Waste management and energy conservation: hospitals want to be sustainable, but hygiene must come first.
The urgency around climate change has pushed traditionally high-polluting industries such as aviation and automotive manufacturing to rethink environmental issues. Hospitals fall in that category. Healthcare facilities are trying to reduce their climate footprint, which accounts for 4.4% of the world’s emissions. That’s more than absolute emissions from Brazil, according to the NGO Health Care Without Harm. In Switzerland, healthcare is the fourth-largest consumer of environmental resources after the food, transport and housing industries, as reported by the Green Hospital study led in 2017 by the Swiss National Science Foundation (SNSF).
“Hospitals can have a very significant impact, but do not seem to be fully aware of it," says Professor Renaud Du Pasquier, chief of the Service of Neurology at Lausanne University Hospital (CHUV). “Nurses and doctors are on the front line, witnessing first-hand the worsening effects of climate change on health. They have a duty to set the example.” In 2009, Geneva University Hospitals (HUG) were the first European university hospital establishment to conduct an environmental assessment. Since then, they have applied a number of sustainable development measures.
Bern’s cantonal hospital is currently renovating its buildings in line with new construction standards. The CHUV also works to reduce its carbon footprint and has adopted several measures to achieve that. For example, in 2019 the hospital replaced its disposable tableware at its staff restaurants with reusable containers. This initiative is expected to reduce waste by 4.4 tonnes per year, bearing in mind that in 2018 100,000 plastic trays and utensils, along with 80,000 polystyrene bowls, were distributed for takeaway service.
But that is just the beginning. With 12,000 employees, CHUV consumes as much as a small town. Some 11 tonnes of linens and 5,500 articles of clothing are used every day, and the hospital produces 4,100 tonnes of waste a year. Household waste such as paper and office plastic can be recycled, but medical waste cannot. In Switzerland, nearly 16,000 tonnes of medical waste (including bandages, syringes and medications) is treated within the country and 115 tonnes abroad. The Swiss Federal Office for the Environment (FOEN) estimates that about 99.5% of this medical waste is incinerated.
New solutions are being developed, such as sterilising medical equipment at high temperatures to remove any potential residue from pathogens and make the waste inert. Although these costly techniques are still being studied, they are starting to make their way into hospitals.
“Medical practice faces off against current hygiene standards, which ends up in a waste of disposable supplies,” says Professor Christophe Büla, chief of the CHUV Geriatrics Service. “This mindset reveals the paradoxes of a society that wants to minimise its environmental footprint but is unwilling to compromise on healthcare.”
In terms of food, the CHUV produces 2.2 million meals a year, half of which go to patients and the rest to employees. Every day, almost two-thirds of food waste comes from patients. “A patient’s diet is medically prescribed and must be part of their food intake. We cannot alter the nutritional content of the meals served,” says Pierre-Yves Müller, director of the Hospital Logistics Department at the CHUV. “But once the tray is at the patient’s bedside, it becomes a contamination risk. We therefore have to throw any out leftovers to eliminate any health hazards.” Professor Büla explains how, 20 years ago, food uneaten by patients used to be fed to pigs on a neighbouring farm. “That stopped in favour of hygiene, but these practices were a good way of recycling.”
Meanwhile, plastic is everywhere in laboratories. “Unfortunately, we don’t have any other safe, viable alternatives,” Professor Du Pasquier says. “For example, going back to using glass would mean higher risks of injury and contamination.”
Pierre-Yves Müller confirms this point, “Acute care units are a top concern regarding environmental issues. They require large amounts of equipment, staff and complex tools that use a lot of energy, such as MRI machines, scanners and radiation therapy equipment.” Éric Albrecht, senior physician with the CHUV’s Anaesthesiology Service, recommends “raising the awareness of healthcare staff, to encourage them to use to more environmentally-friendly treatment alternatives.”
Different kinds of medication with similar effects do not necessarily have the same environmental footprint, as is the case with anaesthetic gases.
Labels are being developed to reward hospitals’ efforts to limit their carbon impact. In France, High Environmental Quality certification is awarded by the organisation under the same name and approved by the Ministry of Health to hospitals on a voluntary basis. Their environmental performance is measured in the areas of sustainable construction, sustainable building management, comfort, and air and water quality.
“Introducing a controlled Europe-wide label would have the advantage of promoting efforts to reduce carbon footprints while avoiding accusations of “greenwashing”, or using environmental issues solely to enhance one’s image,” says Pierre-Yves Müller. “However, hospitals as they are run today cannot be carbon neutral. But we can rationalise consumption and come up with more eco-friendly solutions when we do have to replace equipment or develop a new building. For example, the new children’s hospital planned for 2022 meets Minergie’s building standards.”
Pollution is even in the operating room. The gases used to put patients under are big pollutants, destroying the ozone layer and increasing greenhouse gases. Anaesthetic gases are currently expelled, untreated, from operating rooms to outside the building. That means that one hour of anaesthesia using desflurane, the gas with the highest global warming potential factor on the market, produces as much CO2 as a 400-km trip in a car, according to a 2017 study published in the medical scientific journal The Lancet.
“About 3 million tonnes of carbon dioxide are released into the atmosphere every year due to anaesthetic gases, i.e. almost 3% of global emissions,” says Éric Albrecht, senior physician with the CHUV’s Anaesthesiology Service. “I think we have to favour the use of local and regional anaesthetics, which only desensitise part of the body and do not require the use of gases. But more importantly, we need to inform and reassure patients about these anaesthetics, which are less dangerous and just as effective as general anaesthesia.”
Household and food waste must be recycled whenever possible. Hospitals are also trying to find new solutions for treating medical waste, which is currently incinerated.
In its daily practice, hospitals can encourage the use of drugs and anaesthetics that harm the environment less.
Hospitals bring together a vast number of workers. Staff could be encouraged to leave their car at home and take public transportation or ride a bike to work, which would significantly reduce hospitals’ carbon impact.
Choose LED bulbs, install solar panels, renovate infrastructure, and so on. Making choices to reduce their energy bill would automatically make hospitals more eco-friendly.
Hospitals can decide to source products locally to make meal trays. This would reduce pollution due to shipping goods.