Background: The setting of tidal volume (VT) during controlled mechanical ventilation (CMV) in critically ill patients without acute respiratory distress syndrome (ARDS) is likely important but ...currently unknown. We aimed to describe current CMV settings in intensive care units (ICUs) across Victoria.
Methods: We performed a multicentre, prospective, observational study. We collected clinical, ventilatory and arterial blood gas data twice daily for 7 days. We performed subgroup analysis by sex and assessment of arterial partial pressure of carbon dioxide (PaCO2) management where hypercapnia was potentially physiologically contraindicated.
Results: We recorded 453 observational sets in 123 patients across seven ICUs. The most commonly selected initial VT was 500 mL (33%), and this proportion did not differ according to sex (32% male, 34% female). Moreover, 38% of patients were exposed to initial VT per predicted body weight (VT-PBW) > 8.0 mL/kg. VT-PBW in this range were more likely to occur in females, those with a lower height, lower ideal body weight or in those for whom hypercapnia was potentially physiologically contraindicated. As a consequence, females were more frequently exposed to a lower PaCO2 and higher pH.
Conclusions: In adults without ARDS undergoing CMV in Australian ICUs, the initial VT was a stereotypical 500 mL in one-third of participants, irrespective of sex. Moreover, around 40% of patients were exposed to an initial VT-PBW > 8.0 mL/kg. Finally, women were more likely to be exposed to a high VT and hyperventilation.
The key aspects and features of the National Greenhouse and Energy Reporting (NGER) Act 2007 enacted by the Australian Government in response to climate change are discussed. The different steps that ...need to be taken by hospitals in order to meet the hospital accreditation standards are highlighted.
A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured ...products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy- and market-driven solutions are needed to encourage systemic transformation.
The carbon footprint of pathology testing McAlister, Scott; Barratt, Alexandra L; Bell, Katy JL ...
Medical journal of Australia,
20/May , Letnik:
212, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Objectives
To estimate the carbon footprint of five common hospital pathology tests: full blood examination; urea and electrolyte levels; coagulation profile; C‐reactive protein concentration; and ...arterial blood gases.
Design, setting
Prospective life cycle assessment of five pathology tests in two university‐affiliated health services in Melbourne. We included all consumables and associated waste for venepuncture and laboratory analyses, and electricity and water use for laboratory analyses.
Main outcome measure
Greenhouse gas footprint, measured in carbon dioxide equivalent (CO2e) emissions.
Results
CO2e emissions for haematology tests were 82 g/test (95% CI, 73–91 g/test) for coagulation profile and 116 g/test (95% CI, 101–135 g/test) for full blood examination. CO2e emissions for biochemical tests were 0.5 g/test CO2e (95% CI, 0.4–0.6 g/test) for C‐reactive protein (low because typically ordered with urea and electrolyte assessment), 49 g/test (95% CI, 45–53 g/test) for arterial blood gas assessment, and 99 g/test (95% CI, 84–113 g/test) for urea and electrolyte assessment. Most CO2e emissions were associated with sample collection (range, 60% for full blood examination to 95% for coagulation profile); emissions attributable to laboratory reagents and power use were much smaller.
Conclusion
The carbon footprint of common pathology tests was dominated by those of sample collection and phlebotomy. Although the carbon footprints were small, millions of tests are performed each year in Australia, and reducing unnecessary testing will be the most effective approach to reducing the carbon footprint of pathology. Together with the detrimental health and economic effects of unnecessary testing, our environmental findings should further motivate clinicians to test wisely.
For most items used in operating rooms, it is unclear whether reusable items are environmentally and financially advantageous in comparison with single-use variants. We examined the life cycles of ...reusable and single-use central venous catheter kits used to aid the insertion of single-use, central venous catheters in operating rooms. We did not examine the actual disposable catheter sets themselves. We assessed the entire financial and environmental costs for the kits, including the influence of the energy source used for sterilization.
For the reusable central venous catheter kit, we performed a "time-in-motion" study to determine the labor costs and measured the energy and water consumption for cleaning and sterilization at Western Health, Melbourne, Australia. For the majority of the inputs for the single-use kit, we relied upon industry and inventory-sourced databases. We modeled the life cycles of the reusable and single-use central venous catheter kits with Monte Carlo analysis.
Inclusive of labor, the reusable central venous catheter insertion kits cost $6.35 Australian ($A) (95% confidence interval CI, $A5.89 to $A6.86), and the single-use kits cost $A8.65. For the reusable kit, CO(2) emissions were 1211 g (95% CI, 1099 to 1323 g) and for the single-use kit 407 g (95% CI, 379 to 442 g). Water use was 27.7 L (95% CI, 27.0 to 28.6 l) for the reusable kit and 2.5 L (95% CI, 2.1 to 2.9 l) for the single-use kit. For the reusable kit, sterilization had the greatest environmental cost, and for the single-use kit, the manufacture of plastic and metal components had the largest environmental costs. Different sources of electricity to make the reusable kits patient-ready again affected the CO(2) emissions: electricity from hospital gas cogeneration resulted in 436 g CO(2) (95% CI, 410 to 473 g CO(2)), from the United States electricity grid 764 g CO(2) (95% CI, 509 to 1174 g CO(2)), and from the European electricity grid 572 g (95% CI, 470 to 713 g CO(2)).
Inclusive of labor, the reusable central venous catheter insertion kits were less expensive than were the single-use kits. For our hospital, which uses brown coal-sourced electricity, the environmental costs of the reusable kit were considerably greater than those of the single-use kit. Efforts to reduce the environmental footprint of reusable items should be directed towards decreasing the water and energy consumed in cleaning and sterilization. The source of hospital electricity significantly alters the relative environmental effects of reusable items.
An LCA of hospital pathology testing McAlister, Scott; Grant, Tim; McGain, Forbes
The international journal of life cycle assessment,
09/2021, Letnik:
26, Številka:
9
Journal Article
Recenzirano
Purpose
There is increasing interest within the healthcare sector about the environmental impacts associated with the provision of health services, with the sector being responsible for approximately ...4.4% of global greenhouse gas emissions. The aim of this study is to develop an LCA of six commonly used pathology tests in hospitals in Australia, as testing is ubiquitous within healthcare.
Methods
The study is a cradle-to-grave assessment of pathology testing, from raw material acquisition for collection equipment and reagents, the collection of the sample from the patient, sample transport to the pathology lab and its subsequent analysis, and the disposal of clinical waste. The study has been performed in accordance with ISO 14,040 and ISO 14,044. The data were modelled using SimaPro® software, version 9.0.0.27, using the Australian National Life Cycle Inventory Database (AusLCI) for Australian specific data, and from Ecoinvent 3.5® for all other data. Impact assessment was performed using the ReCiPe 2016 V1.02 (H). We focused on midpoint indicators that damage human health, as well as reporting in disability adjusted life years (DALYs).
Results and discussions
Focussing on climate change, the impact of a single blood test given in a hospital ranges from 74 g CO
2
e through to 274 g CO
2
e, whilst for a urinalysis in a hospital the impact is greater at 538 g CO
2
e. Expressed in DALYs, blood tests ranged from impacts range from 0.146 µDALYs through to 0.383 µDALYs, whilst urinalysis was 0.701 µDALYs. For the majority of the tests, the major source of impacts was the collection tubes and jars, and the electricity use of the analysers. Test reagents had only a minimal impact. Urinalysis had additional impacts due to test consumables (agar plate), and compressed air required for the automated analyser and incubator.
Conclusion
Globally, tens of billions of pathology tests are performed annually, with each individual test having a low environmental impact. Not all testing, however, is necessary, and reducing this unnecessary testing will reduce environmental and economic impacts and potential adverse health outcomes. Increasing laboratory utilisation (efficiency) will additionally reduce environmental impacts per test.
Health professionals are well positioned to effect change by reshaping individual practice, influencing healthcare organisations, and setting clinical standards, argue Jodi Sherman and colleagues
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