Our climate crisis
Written and edited by Nida Fatima, MD and Jakob Bower.
“I went inside the illuminated and adequately-ventilated OR. The patient was put on anesthesia, and I did my surgery using sterilized instruments and thermocoagulation. The room remained a cool temperature throughout the procedure. I clipped the surgical site and removed the surgical drapes. I stepped out of the OR thinking that the surgery was successful.”
Described above is the average surgical routine occurring in millions of ORs each day. Have you noticed what we missed? Likely not.
Now comes the inner reality we often overlook: the climate crisis. Yes, the climate crisis. Hundreds and thousands of ORs are adding to environmental issues every second.
Let’s start with lighting. The OR is illuminated with several thousands of lights. Obviously, lighting is important for patient safety and operations. However, some lights, such as compact fluorescent light bulbs, contain harmful substances, meaning using and disposing of them is difficult and possibly harmful. LEDs are longer-lasting, more energy efficient, and could serve as OR lighting without the associated issues of mercury exposure and fossil-fuel related greenhouse gases that are produced to power our ORs.
Anesthetics used in the OR are another contributor of ozone-destroying greenhouse gases. These inhaled anesthetics have impacts on the environment until they are degraded in the atmosphere—which, for nitrous oxide, is 114 years. The only way to overcome this situation is to use environmentally friendly anesthetics. Further, fresh flow gas techniques are necessary to reduce anesthesia vapor concentration, achieve adequate anesthetic depth, and minimize environmental contamination.
We should be aware of other types of drug waste common to the OR, such as unnecessary opening of vials or minimum drug amounts needed to achieve dilution. There are pre-filled syringes on the market, but we must work to develop vials and drugs that can either be sterilized or used again.
Adequate ventilation is necessary in the OR; it is important to remove harmful substances in the environment to prevent surgical site infection. However, greenhouse gases and harmful substances produced in the OR environment are usually removed to the outdoors, thus adding to global climate issues. We could try and negate the effects of these ventilated substances by using uni-directional or mixed flow ventilators.
Here is another idea for minimizing the environmental effects of surgery: vegetation inside the OR. Sounds crazy, right? Plants inside the OR could help with the absorption of gases and minimize harmful environmental substances. Greenery inside the OR can also help with refraction and glare caused by bright lighting, and the excessive heat produced by these lights can be diligently absorbed by the plants.
There are several varieties of instruments available in the OR, some disposable, and others not. Both may contribute to environmental issues. Disposable instruments can add to hospital waste, while non-disposable instruments can breed infections. It is of utmost importance to sterilize non-disposable instruments—and we should consider less wasteful alternatives to common disposable instruments.
Surgical drapes, often made of polypropylene, can lead to carbon dioxide production. It can take 20-30 years for the polypropylene to degrade once in landfills. Ideally, these types of surgical drapes should be replaced with re-usable surgical drapes, sheets, and gowns to reduce the environmental impacts of these materials.
Simple choices, like the ones listed above, could have lasting effects on our climate and associated environmental degradation, natural disasters, weather extremes, food and water insecurities, and economic disruptions. There’s no time for hesitation: we should all come together to devise practical solutions as early as possible if we are to avoid further climate crisis.