Green Medicine
(also known as ‘Health Care Environmentalism’ or ‘Green Health Care’)
The two parts to this piece.
- We waste a ton of material in health care. Can we reduce this safely?
- We waste a ton of material to prevent and reduce infection; other industries must clean up their act because to some degree, we can’t.
Number One.
I don’t hear much about the topic, and while there’s a few organizations who are aware of it, we don’t discuss it much. It’s hard to imagine that hospitals create over 2 million tons of waste each year, but when you think how many nitrile gloves a person goes through in a typical day, it certainly adds up. Then add all the sharps (needles, syringes, guide wires, glass ampules, scalpels, instruments) and it adds up even more. Did you realize these kits just get thrown away? Metal tweezers and scissors, tossed away. Then add the gowns and kit packaging, and it gets even worse.
So first of all, can we do better? Can we reduce packaging, or identify recyclable materials? I would imagine some manufacturers are already looking into this as a way to reduce their costs, but certainly none of it is done around here, in the progressive stronghold of the Bay Area. (We certainly could save on paper by moving to electronic medical records as well.)
Number Two.
The reason there’s so much waste in the first place is to encourage sterility. When you typically open a package to do a procedure (a lumbar puncture, a central line, etc) you open up a water-resistant plastic kit with waxed-paper lid and find a paper-wrapped package inside, sterile on the inside. Often there’s also a gown inside to wear, as well as a standard size of sterile gloves to put on. You gown up, put on the sterile gloves, and now you can go through the insides of the package, which include: multiple needles, multiple syringes, guidewires, glass bottles with lidocaine in them, a disposalble scalpel, some suture with needle, and some skin-cleaning pads as well. All of this is packaged under sterile conditions, so that very limited bacteria will be present when you’re doing the procedure, to prevent the patient from getting an infection due to the procedure.
A lot of this we can’t easily eliminate without creating large hurdles to performing the procedure–and even if we packaged items separately, they would require separate sterile packaging, which may just add the trash mess as well, and taking more time to gather supplies. And the costs (financial as well as to the patient, obviously) to an infection in the blood are great–they can kill people. So a lot of this we can’t improve.
That’s why other industries need to do a better job of reducing their waste–because we in health care have some degree of “fixed” waste that we will always have (until we develop wireless IV tubing, of course). Other industries must work even harder to clean up their environmental acts to compensate for the continued mess that health care makes.
As a medical student who has always tried to decrease waste to the point where friends tease me about it, this is something that weighs on my mind heavily everyday in the hospital. I wish there were a solution…
Our hospital saves the unused stuff out of sterile kits and the doctors bring the stuff to poor countries where they do charity work. We have a special collection box in our ER for that. They’re so short on supplies in Peru (where our stuff goes) that clean gauze is okay, even if it’s not sterile.
On Sept 24, 2007 the Teleosis Institute will offer Green Health Care Online – an 8-week leadership training course in Sustainable Medicine. Throughout the course, health professionals highlight the links between themselves, their patients, their communities, and the environment. Graduates of Green Health Care reap immediate benefits including reduced resource consumption, financial savings, increased client satisfaction, improved employee morale and wellness, and recognition in the industry as an environmental leader. Request for CME accreditation for this program has been made. Learn more at http://www.teleosis.org/greenhealthcare
[...] on my Green Medicine post; there’s a very easy way to reduce the usage of supplies in the hospital: PATIENTS, QUIT [...]
Actually, reducing waste is a bit easier then you might think. In medical terms its called prevention. Many studies show that investing in wellness and prevention saves money which is health care expenditures. These studies also show that prevention reduces the onset of chronic disease, which again saves money and in ecological terms saves resources. (See the work of James Fries, MD at Stanford for proof of this.)
So if we are really serious about reducing the footprint of health care, the focus can shift to investing in health or disease prevention, which is the focus of public health, rather then on cleaning up hospital medicine, which of course needs to be done as well. Public health and prevention stategies will go a long way in reducing the downstream waste of hospital medicine, saving lives and promoting higher levels of health all at once!
Whew! I thought I was the only one who cringed every time they pitched a perfectly good pair of scissors / hemostats away in the name of sterile technique.
So, I can’t honestly remember if I’ve commented before ever, but if not, I’m de-lurking for this one.
As an environmental science researcher in the thick of med school apps, Green Medicine is something I think about a lot. I’ve been pretty frustrated trying to figure out what the few green med orgs are even doing.
It it a possibility to reuse metal components? I’m assuming they aren’t actually produced in a sterile environment, and thusly have to be sterilized before getting packaged and sent off to you folks. I guess I’m not sure exactly how good we are at killing microbes, but could things be re-sterilized? Or at least recycled, sheesh.
I think it is interesting that greening medicine isn’t more talked about since it is so often public health hazard that makes people care about environmental issues.
Thinking that an EMR reduces paper waste is a fallacy. Ours prints out each med order on one piece of paper. The finished printed out ER chart is 10 pages long. We use reams and reams of paper now.
Sure they could be resterilized. Thats what autoclaves are for. But its more expensive to collect them, have someone sterilize them, and then repackage them than it is to just buy a new set. So things get wasted. Just like its cheaper to buy paper gowns than it is to wash and sterilize cloth gowns. I know there are some places that still use washable gowns in the OR suites, but not any hospitals I’ve been at recently. What I really hate is when u spend time struggling to get a central line in, only to have the needle clot off or become bent/unusable. The only solution is to open a whole other kit (~$800) to get a needle.
It’s not necessarily a fallacy, ERNursey–it’s a poor implementation of an EMR.
[...] had the opportunity to write much on “living lightly” lately, please go read Graham’s post. The reason there’s so much waste in the first place is to encourage sterility. When you [...]
[...] by A’Llyn Ettien on 15 Sep 2007 at 05:43 pm | Tagged as: Course-Related Reflections This Green Medicine post by Graham on Over!My!Med!Body!, talking about how much waste material hospitals produce, is [...]
There is plenty of land-fill space in our mostly empty country. Many municipalities solicit solid waste as a source of revenue from larger cities that do not have the space.
A physician or nurse’s time is worth more than a couple of unused needles or a pair of gloves. Time is money. I’d rather grab an LP kit even if I may not use everything in it every time than spend ten minutes of my time (or a nurses) getting everything together.
[...] supplies once I’m done. I wrote a bit about it years ago on my old blog, describing it as Green Medicine, not to be confused with medical marijuana “green” medicine. But the fact is we go [...]