Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use.

INTRODUCTION: As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology. METHODS: LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact. This study compared the impacts of three independent system scenarios at a single large academic hospital: reusable bed covers with 50 laundry cycles and subsequent landfill disposal (System 1), single-use bed covers with waste landfill disposal (System 2), and single-use bed covers with waste disposal using incineration (System 3). RESULTS: The total carbon footprint of System 1 for 50 uses was 19.83 â€‹kg carbon dioxide equivalents (CO2-eq). System 2 generated 64.99 â€‹kg CO2-eq. For System 3, the total carbon footprint was 108.98 â€‹kg CO2-eq. The raw material extraction for all the material to produce an equivalent 50 single-use OR bed cover kits was tenfold more carbon-intensive than the reusable bed cover. Laundering one reusable OR bed cover 50 times was more carbon intensive (12.12 â€‹kg CO2-eq) than landfill disposal of 50 single-use OR bed covers (2.52 â€‹kg CO2-eq). DISCUSSION: Our analysis demonstrates that one reusable fabric-based OR bed cover laundered 50 times, despite the carbon and water-intensive laundering process, exhibits a markedly lower carbon footprint than its single-use counterparts. The net difference is 45.16 â€‹kg CO2-eq, equivalent to driving 115 miles in an average gasoline-powered passenger vehicle. This stark contrast underscores the efficacy of adopting reusable solutions to mitigate environmental impact within healthcare facilities.

Environmental impacts of circularity strategies for social distancing plastic shields made of polymethyl methacrylate in the United States.

One application of plastics that grew during the COVID-19 pandemic is for social distancing plastic shields, or protective barriers, made from polymethyl methacrylate (PMMA) such as transparent face guards. Although available for other applications, end-of-life impacts for barriers are currently lacking in the literature, and there is a need to fill in this gap to guide decisions. This study evaluated the end-of-life environmental impacts of PMMA barriers in the United States by using life cycle assessment. We evaluated five strategies including landfilling, waste-to-energy, mechanical recycling, chemical recycling and reuse. Data were sourced from literature and various life cycle inventory databases. The Tool for Reduction and Assessment of Chemicals and Other Environmental Impacts (TRACI) was used as the life cycle impact assessment method. Landfilling exhibited the highest impact in all indicators and reuse demonstrated optimal results for global warming potential. A scenario analysis was conducted to explore a combination of strategies, revealing that the most promising approach involved a mix of 40% reuse, 20% mechanical recycling and 40% chemical recycling. Circular economy recommendations are proposed for managing these sources of plastic waste in the United States.

Strategies to Reduce Greenhouse Gas Emissions from Laparoscopic Surgery.

OBJECTIVES: To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy. METHODS: We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania). RESULTS: The largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases. CONCLUSIONS: To reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint. Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices.

Dynamic Life Cycle Assessments of a Conventional Green Building and a Net Zero Energy Building: Exploration of Static, Dynamic, Attributional, and Consequential Electricity Grid Models.

Our study assesses the differences between regional average- and marginal-electricity generation mixes as well as the variability between predicted and observed energy consumption of a "conventional green" Leadership in Energy and Environmental Design (LEED) building and a Net-Zero Energy Living Building (NZEB). The aim of our study was to evaluate the importance of using temporally resolved building-level data while capturing the dynamic effects a changing electrical grid has on the life cycle impacts of buildings. Two static and four dynamic life cycle assessment (LCA) models were evaluated for both buildings. Both buildings' results show that the most appropriate models ( hybrid consequential for the LEED Gold building, hourly consequential for the NZEB) significantly modified the use-phase global warming potential (GWP) impacts relative to the design static LCA (49% greater impact for the LEED Gold building; 45% greater reduction for the NZEB). In other words, a "standard" LCA would underestimate the use phase impacts of the LEED Gold building and the benefits of the NZEB in the GWP category. Although the results in this paper are specific to two case study buildings, the methods developed are scalable and can be implemented more widely to improve building life cycle impact estimates.

Evaluating the Life Cycle Environmental Benefits and Trade-Offs of Water Reuse Systems for Net-Zero Buildings.

Aging water infrastructure and increased water scarcity have resulted in higher interest in water reuse and decentralization. Rating systems for high-performance buildings implicitly promote the use of building-scale, decentralized water supply and treatment technologies. It is important to recognize the potential benefits and trade-offs of decentralized and centralized water systems in the context of high-performance buildings. For this reason and to fill a gap in the current literature, we completed a life cycle assessment (LCA) of the decentralized water system of a high-performance, net-zero energy, net-zero water building (NZB) that received multiple green building certifications and compared the results with two modeled buildings (conventional and water efficient) using centralized water systems. We investigated the NZB's impacts over varying lifetimes, conducted a break-even analysis, and included Monte Carlo uncertainty analysis. The results show that, although the NZB performs better in most categories than the conventional building, the water efficient building generally outperforms the NZB. The lifetime of the NZB, septic tank aeration, and use of solar energy have been found to be important factors in the NZB's impacts. While these findings are specific to the case study building, location, and treatment technologies, the framework for comparison of water and wastewater impacts of various buildings can be applied during building design to aid decision making. As we design and operate high-performance buildings, the potential trade-offs of advanced decentralized water treatment systems should be considered.

On-Site Renewable Energy and Green Buildings: A System-Level Analysis.

Adopting a green building rating system (GBRSs) that strongly considers use of renewable energy can have important environmental consequences, particularly in developing countries. In this paper, we studied on-site renewable energy and GBRSs at the system level to explore potential benefits and challenges. While we have focused on GBRSs, the findings can offer additional insight for renewable incentives across sectors. An energy model was built for 25 sites to compute the potential solar and wind power production on-site and available within the building footprint and regional climate. A life-cycle approach and cost analysis were then completed to analyze the environmental and economic impacts. Environmental impacts of renewable energy varied dramatically between sites, in some cases, the environmental benefits were limited despite the significant economic burden of those renewable systems on-site and vice versa. Our recommendation for GBRSs, and broader policies and regulations, is to require buildings with higher environmental impacts to achieve higher levels of energy performance and on-site renewable energy utilization, instead of fixed percentages.

Life-cycle thinking and the LEED rating system: global perspective on building energy use and environmental impacts.

This research investigates the relationship between energy use, geographic location, life cycle environmental impacts, and Leadership in Energy and Environmental Design (LEED). The researchers studied worldwide variations in building energy use and associated life cycle impacts in relation to the LEED rating systems. A Building Information Modeling (BIM) of a reference 43,000 ft(2) office building was developed and situated in 400 locations worldwide while making relevant changes to the energy model to meet reference codes, such as ASHRAE 90.1. Then life cycle environmental and human health impacts from the buildings' energy consumption were calculated. The results revealed considerable variations between sites in the U.S. and international locations (ranging from 394 ton CO2 equiv to 911 ton CO2 equiv, respectively). The variations indicate that location specific results, when paired with life cycle assessment, can be an effective means to achieve a better understanding of possible adverse environmental impacts as a result of building energy consumption in the context of green building rating systems. Looking at these factors in combination and using a systems approach may allow rating systems like LEED to continue to drive market transformation toward sustainable development, while taking into consideration both energy sources and building efficiency.

Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States.

The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system.

Process based life-cycle assessment of natural gas from the Marcellus Shale.

The Marcellus Shale (MS) represents a large potential source of energy in the form of tightly trapped natural gas (NG). Producing this NG requires the use of energy and water, and has varying environmental impacts, including greenhouse gases. One well-established tool for quantifying these impacts is life-cycle assessment (LCA). This study collected information from current operating companies to perform a process LCA of production for MS NG in three areas--greenhouse gas (GHG) emissions, energy consumption, and water consumption--under both present (2011-2012) and past (2007-2010) operating practices. Energy return on investment (EROI) was also calculated. Information was collected from current well development operators and public databases, and combined with process LCA data to calculate per-well and per-MJ delivered impacts, and with literature data on combustion for calculation of impacts on a per-kWh basis during electricity generation. Results show that GHG emissions through combustion are similar to conventional natural gas, with an EROI of 12:1 (90% confidence interval of 4:1-13:1), lower than conventional fossil fuels but higher than unconventional oil sources.

Evaluating the Global Plastic Waste Management System with Markov Chain Material Flow Analysis.

We present a global Markov chain-based material flow analysis of plastic waste of all types to estimate global virgin waste generation and waste mismanagement rates. We model nine alternative scenarios related to the elimination of plastic waste trade and improvements at various stages of the recycling chain, including "limitless" recycling promised by certain new chemical recycling technologies. We found that the elimination of trade increased global mismanagement when displaced waste was disposed but decreased mismanagement when it was instead recycled. Recycling scenarios showed little benefit for limitless recycling without prior increases in collection rates, which are currently the main constraint in the recycling chain. The most ambitious scenario only led to a 34% decrease in virgin waste generation. While significant, this implies that, given our current 40% mismanagement rate and 2050 forecasts of waste generation, landfilling and incineration capacity must increase 2.5-fold in addition to these extreme recycling targets to eliminate waste mismanagement. These results highlight the requirement for waste exporters to increase domestic recycling capacity as trade restrictions become tighter and express the urgent global need for alternative waste reduction interventions in addition to recycling.

Environmental Sustainability in Orthopaedic Surgery.

Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery.

Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room.

BACKGROUND: The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis of the respective costs and waste generation of the 2 techniques. METHODS: We created a "minimal" custom pack of disposable surgical supplies expressly for small hand surgery procedures and then measured the waste from 178 small hand surgeries performed using either the "minimal pack" or the "standard pack," depending on physician pack choice. Patients were also asked to complete a postoperative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t tests, and Fisher exact tests. RESULTS: As expected, WAHS with the minimal pack produced 0.3 kg (13%) less waste and cost $125 (55%) less in supplies per case than sedation & local with the standard pack. Pack size was found to be the driving factor in waste generation. Patients who underwent WAHS reported slightly greater pain and anxiety levels during their surgery, but also reported greater satisfaction with their anesthetic choice, which could be tied to the enthusiasm of the physician performing WAHS. CONCLUSIONS: Surgical waste and spending can be reduced by minimizing the materials brought into the operating room in disposable packs. WAHS, as a nascent technique, may provide an opportunity to drive sustainability by paring back what is considered necessary in these packs. Moreover, despite some initial anxiety, many patients report greater satisfaction with WAHS. All told, our study suggests a potentially broader role for WAHS, with its concomitant emphases on patient satisfaction and the efficient use of time and resources.

Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents?

Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women's Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts.

A network-based framework for assessing infrastructure resilience: a case study of the London metro system.

Modern society is increasingly dependent on the stability of a complex system of interdependent infrastructure sectors. It is imperative to build resilience of large-scale infrastructures like metro systems for addressing the threat of natural disasters and man-made attacks in urban areas. Analysis is needed to ensure that these systems are capable of withstanding and containing unexpected perturbations, and develop heuristic strategies for guiding the design of more resilient networks in the future. We present a comprehensive, multi-pronged framework that analyses information on network topology, spatial organization and passenger flow to understand the resilience of the London metro system. Topology of the London metro system is not fault tolerant in terms of maintaining connectivity at the periphery of the network since it does not exhibit small-world properties. The passenger strength distribution follows a power law, suggesting that while the London metro system is robust to random failures, it is vulnerable to disruptions on a few critical stations. The analysis further identifies particular sources of structural and functional vulnerabilities that need to be mitigated for improving the resilience of the London metro network. The insights from our framework provide useful strategies to build resilience for both existing and upcoming metro systems.

Toward zero waste: composting and recycling for sustainable venue based events.

This study evaluated seven different waste management strategies for venue-based events and characterized the impacts of event waste management via waste audits and the Waste Reduction Model (WARM). The seven waste management scenarios included traditional waste handling methods (e.g. recycle and landfill) and management of the waste stream via composting, including purchasing where only compostable food service items were used during the events. Waste audits were conducted at four Arizona State University (ASU) baseball games, including a three game series. The findings demonstrate a tradeoff among CO2 equivalent emissions, energy use, and landfill diversion rates. Of the seven waste management scenarios assessed, the recycling scenarios provide the greatest reductions in CO2 eq. emissions and energy use because of the retention of high value materials but are compounded by the difficulty in managing a two or three bin collection system. The compost only scenario achieves complete landfill diversion but does not perform as well with respect to CO2 eq. emissions or energy. The three game series was used to test the impact of staffed bins on contamination rates; the first game served as a baseline, the second game employed staffed bins, and the third game had non staffed bins to determine the effect of staffing on contamination rates. Contamination rates in both the recycling and compost bins were tracked throughout the series. Contamination rates were reduced from 34% in the first game to 11% on the second night (with the staffed bins) and 23% contamination rates at the third game.

Life cycle assessment perspectives on delivering an infant in the US.

This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.