Sustainability: the role of the Surgical CenterINTRODUCTION
The impact of human activities on the planet is well established, and there is much discussion surrounding it(1,2,3). In contrast, less attention has been given to the impact of healthcare services on the planet(4). It is recognized that healthcare services currently experience a vicious cycle, in which they generate significant emissions and impacts on the planet, which affect human health; consequently, people need to use healthcare services more, which generates further impact on the planet(5).
It is believed today that if healthcare services were a country, they would rank fifth among the largest emitters of greenhouse gases(6). Among hospital sectors, the Surgical Center, comprising the Operating Rooms (OR), Post-Anesthesia Care Unit (PACU), and Central Sterile Supply Department (CSSD), stands out as a major contributor to the carbon footprint(7). Considering only the carbon footprint of SCs, estimates range from 28 kg to 505 kg of carbon dioxide equivalent (CO2e)(8). Although emission levels vary widely depending on a number of factors, it is estimated that a single surgical procedure emits between 4 and 814 kgCO2e(9,10).
This significant carbon footprint stems primarily from anesthetic gases and energy consumption(7,10), but the large amount of waste generated, mainly from disposable materials(8), also has a major impact. In the United States healthcare system alone, approximately 6 million tons of waste are generated annually(11). Furthermore, a complicating factor is that a large portion of the waste generated in the OR is improperly sorted(12).
The healthcare sector has become increasingly dependent on single-use materials, although these materials reflect an inherently unsustainable linear economic model, in which waste management creates a significant burden on public health in terms of environmental pollutants(13). In this model, items are produced, used once, and then discarded.
Of the total waste generated in healthcare, 85% is considered general waste, comparable to household waste, while only 15% consists of infectious, toxic, carcinogenic, flammable, corrosive, reactive, explosive, or radioactive material(14). Were it not for the commonly observed segregation failures, a large portion of the waste generated could be recycled or recovered(15,16).
It is worth noting that both recycling and recovery of medical devices present a number of disadvantages and implementation challenges(17). Issues such as recyclability and commercial viability greatly impact the feasibility of these options. Thus, the focus of healthcare professionals should be, first and foremost, on reducing consumption.
Considering that the volume of surgeries worldwide has been increasing and that this trend is expected to continue(18,19), it is imperative that actions be taken in Surgical Centers to mitigate the impact on the planet. To break this vicious cycle(5) of negative environmental impact generated by healthcare services, mitigation measures must be implemented.
Studies have shown many possibilities for sustainable actions that can be implemented in Surgical Centers. Several possibilities can be implemented within the physical and material infrastructure itself and using the human resources already available in these sectors. Other proposals, however, require that measures for disease prevention and revisions to treatment choices be instituted, so that these are less invasive or interventionist(5,20).
There are several proposed—and even already implemented—possibilities available in the scientific literature, such as eliminating the use of anesthetic gases with a high environmental impact, such as nitrous oxide; the conscientious use of oxygen in the PACU and during surgeries; installing motion sensors for lighting and air conditioning; the reuse of medical devices; the proper use of Personal Protective Equipment (PPE) and sanitizers; the revision of surgical kits and boxes; the replacement of disposable materials with reusable ones; well-managed inventories and consistent expiration dates for use in the CSSD; proper waste segregation; attention to the energy consumption of equipment in standby mode; etc.
It should be emphasized that for these actions to have an impact, institutions must invest in training and capacity building(21). They must also identify potential environmentally-focused transformational leaders who aim to influence workers to engage in voluntary pro-environmental behavior(22), as the involvement of local communities in decision-making processes is an important aspect of sustainable development.
Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs(23). Surgical Centers Nurses can lead initiatives that synergistically integrate government, businesses, universities, civil society, and the natural ecological environment of these communities, taking ecological needs into account in the production of knowledge, innovation, and implementation of protocols, in what is known as the quintuple helix model(24).
Taking intelligent and informed measures to promote equity in various settings, ensuring Planetary Health, is also a responsibility of Surgical Centers professionals. Therefore, contextualizing, developing solutions, and enabling the implementation of actions that align with the 17 Sustainable Development Goals (SDG) and their corresponding targets will help mitigate the negative impacts of care provided in the operating room on the health of the planet.
Environmentally sound, evidence-based measures aimed at conserving the planet’s natural resources and habitat, without threatening the safety of patients or professionals involved in care, must be taken. To this end, awareness, education, and a willingness to change are necessary to enable a virtuous cycle in perioperative healthcare and in Surgical Centers as a whole. Believing that changes must come solely from the government or commercial organizations outsources responsibility for Planetary Health, a responsibility that also lies with the individual and the health professional. It is up to all of us.
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