Persistent use of nitrous oxide for anaesthesia in European hospitals despite its harmfulness to the climate - how emission taxation can achieve the coupling of cost-effectiveness and climate protection: observational study.

BACKGROUND: Health care has the intrinsic obligation to preserve health. This concept is also applicable to planetary health. Nitrous oxide (N2O) lacks clinical indications in modern anaesthesia, while it is a high-potential greenhouse gas. Its seemingly low cost contrasts with the consequential externalised socio-economic costs due to its contribution to the climate crisis, which is approximately €698 per emitted ton of CO2 equivalent. This difference can be internalised through emission taxation. In this study, we aim to evaluate how much N2O - total amount and converted to CO2 equivalent - is used at a German university hospital and compare this amount to that used at European hospitals. Furthermore, how the cost of N2O usage changes under different emission taxation scenarios is calculated. METHODS: This trial was a retrospective observational study at a German university hospital with approximately 1,250 beds between 2016 and 2020. Additionally, five European hospitals from the Health Care Without Harm Network were used for comparison from a European perspective. The main outcome parameters were the amount of N2O used, in total and converted to CO2 equivalent, and the total cost at emission taxation of €0, €25, €55 and €698 per ton CO2 equivalent. RESULTS: At the peak, 2,104 tCO2 equivalent in N2O was emitted in 2019. The actual cost was €14,040 in this year, while the corresponding socio-economic damage due to the climate crisis was almost €1.5 million. Other European hospitals showed comparable amounts of emissions. CONCLUSIONS: The annual peak amount of emitted N2O corresponded to the total annual greenhouse gas emission of 188 people in Germany. To achieve a drastic reduction in use, the abandonment of recommendations by anaesthesiologic societies appears necessary, in addition to an internalisation of future costs via emission taxation, which will cause inadequate cost for a medication without relevant benefit or indication. To that end, the inclusion of health sector emissions within national or international greenhouse gas taxation, for example, the European Union Emissions Trading System, appears necessary and expedient in view of the urgent need to address the ecological transformation. TRIAL REGISTRATION: The trial was registered with the German Clinical Trials Register, identifier DRKS00024973 on 12/04/2021.

Nachhaltigkeit im OP ­ korrelieren Sterilität, Sicherheit und Service auch mit einer ressourcenschonenden Verwendung von Medizinprodukten?

In times of an unprecedented energy crisis, sustainability is becoming increasingly important. This development does not stop at medicine and especially at the operating room, where a considerable amount of greenhouse gases is produced. Due to this development, the question arises whether sterility, safety and service can be reconciled with a resource-saving use of medical devices. One goal here must be to replace disposables, which offer a high degree of sterility, with safely reprocessable reusables. Due to rising energy costs as well as supply bottlenecks, reprocessing of products offers increasing independence for the hospital. Furthermore, the move towards renewable energy for reusable products is visibly improving the carbon footprint. The independence gained by clinics also offers greater safety for patients, as the risk of unavailable materials is reduced. In addition to the goal of increasing the use of reusable items, the recycling of disposable products will also play an increasing role. Life cycle assessments will increasingly guide the optimal choice of products in this regard. In summary, these options offer the possibility of implementing the increasing need for sustainability in the OR.

Mitigation of climate change in health care: A survey for the evaluation of providers' attitudes and knowledge, and their view on their organization's readiness for change.

BACKGROUND: Climate change is the 21st century's greatest threat to health. Anaesthesia is responsible for high levels of waste production, significant greenhouse gas emissions and extensive energy consumption. Our aim was to design an instrument to assess attitudes and knowledge among anaesthetists as well as their organisation's readiness for change regarding climate action. METHODS: In 2020, the Provider Education and Evaluation Project (PEEP) questionnaire was sent to anaesthetists working at a university hospital, which contains 65 items in five areas: demographics, personal attitudes, organisational readiness, opportunities, and specific anaesthesiologic knowledge regarding climate action. Except for two open text questions, all questions were closed questions. RESULTS: 104 anaesthetists responded to the survey (response rate 62%). Environmental protection and sustainability were important to all participants (100%). Most felt threatened by the ongoing climate crisis (94.2%). While most participants agreed that their employer had the financial or technological capacities and that sustainability targets were compatible with core business activities (approval >60% for all), they felt unprepared and stated that they had too little time to consider environmental aspects during daily routines (disapproval >60% for all). Furthermore, knowledge on topics such as ongoing efforts to tackle climate change or the climate footprint of drugs and medical products, was rather scarce. CONCLUSION: The PEEP questionnaire is an applicable and viable tool to assess anaesthetists' knowledge and attitudes towards climate change and organisational readiness for change. While participants care about the climate crisis, organisational readiness was low, especially when it comes to staff readiness (i.e., skills and knowledge) and cultural readiness (i.e., shared values). These aspects need to be considered in order to successfully implement a carbon neutral health care system.