Past, present, and future of sustainable intensive care: narrative review and a large hospital system experience.

Healthcare systems are large contributors to global emissions, and intensive care units (ICUs) are a complex and resource-intensive component of these systems. Recent global movements in sustainability initiatives, led mostly by Europe and Oceania, have tried to mitigate ICUs' notable environmental impact with varying success. However, there exists a significant gap in the U.S. knowledge and published literature related to sustainability in the ICU. After a narrative review of the literature and related industry standards, we share our experience with a Green ICU initiative at a large hospital system in Texas. Our process has led to a 3-step pathway to inform similar initiatives for sustainable (green) critical care. This pathway involves (1) establishing a baseline by quantifying the status quo carbon footprint of the affected ICU as well as the cumulative footprint of all the ICUs in the healthcare system; (2) forming alliances and partnerships to target each major source of these pollutants and implement specific intervention programs that reduce the ICU-related greenhouse gas emissions and solid waste; and (3) finally to implement a systemwide Green ICU which requires the creation of multiple parallel pathways that marshal the resources at the grass-roots level to engage the ICU staff and institutionalize a mindset that recognizes and respects the impact of ICU functions on our environment. It is expected that such a systems-based multi-stakeholder approach would pave the way for improved sustainability in critical care.

Herpes zoster in older adults: Impact on carbon footprint in the United States.

We provide estimates for (I) annual herpes zoster (HZ) cases, (II) carbon costs related to healthcare utilization, and (III) annual carbon emissions due to HZ among ≥50 years of age (YOA) United States (US) population. We estimated the annual number of HZ cases in the US based on available incidence data and demographic data of individuals ≥50 YOA. Both the healthcare resource utilization (HCRU) associated with HZ cases and the unit carbon dioxide equivalent (i.e. CO2e) costs associated with each type of HCRU in the US were estimated based on literature and studies available online. The carbon footprint associated with HZ annually among US adults ≥50 YOA was estimated by multiplying the unit carbon estimates by the HCRU. In the US population aged ≥50 YOA in 2020 (i.e. approximately 118 million), approximately 1.1 million cases of HZ occur annually assuming no vaccination. Based on 2 sources of HCRU the average kgCO2e per HZ patient ranged from 61.0 to 97.6 kgCO2e, with values by age group ranging from 40.9 kgCO2e in patients aged 50-59 to 195.9 kgCO2e in patients ≥80 YOA. The total annual HZ associated carbon ranged between 67,000 and 107,000 tons of CO2e in the US population aged ≥50 YOA. The impact of HZ on carbon footprint in the US results in considerable greenhouse gas (GHG)emissions. Assuming no vaccination, the burden of HZ is projected to rise over the coming years with the aging populations consequently worsening its impact on GHG emissions. (Figure 1).

Implementation of sustainable food service systems in hospitals to achieve current sustainability goals: A scoping review.

BACKGROUND: Food waste is a pivotal contributor to environmental degradation in the modern world. Vast amounts of food are wasted and many individual efforts and collective initiatives being underway to deal with this challenge. Hospitals are institutions that produce and provide food, but at the same time contribute greatly to food waste. The objective of this scoping review is to present available data regarding quantity of food waste generated in public hospitals and summarizes studies that assess and quantify the greenhouse gas emissions (carbon footprint) associated to food service management in hospitals. METHODS: A systematic literature research was conducted by two qualified researchers in PubMed, Scopus, ISI Web of Science and Science Direct. The publication date was set to the last ten years, i.e., 2013-2023. All the abstracts retrieved were screened, and the eligible articles were selected after a two-step process. Abstracts from the retrieved full papers' references were also screened for eligibility. The selected papers were included in the final scoping review. RESULTS: Overall, 2870 studies were identified and 69 were included in the review. Most of the studies (n = 33) assessed the causes and quantified the amount of food waste generated in hospitals. A small number of studies (5) estimated carbon dioxide equivalent (CO2-eq) produced by food waste. Although several studies suggested strategies and measures to reduce the environmental impact of foodservice operations, none of them implemented a comprehensive foodservice management system. CONCLUSION: This scoping review suggests that hospital diets contribute to food waste and may have a negative environmental impact. There are several internal and external factors and practices that influence positively or negatively the sustainability of hospital food service systems. Systematic efforts are needed to identify and enhance parameters that could improve the environmental footprint of hospitals in terms of more effective management of food waste.

Carbon footprint of a laser unit: a study of two centres in the UK.

PURPOSE: Climate change has serious consequences for our wellbeing. Healthcare systems themselves contribute significantly to our total carbon footprint, of which emissions from surgical practice are a major component. The primary sources of emissions identified are anaesthetic gases, disposal of single-use equipment, energy usage, and travel to and from clinical areas. We sought to quantify the waste generated by laser surgery which, to our knowledge, has not been previously reported. METHODS: The carbon footprint of two laser centres operating within the United Kingdom were measured. The internationally recognised Greenhouse Gas Protocol was used as a guiding framework to classify sources of waste and conversion factors issued by the UK government were used to quantify emissions. RESULTS: The total carbon footprints per day at each unit were 299.181 carbon dioxide equivalents (kgCo2eq) and 121.512 kgCO2eq, respectively. We found the carbon footprint of individual laser treatments to be approximately 15 kgCO2eq per procedure. The biggest overall contributor to the carbon footprint was found to be the emissions generated from staff, patient and visitor travel. This was followed by electricity usage, and indirect emissions from physical waste and laundry. CONCLUSIONS: The carbon footprint of laser procedures was considerably less than the average surgical operation in the UK. This initial study measures the carbon footprint of a laser center in a clinical setting and allows us to identify where improvements can be made to eventually achieve a net carbon zero health care system.

How to reduce the carbon footprint of the agricultural sector? Factors influencing farmers' decision to participate in carbon sequestration programs.

Mitigating climate change by sequestering carbon in agricultural soils through humus formation is a crucial component of sustainable agriculture. Humus programs that are designed to incentivize farmers to build more humus are still recent innovations, so current knowledge about farmers' motivation to participate is limited. This study examines the adoption of non-governmental humus programs to promote carbon sequestration by analyzing farmers' willingness to participate in humus programs and influential factors. We specifically investigate behavioral factors underlying farmers' adoption of humus programs using the Theory of Planned Behavior. To this end, we collected data using an online survey with 190 German farmers and applied partial least squares structural equation modeling. The results show that (i) perceived economic benefits, (ii) the actions of fellow farmers, and (iii) farmers' sense of responsibility with regard to climate change have a statistically significant influence on farmers' intention to participate in a humus program. In contrast, the perceived ecological benefits, political pressure, the possibility of establishing humus-building measures, and prior knowledge of humus programs have no statistically significant influence. Our findings suggest that farmers' decision to participate in humus programs is strongly influenced by the financial benefits, but the actions and thoughts of other farmers, as well as their own moral claims regarding climate change, also play a crucial role. We found that farmers lack knowledge about the registration and general functioning of humus programs, which can currently be one of the biggest barriers to participation in such initiatives.

Roadmap to a net-zero carbon cement sector: Strategies, innovations and policy imperatives.

The cement industry plays a significant role in global carbon emissions, underscoring the urgent need for measures to transition it toward a net-zero carbon footprint. This paper presents a detailed plan to this end, examining the current state of the cement sector, its carbon output, and the imperative for emission reduction. It delves into various low-CO2 technologies and emerging innovations such as alkali-activated cements, calcium looping, electrification, and bio-inspired materials. Economic and policy factors, including cost assessments and governmental regulations, are considered alongside challenges and potential solutions. Concluding with future prospects, the paper offers recommendations for policymakers, industry players, and researchers, highlighting the roadmap's critical role in achieving a carbon-neutral cement sector.

Carbon footprint of healthcare systems: a systematic review of evidence and methods.

OBJECTIVE: Given the demand for net-zero healthcare, the carbon footprint (CF) of healthcare systems has attracted increasing interest in research in recent years. This systematic review investigates the results and methodological transparency of CF calculations of healthcare systems. The methodological emphasis lies specifically on input-output based calculations. DESIGN: Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. DATA SOURCES: PubMed, Web of Science, EconBiz, Scopus and Google Scholar were initially searched on 25 November 2019. Search updates in PubMed and Web of Science were considered until December 2023. The search was complemented by reference tracking within all the included studies. ELIGIBILITY CRITERIA: We included original studies that calculated and reported the CF of one or more healthcare systems. Studies were excluded if the specific systems were not named or no information on the calculation method was provided. DATA EXTRACTION AND SYNTHESIS: Within the initial search, two independent reviewers searched, screened and extracted information from the included studies. A checklist was developed to extract information on results and methodology and assess the included studies' transparency. RESULTS: 15 studies were included. The mean ratio of healthcare system emissions to total national emissions was 4.9% (minimum 1.5%; maximum 9.8%), and CFs were growing in most countries. Hospital care led to the largest relative share of the total CF. At least 71% of the methodological items were reported by each study. CONCLUSIONS: The results of this review show that healthcare systems contribute substantially to national carbon emissions, and hospitals are one of the main contributors in this regard. They also show that mitigation measures can help reduce emissions over time. The checklist developed here can serve as a reference point to help make methodological decisions in future research reports as well as report homogeneous results.

Ecotourism or ecological concerns? Tracing the impact of economic policy uncertainty and natural resources on tourism-driven ecological footprints.

The influence of tourism development and economic policy uncertainties on environmental sustainability is substantial. Promoting responsible tourism and using sustainable tourism practises, like offering eco-friendly lodging, is a key part of protecting natural habitats and lowering carbon footprints. Hence, this study tries to examine the relationship between tourism development, economic policy uncertainty, renewable energy, and natural resources on the ecological footprint of India during 1990-2022. This study applies a novel dynamic ARDL simulation approach for long-run and short-run analyses. The study also employs frequency-domain causality to check the causal relationship between the variables. The result reveals that tourism has a positive effect on the ecological footprint. Similarly, economic policy uncertainty has a positive and significant effect on the ecological footprint in India during the sample period. Additionally, natural resource rent shows a positive effect on the ecological footprint or deteriorating environmental quality in the short and long run in the sample period. However, renewable energy consumption indicates a negative effect on the ecological footprint. The results reveal that TDI and EPU have rejected the null hypothesis of no Granger cause in the long, medium, and short term. While renewable energy has a causal relationship with ecological footprints in both the long run and medium run, it is imperative for India to adopt measures that facilitate the advancement of sustainable tourism, with a particular focus on promoting environmentally friendly lodging options, enhancing public transportation systems, and implementing effective waste management strategies.

Impacts of Behavioral, Organizational, and Spatial Factors on the Carbon Footprint of Traditional Retail and E-commerce in the Paris Region.

Carbon footprint assessment of retail is necessary to optimize procurement strategies and adopt sustainable shopping habits. However, estimating carbon footprints is a complex task, given the diversity of existing distribution channels. Average values for carbon emissions of "conventional" retail (i.e., purchasing and receiving the product directly at the physical point of sale) found in most studies mask a heterogeneous reality: different retail strategies entail diverse shopping behavior for consumers, as well as varied procurement processes for outlets. In this paper, we propose a methodology to assess greenhouse gas (GHG) impacts of different distribution systems related to the consumption of goods in the Paris Region by coupling traditional transport modeling with a life-cycle assessment (LCA) approach. We model and compare six distribution systems, including five traditional retail formats (hypermarkets, supermarkets, small generalist retail, small food retail, and small nonfood retail) and E-commerce home deliveries. Our model includes warehouse activity, shop and home delivery, shop energy consumption, consumer mobility, and goods packaging. Overall, we conclude that E-commerce emits fewer GHG emissions than retail outlets per kilogram of product purchased. This result is in line with the existing literature on the topic. However, the carbon footprint varies greatly within the case study depending on the characteristics of the logistics procurement processes of outlets, the behavior of shoppers, and spatial characteristics.

Carbon reduction and water saving potentials for growing corrugated boxes for express delivery services in China.

Corrugated packaging for express grew by 90 times to 16.5 Mt y-1 in China, where 81% of recent global express delivery growth occurred. However, the environmental impacts of production, usage, disposal, and recycling of corrugated boxes under the entire supply chain remain unclear. Here, we estimate the magnitudes, drivers, and mitigation potentials of cradle-to-grave life-cycle carbon footprint (CF) and three colors of water footprints (WFs) for corrugated cardboard packaging in China. Over 2007 to 2021, CF, blue and gray WFs per unit package decreased by 45%, 60%, and 84%, respectively, while green WF increased by 23% with growing imports of virgin pulp and China's waste ban. National total CF and WFs were 21 to 102 folded with the scale effects. Only a combination of the supply chain reconstruction, lighter single-piece packaging, and increased recycling rate can possibly reduce the environmental footprints by 24 to 44% by 2035.

Exploring the impact of climate technology, financial inclusion and renewable energy on ecological footprint: Evidence from top polluted economies.

Most South Asian countries' economies have grown dramatically during the past few decades. However, in light of their environmental sustainability goals, the quality of such growth performances by South Asian nations is called into doubt by the concurrent degradation in environmental quality. Consequently, reducing the environmental challenges these nations encounter is prioritized on the agendas of the relevant authorities. This study aimed to analyze the effect of the top 11 most polluted countries' levels of financial inclusion, technological innovation, consumption of renewable energy, and adoption of climate technology on environmental deterioration from 2000 to 2022. Therefore, this research aims to use cutting-edge panel data econometric techniques to investigate the factors contributing to high carbon footprints in the world's most polluted nations. The results support an inverted U-shaped relationship between economic growth and carbon footprints, crediting the environmental Kuznets curve concept. In addition, it has been shown that TECH, REC, and CT can reduce carbon footprints in both the short and long term, while GDP and financial inclusion only affect carbon footprints in the long term. The results further endorsed the pollution haven hypothesis by showing that GDP positively affects carbon footprint. As a result, leading polluting economies need to strengthen their financial sectors, create green technology, migrate to renewable energy, and limit financial inclusion to improve environmental quality.

Healthcare in the era of climate change and the need for environmental sustainability.

ABSTRACT: Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.

Manure replacing synthetic fertilizer improves crop yield sustainability and reduces carbon footprint under winter wheat-summer maize cropping system.

Manure replacing synthetic fertilizer is a viable practice to ensure crop yield and increase soil organic carbon (SOC), but its impact on greenhouse gas (GHG) emissions is inconsistent, thus remains its effect on CF unclear. In this study, a 7-year field experiment was conducted to assess the impact of replacing synthetic fertilizer with manure on crop productivity, SOC sequestration, GHG emissions and crop CF under winter wheat-summer maize cropping system. Five treatments were involved: synthetic nitrogen, phosphorus, and potassium fertilizer (NPK) and 25%, 50%, 75%, and 100% of manure replacing synthetic N (25%M, 50%M, 75%M, and 100%M). Compared with NPK treatment, 25%M and 50%M treatments maintained annual yield (winter wheat plus summer maize) and sustainable yield index (SYI), but 75%M and 100%M treatments significantly decreased annual yield, and 100%M treatment also significantly reduced annual SYI. The SOC content exhibited a significant increasing trend over years in all treatments. After 7 years, SOC storage in manure treatments increased by 3.06-11.82 Mg ha-1 relative to NPK treatment. Manure treatments reduced annual GHG emissions by 14%-60% over NPK treatment. The CF of the cropping system ranged from 0.16 to 0.39 kg CO2 eq kg-1 of grain without considering SOC sequestration, in which the CF of manure treatments lowered by 18%-58% relative to NPK treatment. When SOC sequestration was involved in, the CF varied from -0.39 to 0.37 kg CO2 eq kg-1 of grain, manure treatments significantly reduced the CF by 22%-208% over NPK treatment. It was concluded that replacing 50% of synthetic fertilizer with manure was a sound option for achieving high crop yield and SYI but low CF under the tested cropping system.

Carbon footprint of synthetic nitrogen under staple crops: A first cradle-to-grave analysis.

More than half of the world's population is nourished by crops fertilized with synthetic nitrogen (N) fertilizers. However, N fertilization is a major source of anthropogenic emissions, augmenting the carbon footprint (CF). To date, no global quantification of the CF induced by N fertilization of the main grain crops has been performed, and quantifications at the national scale have neglected the CO2 assimilated by plants. A first cradle-to-grave life cycle assessment was performed to quantify the CF of the N fertilizers' production, transportation, and application to the field and the uses of the produced biomass in livestock feed and human food, as well as biofuel production. We quantified the direct and indirect inventories emitted or sequestered by N fertilization of main grain crops: wheat, maize, and rice. Grain food produced with N fertilization had a net CF of 7.4 Gt CO2eq. in 2019 after excluding the assimilated C in plant biomass, which accounted for a quarter of the total CF. The cradle (fertilizer production and transportation), gate (fertilizer application, and soil and plant systems), and grave (feed, food, biofuel, and losses) stages contributed to the CF by 2%, 11%, and 87%, respectively. Although Asia was the top grain producer, North America contributed 38% of the CF due to the greatest CF of the grave stage (2.5 Gt CO2eq.). The CF of grain crops will increase to 21.2 Gt CO2eq. in 2100, driven by the rise in N fertilization to meet the growing food demand without actions to stop the decline in N use efficiency. To meet the targets of climate change, we introduced an ambitious mitigation strategy, including the improvement of N agronomic efficiency (6% average target for the three crops) and manufacturing technology, reducing food losses, and global conversion to healthy diets, whereby the CF can be reduced to 5.6 Gt CO2eq. in 2100.

Mixed diets can meet nutrient requirements with lower carbon footprints.

Achieving sustainable dietary change is essential for safeguarding human and environmental health. However, dietary recommendations based on broad food groups may not accurately reflect real-world realities because individuals select and consume dishes with multiple food items influenced by diverse context-specific factors. Therefore, here we explored the sustainability trade-offs of dietary choices at the dish level through an optimization modeling approach tested in Japan. We estimated the nutritional quality, price, and carbon footprint of major Japanese dishes and examined 16 dietary scenarios to identify options that meet the nutritional requirements and minimize carbon footprint. Overall, mixed diets contain more combinations of dishes that meet nutritional requirements with lower carbon footprints compared to more restrictive dietary scenarios. We argue that the approach developed here enables a better understanding of dietary trade-offs, complements existing methods, and helps identify sustainable diets by offering nuanced information at the national and sub-national levels.

A holistic approach for performance evaluation of wastewater treatment plants: integrating grey water footprint and life cycle impact assessment.

Wastewater treatment plants (WWTPs) have positive and negative impacts on the environment. Therefore, life cycle impact assessment (LCIA) can provide a more holistic framework for performance evaluation than the conventional approach. This study added water footprint (WF) to LCIA and defined ϕ index for accounting for the damage ratio of carbon footprint (CF) to WF. The application of these innovations was verified by comparing the performance of 26 WWTPs. These facilities are located in four different climates in Iran, serve between 1,900 and 980,000 people, and have treatment units like activated sludge, aerated lagoon, and stabilization pond. Here, grey water footprint (GWF) calculated the ecological impacts through typical pollutants. Blue water footprint (BWF) included the productive impacts of wastewater reuse, and CF estimated CO2 emissions from WWTPs. Results showed that GWF was the leading factor. ϕ was 4-7.5% and the average WF of WWTPs was 0.6 m3/ca, which reduced 84%, to 0.1 m³/ca, through wastewater reuse. Here, wastewater treatment and reuse in larger WWTPs, particularly with activated sludge had lower cumulative impacts. Since this method takes more items than the conventional approach, it is recommended for integrated evaluation of WWTPs, mainly in areas where the water-energy nexus is a paradigm for sustainable development.

A life cycle analysis of the environmental impact of procurement, waste and water in the dental practice.

Background Health care is a significant contributor to climate change. Global pressure for a change towards a more sustainable way of providing dental health care has resulted in the creation of the Green Impact Toolkit, which is comprised of a list of suggested changes that dental practices can make to become more sustainable in a number of categories, such as procurement, waste and water.Aims To compare the effectiveness of changes suggested by the Green Impact Toolkit.Materials and methods A comparative life cycle assessment (LCA) was conducted using the Ecoinvent database v3.8 and these data were processed using OpenLCA v1.10.3 software.Results The carbon footprint per patient was significantly reduced after the recommendations were implemented. For instance, using water from a rainwater collection tank instead of the mains supply saved 30 g CO2eq (carbon dioxide equivalents) per patient, a 90% reduction in carbon footprint.Discussion This comparative LCA identified some effective changes which can be easily made by a dental practice. Nevertheless, some actions require some initial financial investment and may be difficult to implement in a busy modern dental practice setting.Conclusion The findings from this study can be used to guide dental practices to making choices which are more sustainable and eco-friendly in the future.

Plastic footprint deteriorates dryland carbon footprint across soil-plant-atmosphere continuum.

Plastic fragments are widely found in the soil profile of terrestrial ecosystems, forming plastic footprint and posing increasing threat to soil functionality and carbon (C) footprint. It is unclear how plastic footprint affects C cycling, and in particularly permanent C sequestration. Integrated field observations (including 13C labelling) were made using polyethylene and polylactic acid plastic fragments (low-, medium- and high-concentrations as intensifying footprint) landfilling in soil, to track C flow along soil-plant-atmosphere continuum (SPAC). The result indicated that increased plastic fragments substantially reduced photosynthetic C assimilation (p < 0.05), regardless of fragment degradability. Besides reducing C sink strength, relative intensity of C emission increased significantly, displaying elevated C source. Moreover, root C fixation declined significantly from 21.95 to 19.2 mg m-2, and simultaneously root length density, root weight density, specific root length and root diameter and surface area were clearly reduced. Similar trends were observed in the two types of plastic fragments (p > 0.05). Particularly, soil aggregate stability was significantly lowered as affected by plastic fragments, which accelerated the decomposition rate of newly sequestered C (p < 0.05). More importantly, net C rhizodeposition declined averagely from 39.77 to 29.41 mg m-2, which directly led to significant decline of permanent C sequestration in soil. Therefore, increasing plastic footprint considerably worsened C footprint regardless of polythene and biodegradable fragments. The findings unveiled the serious effects of plastic residues on permanent C sequestration across SPAC, implying that current C assessment methods clearly overlook plastic footprint and their global impact effects.

Exploring the Environmental Impact of Telemedicine: A Life Cycle Assessment.

BACKGROUND: Telemedicine has emerged as a potential solution to mitigate the significant greenhouse gas emissions of the healthcare sector. A comprehensive evaluation is required to quantify the environmental benefits of its implementation. OBJECTIVES: The study aims to compare the environmental sustainability of in-person and virtual examinations for heart failure patients. METHODS: A standard life cycle assessment has been applied to quantify the equivalent CO2 of direct and indirect activities required to release a medical examination (virtual or physical) for a patient in an Italian hospital. Inputs of the analysis include electronic devices of hospital and patients, energy consumption, wastes, internet usage and patient travel. Depending on the type of visit (virtual or physical), inputs have been processed differently, considering actual consumption and utilization. RESULTS: Televisit reduces emissions from 9.77 kgCO2e to 0.41 kgCO2e. Transport and internet data use are key inputs for in-person (i.e., 98%) and telemedicine visits (i.e., 72%), respectively. DISCUSSION: Given the frequent car travels, telemedicine emerges as a tool to improve environmental benefits and reduce time for patients and caregivers.