Environmentally Sustainable Intensive Care

Climate change is now considered to be a climate crisis because of the health emergency occurring from increasing carbon dioxide levels, rising temperatures, climbing sea levels, more frequent extreme weather events, worsening air pollution and loss of biodiversity^{1, 2}. 

The recently published Intergovernmental Panel on Climate Change report³ presents a startling account of how this international public health crisis will severely worsen unless urgent, worldwide actions are taken to dramatically reduce carbon dioxide and other greenhouse gas emissions. 

The healthcare sector is a significant contributor to the global carbon footprint by causing 4.4% of total emissions⁴.  Therefore, healthcare professionals have an opportunity to help reduce climate change by delivering their specialist area of practice in a way which is less damaging to the environment⁵.

The Association of Anaesthetists offers a range of information on how anaesthesia can be more environmentally sustainable. 

Knowledge about reducing the carbon footprint of intensive care practice is less extensive.  The GREEN-ICU (GREater ENvironmental sustainability in Intensive Care Units) collaboration developed to address this need for a stronger evidence-base about environmental sustainability in intensive care.  The GREEN-ICU website contains information about current and future research workstreams aiming to provide guidance on lowering the carbon footprint of ICUs, but in a manner which is also financially affordable and socially responsible. 

GREEN-ICU initiative – multi-disciplinary collaboration developing evidence-based guidance on reducing environmental footprint of ICUs

The Critical Care Susnet from the Centre for Sustainable Healthcare is a free online network for sharing resources, asking questions and advertising events about environmental sustainability related to critical care.  All members of the multi-disciplinary team, or other roles interested in hospital sustainability, are very welcome to join the Critical Care Susnet.

Critical Care Susnet – free online network

Sustainable healthcare resources

Sustainability literature – publications related to environmental sustainability of intensive care units, as well as general articles about sustainable healthcare, quality improvement and sustainability, materials science, design and circular economy including waste management.

Environmentally sustainable healthcare programme – free e-learning from Health Education England in partnership with the Centre for Sustainable Healthcare.

Health Emergency and Climate Change – series of videos from the Royal Society of Medicine on the links between health and climate change, including Episode 8 that focuses on the environmental impact of healthcare systems.

Health Care Without Harm Europe – non-profit organisation offering guidance on how to achieve a more environmentally sustainable healthcare sector through reports, webinars and profession specific programmes such as Doctors for Greener Healthcare and the Nurses Climate Challenge.  

Green Health Wales | Iechyd Gwyrdd Cymru – network for healthcare professionals in Wales who are interested in developing a more sustainable healthcare service. 

National sustainability programmes in the UK

• NHS England – Greener NHS
• NHS Wales – Decarbonisation Strategic Delivery Plan
• NHS Scotland –  Sustainability Action

Championing environmental sustainability in your ICU

If you would like to reduce your own carbon footprint while working in intensive care and support colleagues in doing the same, here are some suggested actions:

• Find out if your hospital has a strategic sustainability plan (previously called Sustainable Development Management Plan and now referred to as a Green Plan in England) and identify aspects which can be applied to intensive care clinical practice.
• Find out if your hospital has an environmental group, and if not, set one up to link together green champions from each department and to enable communication with estates and hospital wide sustainability teams.
• Join/create a sustainability group for your intensive care unit to develop specific local goals and provide a place for those interested in environmental sustainability to share ideas, support each other and take a multi-disciplinary approach to addressing green issues.
• Connect in with your hospital’s procurement and waste management teams to provide clinician and intensive care perspectives on potential ways to reduce the carbon footprint of clinical supplies and consumables.
• Evaluate your intensive care unit’s use of infection prevention and control measures, energy, water, food, non-clinical items and travel and identify areas for waste reduction and sustainability improvements while still maintaining quality care.  
• Apply the Centre for Sustainable Healthcare’s four principles of sustainable clinical practice to your own daily practice and while planning sustainability projects:  prevention, patient empowerment and self-care, lean systems and low carbon alternatives. 
• Provide evidence-based practice using interventions that are known to positively influence clinical outcomes but which also reduce resource use in the longer term, such actions which decrease length of stay in intensive care, mechanical ventilation time and the need for renal replacement therapy and approaches to prevent/minimise reintubation, pain, agitation, delirium, sleep deprivation and psychological distress.
• Embed stewardship into clinical decision-making to maintain high-quality, patient-centred intensive care practice without over-using or under-using resources (Goldilocks principle of not too much, not too little, but just right). 
• Use the SusQI framework while conducting audits and quality improvement projects to embed sustainability principles into initiatives improving quality in healthcare.
• Join the Critical Care Susnet to hear about sustainability projects in other intensive care units and share experiences about your own successes and challenges in greening up your local intensive care unit.

References

1. National Center for Environmental Health. 2021.  Climate effects on health. Centers for Disease Control and Prevention. Available from:  https://www.cdc.gov/climateandhealth/effects/
2. Lancet Countdown: Tracking Progress on Health and Climate Change. 2021. Tracking the connections between public health and climate change. Available from: https://www.lancetcountdown.org/ 
3. Intergovernmental Panel on Climate Change. 2021. Climate change 2021: The physical science basis. https://www.ipcc.ch/report/sixth-assessment-report-working-group-i/
4. Karliner, J., Slotterback, S., Boyd, R., Ashby, B., Steele, K. 2019. Health care’s climate footprint: how the health sector contributes to the global climate crisis and opportunities for action. https://noharm-global.org/documents/health-care-climate-footprint-report
5. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Beagley, J., Belesova, K., Boykoff, M., Byass, P., Cai, W., Campbell-Lendrum, D. and Capstick, S. 2020. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet. 397 (10269): 129-170. https://doi.org/10.1016/S0140-6736(20)32290-X