Can more than one trainee do this?

Q: What is the collective noun for a group of sustainably minded health workers?

A: A Green Theatres group

Of course - the more the merrier we say! Operation Clean Up relies on collaboration, group-thinking and teamwork to implement department-specific changes for improving sustainability.

What is a carbon footprint?

Every single item you use has a carbon footprint. It involves complex calculations and specialist software. It takes into account the energy involved in sourcing materials, transporting those materials, manufacturing the item, sterilising it and transporting it. It is often expressed as equivalent tons of CO2.

Reusing something uses energy to wash it, is that better?

It depends on the type of energy your state/country uses; we can also advocate for cleaner energy sources but we also need more information about how many non-biodegradable items like blueys and drug trays go to landfill.

What if it is marketed as “biodegradable”?

Biodegradable plastic can either be compostable or designed to break down into microplastics in the presence of UV-light (the sun). Both methods require specific conditions to break down and take 2-3 years to do so, whilst releasing CO2 as the carbon chains are broken down. 

Breakdown  is impossible in hospital-landfill and will undergo more or less the same fate as ordinary plastic. It is best to REDUCE overall use/REUSE existing resources, rather than putting our faith in single-use “biodegradable” products.

What happens to clinical waste and sharps bins?

Clinical waste & sharps bins are disposed of in 2 ways - either incineration (releasing CO2 & other toxic fumes) or landfill. Landfill clinical waste undergoes an energy-intensive process of high pressure/temperature pretreatment before being crushed, compressed & buried > 8m underground.

Australian hospitals create 3.3kg of waste per patient per day & emit 7% of national carbon emissions. Segregating waste effectively reduces water, air & soil pollution and increases recycling potential. Does this item really need to go in the yellow clinical waste bin? Is this really a sharp item? Take photos, do audits & feedback to your department.

What is so bad about blueys?

Blueys have an important function; reducing the risk of dermatitis and pressure sores caused by prolonged skin exposure to fluids. A bluey is made of 2 plastic layers and an absorbent cotton layer (+/- added polyacrylics for added absorbency). TRA2SH traced an “Australian-made” bluey’s cradle-to-grave journey and discovered that up to 12 countries are involved! Each step involves significant air, water and/or soil pollution. Further, bluey breakdown in landfill exceeds 100 years and some hospitals will classify blueys as clinical waste (see Q. re clinical waste). A TRA2SH survey showed that DAPs are used for many purposes other than to reduce prolonged skin exposure to fluids; therefore contributing to preventable waste.

Why not choose other items?

There are lots of other items that we use freely without appreciating their environmental impact. Try to think “lean”. What adds value to patient care and what does not? Where is there a more sustainable alternative? Reflect whether the alternative could be harmful? Anything that will prolong a patient’s hospital stay is environmentally worse. REDUCE your use of items whilst upholding excellent patient care

Why don’t you give explicit alternatives to using Blueys?

Hospitals and departments function very differently, we think the solutions need to be found locally and great ideas can be shared with others! Have a look at posters in the Google Drive made by trainees in other institutions for inspiration.  We do not want to be too prescriptive and limit creativity! We encourage new solutions but also reflect on whether the new solution may actually be worse? TRA2SH is advocating for 2 ideas that came to light from our previous research: 

1. Keep blueys outside of theatre (i.e. not readily available)

2. Sustainably sourced absorbent paper, kept readily available in theatre, could be a suitable alternative for many uses identified in the survey.

My department says they will never get rid of desflurane due to its anaesthetic advantages, how should I respond?

Fortunately 2 great review articles (1 & 2) were published in 2020 - you can even present these in a departmental meeting. The triple bottom line is:

1. There is little evidence for Desflurane’s clinical benefit (including haemodynamic stability, pulmonary complications and turn-over time)

2. There is a large body evidence for desflurane’s environmental harm and suitable alternatives exist. 

3. Large financial savings are to be made when desflurane use is reduced.