Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002-2022: a retrospective descriptive analysis.

Objectives: To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002-2022, overall and by state or territory and hospital type.

Study Design: Retrospective descriptive analysis of IQVIA anaesthetic gases purchasing data.

Setting: All Australian public and private hospitals, 1 January 2002 - 31 December 2022.

Implementation of reusable linen in the intensive care unit: Impact on pressure injury, staff satisfaction, and environmental sustainability.

Background: Pressure injuries (PIs) remain a major concern in intensive care units (ICUs), leading to increased morbidity, healthcare costs, and extended hospital stays. While various prevention strategies exist, the impact of reusable linen on PI incidence and environmental sustainability remains underexplored.

Objectives: The effect of transitioning from disposable to reusable linen on PI incidence among ICU patients was evaluated while assessing environmental impact and staff acceptance.

Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment.

Rationale & Objective: As the health impacts of climate change intensify, the health care sector faces growing pressure to minimize its carbon footprint. Achieving this goal requires understanding of the carbon impact of widely used medical treatments. This study evaluated and compared the carbon footprints of in-center hemodialysis, home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD).

A survey of nitrous oxide usage and knowledge of its environmental effects across healthcare worker groups.

Nitrous oxide (NO) is a greenhouse gas that is a significant contributor to the carbon dioxide-equivalent emissions of health services. We aimed to obtain information about NO usage and knowledge of its environmental effects among clinical staff at an Australian metropolitan public health network. We distributed an anonymised survey to doctors, nurses and midwives working in anaesthesia, birthing, adult and paediatric emergency medicine, and paediatrics.

Environmental responsibility in resource utilization during the practice of regional anesthesia: a Canadian Anesthesiologists' Society Delphi consensus study.

Purpose: Regional anesthesia (RA) is often perceived to be more environmentally sustainable than alternative forms of anesthesia. Nevertheless, the principles of sustainable RA remain ill-defined in the presence of variability of resource utilization within RA practice. Many infection prevention practices are based on low-level evidence, and recommendations vary internationally.

The green ICU: how to interpret green? A multiple perspective approach.

Mitigating environmental impacts is an urgent challenge supported by (scientific) intensive care societies worldwide. However, making green choices without compromising high-quality care for critically ill patients may be challenging. The current paper describes a three-step approach towards green intensive care units.

Assessing the environmental impact of coronary artery bypass grafting to decrease its footprint.

Objectives: An urgent transition to environmentally sustainable healthcare is required. The purpose of this study was to identify key areas for environmental impact mitigation for a coronary artery bypass grafting trajectory.

Methods: An ISO14040/44 standardized life cycle assessment was conducted for the functional unit of an individual patient trajectory of elective coronary artery bypass grafting surgery, from operating room admission until intensive care unit discharge.

The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial.

Background: The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.

Australian and Canadian clinicians' views and application of 'carbon health literacy': a qualitative study.

Background: Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care.

Staff satisfaction with reusable surgical drapes.

Background: Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products.

A narrative review of personal protective equipment gowns: lessons from COVID-19.

This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals.

A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives.

Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified.

The carbon footprint of total knee replacements.

Objective Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use.

Interventions to reduce low-value care in intensive care settings: a scoping review of impacts on health, resource use, costs, and the environment.

Purpose: Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare's carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs.

Methods: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles.

Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study.

Background And Aims: Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.

Variations of nitrous oxide procurement per public hospital bed between Australian states and territories: A cross-sectional analysis.

We aimed to identify variations in nitrous oxide (NO) procurement between Australian states and territories per public hospital bed by undertaking a cross-sectional analysis of NO procurement data for all Australian public hospitals from 1 January 2017 to 30 June 2022. Data were obtained from state and territory departments of health. All Australian public hospitals across six states and two territories were included.

The Carbon Footprint of Peritoneal Dialysis in Australia.

Key Points: Automated peritoneal dialysis (APD) had a higher carbon impact than continuous ambulatory peritoneal dialysis (CAPD). This was due to higher emissions from the manufacture and disposal of APD consumables, and their higher weight, meaning greater transport emissions. Polyvinyl chloride recycling can partially mitigate peritoneal dialysis–associated emissions.

Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre.

Background: The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined.

Method: We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre.

Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle assessment.

Background: Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.