Operating rooms are a major source of hospital greenhouse gases


Inhaled anaesthetics that can hang around in the atmosphere for a year or more are being phased out as part of efforts to reduce greenhouse gases. — TNS

Health systems in the Philadelphia area in the United States are phasing out a common anaesthesia gas that hangs in the atmosphere for 14 years.

Desflurane is the most potent greenhouse gas found in hospitals, which are increasingly engaged in efforts to reduce their carbon footprint.

Desflurane was once favoured by doctors because it leaves the body quickly, enabling patients to wake up within minutes of the anaesthesia gas being turned off.

But another inhaled anaesthesia, sevoflurane, is now considered a better option for most patients because it is less likely to cause nausea and is less irritating to the airway.

Sevoflurane is also much less harmful to the environment, dispersing in the atmosphere in a little over a year.

Children's Hospital of Philadelphia and Virtua Health have already eliminated desflurane.

Virtua is increasingly shifting away from all inhaled anaesthetics and encouraging doctors to opt for anaesthesia drugs that can be delivered through an IV, without emitting greenhouse gases.

Main Line Health has also reduced its use of desflurane, although the system's hospitals plan to keep it on hand for select cases.

Penn Medicine has phased out desflurane at four of its six hospitals.

The two Penn hospitals still using desflurane will stop using it by the end of the year (2024).

The push to eliminate the harmful greenhouse gas is part of broader climate initiatives at Philadelphia-area hospitals, with research showing that the health sector contributes about 9% of US national greenhouse gas emissions, according to the US Department of Health and Human Services.

Penn and Main Line Health last month (April 2024) joined more than 130 US health organisations that have signed on to the Health Sector Climate Pledge created by the White House and the US Department of Health and Human Services in 2022.

Jefferson Health is part of a sustainability initiative by The Joint Commission, a leading hospital accreditation organisation.

There's also a business case for becoming more environmentally friendly: Penn expects to save millions of dollars through its emissions reduction initiatives.

"Of course, it's the right thing to do," said University of Pennsylvania Health System sustainability corporate director Greg Evans.

"Being environmentally-conscious doesn't have to cost money; it can actually be a significant savings."

Strategies to reduce emissions

The US health sector climate pledge calls for health organisations to cut greenhouse gas emissions in half by 2030 and eliminate emissions by 2050.

Penn expects that shifting away from electricity to solar power will account for more than half of its emissions reduction.

Penn recently finalised a 25-year solar contract that will provide 70% of the energy for its Philadelphia hospitals and buildings, and save "a couple million dollars" over the course of the contract, Evans said.

Penn has also found energy savings in its operating rooms, which account for a significant portion of any hospital's waste because they require advanced air filtering, powerful lights, and produce lots of medical waste from individually wrapped tools, many of which can't be reused.

Staff now turn off air-filtration systems when operating rooms aren't in use overnight and on weekends.

The hospitals are reducing the amount of medical waste that must be specially disposed of by using smaller receptacles, to ensure they're used only for soiled materials, and not regular trash.

Some single-use medical supplies, such as pulse oximeters and scalpels, are now collected and sent to a plant that sanitises and refurbishes them, then sells them back to the health system at a discounted price.

Other moves, such as giving employees incentive to commute by public transit, reducing medical waste, and phasing out high-pollutant medications, like desflurane, will also be critical to meeting Penn's ambitious zero-emissions goal.

Phasing out desflurane

Penn can save tens of thousands of dollars by eliminating desflurane.

For example, its Princeton hospital saves about USD40,000 (RM187,253) a year by no longer purchasing the medication.

Princeton began exploring the idea of phasing out desflurane in 2021, after national anaesthesia organisations began publishing findings about the drug's environmental toll, said Department of Anesthesiology chair Dr Bridget Ruscito.

Desflurane is inhaled through a breathing tube.

It can be used alone, but more often is used with an IV (intravenous) anaesthetic.

Doctors once favoured it because patients can recover more quickly, which is especially important if they are not staying overnight at the hospital after their procedure.

But it can irritate airways and cause nausea.

Sevoflurane is now preferred in most cases, including because it disperses in the atmosphere after a little over a year, compared to the decade or longer desflurane remains in the air.

Ruscito first asked providers at Princeton to consider sevoflurane or other alternatives before using desflurane, and opt for a slow-flow ventilator if they chose to use desflurane.

When no one seemed to push back, she asked the department: "Would anyone care if we got rid of it entirely?"

Princeton stopped using desflurane in 2022, "and we haven't looked back," she said. – By Sarah Gantz/The Philadelphia Inquirer/Tribune News Service

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