MA, VetMB, CertVDI, CertSAS, FHEA, DECVS, MRCVS
Zoë Halfacree is a specialist small animal surgeon working at Davies Veterinary Specialists, part of Linnaeus Group, in the United Kingdom. She is chair of the Greener Veterinary Practice working group, as well as chair and a director of Vet Sustain, a community interest company supporting changes for sustainability in the veterinary profession (vetsustain.org). Zoë has undertaken training in sustainability in business through the Cambridge Institute of Sustainable Leadership.Read Articles Written by Zoë Halfacree
Sustainability has been defined as “meeting the needs of the present without compromising the ability of future generations to meet their needs.”1 Climate change has been described as the biggest global health threat of the 21st century;2 however, health care itself has a significant environmental impact.3 Health Care Without Harm reports that if global health care was represented as a country, it would be the fifth-largest carbon emitter in the world.4 As veterinary professionals, our individual contributions may seem minor on a global scale, but we can make choices that benefit our patients, planet and pocketbook.
Procurement of equipment and consumables accounts for the largest proportion of carbon footprint in healthcare settings:5 consider what you purchase and communicate with your suppliers about their sustainability credentials. There are many areas where improvements can be made to reduce the environmental impact of clinical practice, while still maintaining outstanding patient care. This article will outline some areas where you can get started.
Use Resources Responsibly
First, consider how energy consumption can be reused in the veterinary hospital, either through changing behavior or making practical substitutions that do not significantly impact performance. Reducing fossil fuel use for energy and heating, by encouraging a switch-off culture, is an important focus and is often overlooked in the workplace.6 This can be achieved by clarifying the benefits and emphasizing certain motivations that will promote team buy-in. Research shows that the motivation behind energy conservation in the workplace predicts intentions — specifically, environmental concern and helping one’s organization stand out as notable positive motivators.7 Take the time to explain these benefits and the reasoning behind them. Make the transition to LED lights, including surgical lighting, to reduce electricity use and costs and, where possible, transition to a renewable energy provider. One switch that saves a notable amount of water is moving to an alcohol hand rub for surgeon hand preparation in place of the traditional scrub technique. Traditional scrub techniques can use up to 20 liters of water (about 5.2 gallons) per surgeon, per procedure.8 There is increasing evidence that alcohol rubs are equally effective or superior to the traditional scrub.9,10
Next, consider areas where resources can be safely reused in place of single-use consumables. Examples in the clinical area include: reusable cloth surgical scrub hats, use of dedicated surgical clogs (shoes) instead of plastic shoe covers and use of reusable surgical textiles (gowns and drapes), for suitable cases. Any changes that we make for sustainability must not compromise patient care, particularly regarding infection control. Laundered reusable cloth scrub hats have been shown to have superior performance when measuring environmental contamination in the operating theater, compared to disposable hats.11,12 Large studies comparing the incidence of surgical site infection when using reusable surgical textiles versus single-use have demonstrated no difference in outcome,13-15 despite increased microbial wicking noted in some in vitro studies with traditional fabrics when wet.16 It has been clearly demonstrated that the environmental impact of single-use gowns is far greater than reusable gowns, even when laundering and resterilizing is taken into account.17 Using reusable surgical textiles on a rational basis can reduce the environmental impact of clinical practice and also builds operational resilience in the event of supply chain issues.
Choose Protocols That Support Sustainable Operation
Anesthesia and Medicines
Inhalant anaesthetic agents are potent greenhouse gases; for example, isoflurane has around 500 times more global warming potential than carbon dioxide.18 Anesthesia is essential for our practice; however, we can reduce the environmental impact by using lower flow techniques and rebreathing circuits when appropriate. Nitrous oxide also has a high global warming potential and persists in the atmosphere for more than 100 years.18 With the multimodal analgesia options now available in veterinary anesthesia, nitrous oxide use should be discontinued. Anesthetic recapture technology is in development and will become essential in coming years. Appropriate medicine use, in particular for antibiotics and parasiticides, is essential for global One Health and veterinary care.19
Health care generates a large volume of waste and this must be handled according to regional-specific legislation. Segregation of offensive waste and infectious or hazardous waste can reduce the volume of waste treated by incineration.20 Non-contaminated waste, such as cardboard packaging and aluminium suture packets, can be collected for recycling, dependent on your waste contractor, returning resources to the circular economy. Sharps containers are mostly single-use, with the entire container incinerated once full. The use of a reusable sharps container, which is emptied at the incineration facility and then washed and returned, affords significant carbon and cost savings, in addition to having excellent health and safety performance.20
Empower Your Team
Embracing sustainability is morally responsible, can improve recruitment and team well-being and makes business sense through cost savings and operational resilience. Take the time to consider what changes can be implemented in the practice to achieve the aforementioned goals while maintaining a high standard of care. Ultimately, these changes can also improve your bottom line and reputation. Clients are prepared to pay more for veterinary care in a clinic that has sustainability accreditation.21 ∞
- World Commission on Environment and Development. Report of the World Commission on Environment and Development: Our Common Future. United Nations; 1987.
- Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet. 2009;373(9676):1693-1733. doi: 10.1016/S0140-6736(09)60935-1
- Dzau VJ, Levine R, Barrett G, Witty A. Decarbonizing the U.S. health sector — a call to action. N Engl J Med. 2021;385(23):2117-2119. doi: 10.1056/NEJMp2115675
- Health Care Without Harm. Health care’s climate footprint. Published September 2019. Accessed June 2023. noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
- NHS Sustainable Development Unit. Goods and Services Carbon Hotspots. National Health Service; 2012.
- Staddon S, Cycil C, Goulden M, et al. Intervening to change behaviour and save energy in the workplace: a systematic review of available evidence. Enrgy Res and Soc Sci. 2016;17:30-51. doi.org/10.1016/j.erss.2016.03.027
- League C, Ferguson E, Spence A. Saving energy in the workplace: why, and for whom? J Environ Psychol. 2017;53:50-62. doi.org/10.1016/j.jenvp.2017.06.006
- Jehle K, Jarrett N, Matthews S. Clean and green: saving water in the operating theatre. Ann R Coll Surg Engl. 2008;90(1):22-24. doi: 10.1308/003588408X242277
- Tavolacci MP, Pitrou I, Merle V, et al. Surgical hand rubbing compared with surgical hand scrubbing: comparison of efficacy and costs. J Hosp Infect. 2006;63(1):55-59. doi: 10.1016/j.jhin.2005.11.012
- Widmer AF, Rotter M, Voss A, et al. Surgical hand preparation: state-of-the-art. J Hosp Infect. 2010;74(2):112-122. doi: 10.1016/j.jhin.2009.06.020
- Kothari SN, Anderson MJ, Borgert AJ, et al. Bouffant vs skull cap and impact on surgical site infection: does operating room headwear really matter? J Am Coll Surg. 2018;227(2):198-202. doi: 10.1016/j.jamcollsurg.2018.04.029
- Markel TA, Gormley T, Greeley D, et al. Hats off: a study of different operating room headgear assessed by environmental quality indicators. J Am Coll Surg. 2017;225(5):573-581. doi: 10.1016/j.jamcollsurg.2017.08.014
- Vasanthakumar M. Reducing veterinary waste: surgical site infection risk and the ecological impact of woven and disposable drapes. Veterinary Evidence. 2019;4(3):1-12. doi: 10.18849/VE.V4I3.251
- World Health Organization. Summary of a systematic review on drapes and gowns. In: Global Guidelines for the Prevention of Surgical Site Infection. World Health Organization; 2018.
- Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med. 2021;40(4):100907. doi: 10.1016/j.accpm.2021.100907
- Blom AW, Gozzard C, Heal J, et al. Bacterial strike-through of re-usable surgical drapes: the effect of different wetting agents. J Hosp Infect. 2002;52(1):52-55. doi: 10.1053/jhin.2002.1262
- Vozzola E, Overcash M, Griffing E. An environmental analysis of reusable and disposable surgical gowns. AORN J. 2020;111(3):315-325. doi: 10.1002/aorn.12885
- Jones RS, West E. Environmental sustainability in veterinary anaesthesia. Vet Anaesth Analg. 2019;46(4):409-420. doi: 10.1016/j.vaa.2018.12.008
- Brookshire WC, Shivley JM. Improving patient outcomes through antibiotic stewardship. Todays Vet Pract. 2021;11(2):64-71.
- West E, Woolridge A, Ibarrola P. How to manage healthcare waste and reduce its environmental impact. In Practice. 2020;42(5):303-308. doi.org/10.1136/inp.m1678
- Deluty SB, Scott DM, Waugh SC, et al. Client choice may provide an economic incentive for veterinary practices to invest in sustainable infrastructure and climate change education. Front Vet Sci. 2021;7:622199. doi: 10.3389/fvets.2020.622199