Technology designed with climate in mind

The following article was authored by Vizient-awarded supplier Dräger. It originally appeared in Pediatric Tech Watch, Vol. 11, published October 2024.

The U.S. healthcare sector is an industry dedicated to healing, however, it faces significant challenges in reducing its adverse environmental impact. In fact, it is responsible for an estimated 8.5% of national carbon emissions and 25% of global health sector emissions, which is the largest proportion attributable to any individual country.¹

Inhaled anesthetics are a critical component of surgical services but also a large contributor to healthcare- related greenhouse gas (GHG) emissions.² In recent years, targeted efforts to deliver more sustainable healthcare services include the use of anesthesia machines that minimize inhalational anesthetic pollution across all patient populations, including pediatrics.

Understanding the impact

Approximately 50 million patients in the U.S. receive general anesthetics each year - including six million pediatric patients.^3,4 With this volume, the environmental impact could be substantial. Inhaled anesthetic gasses, which are exhausted directly into the atmosphere, are estimated to account for 5% of hospital carbon dioxide equivalent (CO2e) emissions and 50% of perioperative department CO2e emissions in high-income countries.⁵ Desflurane and nitrous oxide are the two inhaled anesthetics of greatest concern related to adverse environmental impact.

Healthcare operations also require a staggering amount of energy. The U.S. Environmental Protection Agency (EPA) ranks inpatient healthcare as the second-largest commercial energy user in the nation, and it comes at a price both environmentally and financially - with healthcare spending more than $8 billion on energy every year.⁶ Perioperative services consume significant energy, with research citing operating rooms [ORs) as being three to six times more energy- intense per square foot than the hospital.⁷

Additionally, healthcare facilities produce a sizable amount of waste. Hospitals generate over 29 pounds of waste per bed per day, which equates to more than 5 million tons of waste annually.⁸ Also, ORs are responsible for an estimated 30% of total hospital solid waste.⁹

Building sustainable and resilient surgical systems

Perioperative team members, including anesthesiologists, have several opportunities to integrate climate change considerations into their surgical spaces and clinical practices. Below are three opportunities for sustainability in surgical system design and ways Dräger supports them.

1. Minimizing inhaled anesthetic waste

In 2022, the Association of Anaesthetists published its Action guidance for addressing pollution from inhalational anaesthetics. It offers evidence-based actions that can be assumed to reduce the impact of pollution from inhalational anesthetics, without compromising patient care.¹⁰ As recommended in the guidance, removal of desflurane from drug formularies, avoiding nitrous oxide use and minimizing fresh gas flows during anesthesia are three impactful steps teams can take to reduce harmful emissions.

Dräger's anesthesia equipment is designed with best practice recommendations for reducing consumption of climate-damaging anesthetics. Perioperative teams for adults and pediatric patients can reduce fluorinated gas consumption by effectively utilizing Dräger anesthesia machines through several strategies:

• Implementing low-flow anesthesia as a standard lung protective practice, helps reduce postoperative pulmonary complications and improves patient outcomes
• Closed-circuit anesthesia, which recycles exhaled gasses (Dräger Atlan® and Perseus® anesthesia machines)
• Automated gas control systems precisely manage gas usage, while accurate monitoring and alarms ensure optimal dosing and prevent over-administration (Dräger Vapor series)

Additionally, Dräger offers comprehensive training for clinical staff on the proper use and maintenance of the equipment, including data analytics tools that provide visibility into anesthetic gas usage and the environmental impact of waste.

2. Conserving energy

Selecting energy-efficient HVAC systems, capital equipment and surgical lighting can help reduce OR energy usage and costs.

Dräger's anesthesia products and support services reduce energy usage through the following strategies:

• Adherence to standards ensures energy efficiency is considered during the design process - includes International Electrotechnical Commission (IEC) 60601- 1-9 and IEC 62430
• Use of oil-free compressors in hospital compressed air supply systems, which are more energy-efficient and avoid hazardous waste
• Evaluation of equipment's environmental impact throughout the product lifecycle with a focus on reducing electricity consumption during the utilization phase

3. Reducing solid waste

Perioperative teams can address and reduce solid waste by using durable and reliable capital equipment (e.g., anesthesia machines, monitors) to avoid premature equipment upgrades, and reuseable versus single use disposable components and supplies that are discarded into overflowing landfills.¹¹

Dräger supports perioperative waste reduction in the following ways:

• Designing for durability and longevity - devices decrease the frequency of component replacements
• Prioritizing sustainable manufacturing practices by using recyclable materials and minimizing hazardous substances
• Providing maintenance and repair services to extend the service life of a product
• Promoting the use of reusable components and supplies for the OR, where feasible

Сonclusion

The healthcare sector has a responsibility to patients and the community at-large to mitigate their adverse effects on the environment. Decarbonization efforts, including those that address the environmental harms of inhaled anesthetics, present a practical and achievable path to sustainability.

Anesthesiologists are poised to prioritize environmental stewardship in their inhaled anesthetics practices. This requires guidance from industry associations, such as the Association of Anaesthetists and the American Society of Anesthesiology (ASA), as well as support from their perioperative teams and organization leaders.

Dräger is dedicated to helping clinicians protect, support and save lives. They champion sustainable surgical environments with anesthesia machines, consumable supplies and preventative maintenance services.