Sustainability Projects

Our sustainability projects are designed to be collaborative and to assist the trainee in meeting the requirements of the ANZCA Scholar Role activity. There is an ANZCA Scholar Role library guide to help get started and there is more information in ANZCA Networks. Scholar Role Guidelines are available here but may require Networks login.

We want to hear your ideas!

Please email us if you have an idea or a project that you would like to see at TRA2SH.

We welcome collaboration and innovation!

Background

Planet health is a public health issue, and medical Doctors in Australia are expected to contribute to the health and wellbeing of their patients and community; this includes the environment. Operating Theatres produce around 20-30% of hospital waste, and anaesthetic waste is around 20-25% of that. Up to 60% of this may be recyclable.
In Australia 7% of the total carbon footprint is attributable to healthcare.
We believe that Anaesthetic Trainees are well placed to effect environmental change within their workplaces. Trainees are often engaged with sustainability practices at home, move hospitals and are exposed to alternative practices that might be applicable to a new rotation site.

Reduce

Operating theatres produce around 20-25% of all hospital waste. Of this, Anaesthesia specific waste may be as much as 25%. Reducing waste is the most important step of the “Three R’s”. Taking steps to reduce use of unnecessary items can save money on procuring, storage of a large number of items (particularly if disposable) and reduce the costs of disposal.

Reuse

Life cycle analysis (LCA) of anaesthetic equipment indicates that using reusable anaesthesia items consistently reduces cost compared to single-use items. The environmental costs are dependent on the where electrical energy comes from. In some Australian states a reliance on fossil fuel burning may find in favour of single use items while in areas where renewable energy is used, such as New Zealand, reusable items may be favoured.

Recycle

Recycling operating theatre waste can reduce the amount of waste generated by theatres by up to 60%. Recycling is the final step if reducing or reusing items is not possible. Common recyclable items include paper and cardboard, soft plastics and PVC, glass vials (but not “snap-top” drug vials), copper wire from diathermy pads and theatre packaging. Using items made from recycled products can reduce emissions. Even hospital food waste can be successfully composted and reduce emissions.

For more information please read the ANZCA PS64 Document and the PS64 Background paper here

Local Sustainability Project Ideas

Desflurane

Despite its worse environmental profile, many hospitals still have Desflurane within arm’s reach. Many departments have successfully removed Desflurane vapourisers from operating theatres, some have removed it completely while others have left vapourisers and Desflurane canisters in a locked Anaesthetic cabinet for removal if required.

See our Desflurane-free pledge here

Reusing

Many hospitals reuse items

Drug trays
LMA airways
Bite blocks for gastroscopy
Face masks
Laryngoscope blades
Sterile Gowns
Sterile drapes
Regional or CVC insertion trays or kits
Anaesthesia circuits
Surgical scissors and metal instruments

Unfortunately many hospitals make choices based on price, which means that reusing some items is more expensive than using a disposable item. Experiencing a pandemic has taught us that relying on disposable items to continually be available has its drawbacks, plus it creates more waste without significant patient benefit.

What other items can be reused regularly instead of being thrown out after a single use?

Reducing

Here at TRA2SH we believe that reducing is the single most important mechanism available to us in reducing operating theatres production of waste.

These are only some suggestions, but along with Bluey use, we think there are a number of items that could be reduced. We suggest auditing items used in a cycle (for example; per year, per month or the total number per year / total number of operations performed per annum) via operating theatre procurement. Design an intervention such as an education day or take part in our “Operation Clean Up” day of activity and reaudit to see if behaviour has changed.

Potential for procurement audits:

· Bluey absorbent pads

· Gauze swabs

· Single use trays

· Single use temperature probes

· Items used in disposable CVC or regional packs

TRA2SH can help to promote projects, design promotional material like posters, find mentors and examples where similar success has been found. Please share with us if you plan on undertaking a sustainability project.

Recycling

Hospitals have different approaches to recycling and differences between states can be vast.

We know of several hospitals such that have a strong recycling system, including recycling

Paper and cardboard
Copper wire from diathermy plates
Tempered glass vials (i.e. Cefazolin, Propofol)

PVC recycling including fluid bags and giving sets
Hard plastics
Soft plastics
Kimguard packaging
Blue “huck” hand towels
Single use metal instruments
PET plastics
Aluminium suture packets
Batteries and electronic recycling

Please share with us your recycling success stories.

Audits

TRA2SH is built on the idea of creating audit projects in sustainability to complete an ANZCA scholar role activity. We are designing audits that can be delivered by ANY anaesthetic trainee in ANY hospital in Australia or New Zealand. If more than one trainee completes the same audit there is greater impact, greater sharing of knowledge and greater chance of instilling institutional and individual behaviour change to improve waste management.

Where should I start?

Waste Streams

Many people are interested in sustainability activities but don’t know where to start. A simple place to start may be in understanding and improving your waste streams. This is a multidisciplinary activity and can engage multiple craft groups.

There is some evidence from a single UK hospital about the relative carbon footprints of waste streams. This is useful information to have, but it may not have good external validity to apply to your hospital in Australia or New Zealand. Waste management is complicated! If you have a sustainability officer in your hospital, get in contact early. Likewise, contact your waste manager through the appropriate channels. You may even be able to tour your waste disposal facilities.

Each jurisdiction has regulations about the management of clinical waste which must be adhered to. Clinical waste is often the most expensive to dispose of and may have the highest carbon footprint, as it typically gets incinerated (although this varies with location). Sharps bins are included in clinical waste and are either high-temperature incinerated or are macerated and buried in landfill. Some items must be incinerated, however reducing incineration of items that can be disposed of elsewhere (i..e recycled or in general waste) can have economical and environmental implications.

Improving management of waste streams may be a good place to start in some settings but remember, hospital practices vary significantly.