environmental impact of anesthesia. Operative Techniques in Orthopaedics. 2022;32(4):100997. 

Seglenieks R, Wong A, Pearson F, et al. Discrepancy between procurement and clinical use of nitrous oxide: Waste not, want not. Br J Anaesth. 2022;128(1): e32-34. 

“Environmental impact of nitrous oxide,” “OpenAnesthesia.”