TY - JOUR
AU1 - Badrick, Tony
AB - It is impossible not to be aware of the impact of human activities on our health.1 We know that it is not sustainable to continue to produce nonreusable or recyclable waste at the current rate. Many households are actively reducing this waste and selectively recycling, supporting their local community’s efforts to reduce the dumping of plastics, metals, and paper. In the United States, the carbon footprint of the health care system represents approximately 10% of the country’s total footprint. People who work on and in health care systems wonder what more their organizations can do to reduce this waste. After all, these are essential components of the community, and that waste is “just part of what we do.” That said, about 62% of hospital waste reaches landfills, and that waste is recyclable or combustible. Just as in our broader community, we have individual and group responsibilities to attack this problem. A closer analysis of the carbon footprint source reveals that the majority of waste comes from hospitals—roughly 40%. Pathology testing contributes relatively small volumes to the carbon footprint, which comes mainly from the phlebotomy collection process (ie, plastics) and disposal of clinical waste.2-4 Every reduction counts, however, and everyone must play their part. The impact of climate change on individual health and countries’ health care systems is significant,5 so laboratories have a duty to patients to reduce their footprint. Organizations can react to specific problems or proactively, holistically address the issue. Reactionary initiatives are typically not sustainable and can be counterproductive to staff. Staff are also likely to support and respect an employer that is seen as an excellent corporate citizen that does what its employees see as responsible. It is worth recalling that environmental regulations are becoming more common, so not acting now on waste management issues—particularly chemical, biological, and clinical waste—is a short-term option only. The reputational impact of a breach of such regulations or an environmental incident could be significant. Pathology laboratories have a philosophy of quality improvement using tools such as audits, nonconformances, and management reviews. An effective quality management system drives risk reduction in laboratory processes. Harnessing this same system can improve a laboratory’s environmental risk. The fundamental function of developing a plan to reduce environmental waste should involve an assessment of risk, a policy supported by management (and staff), an activity plan supported by measurable outcomes, audit and nonconformance processes, and oversight and accountability by management.6 An International Organization for Standardization environmental standard7 provides some structure, a point of comparison, and an external review process. Nothing drives improvement like the external audit to compare what you said you would do against what you have achieved. Laboratories can reduce their carbon footprint in many areas, including recycling solvents, reusing clean plastic sample bags, adopting a green purchasing policy, and reducing paper use.8 This issue of AJCP contains an article by Hayward, et al9 that describes the efforts of 1 dermatopathology laboratory to reduce its environmental footprint. The laboratory introduced alcohol, xylene, formalin recycling, and plastic shredding. It also reduced electricity consumption (and cost). Notably, the authors describe savings of $43,000 per annum from these initiatives. In a previous article in the Journal, Gordon et al10 provided a detailed life cycle assessment to quantify greenhouse gas emissions associated with processing a gastrointestinal biopsy. They found that it was possible to reduce these emissions by considering the better use of biopsy jars, thoughtful prescribing of biopsy procedures, and green purchasing practices for equipment and supplies. Organizations often fail to understand that reducing waste saves money, as has been reported elsewhere.11 Laboratories are usually part of larger organizations and may not have the flexibility to change their power or waste usage. Every aspect of a system can influence policy, however. A hospital or network of hospitals can take significant steps to reuse and recycle waste12: Recycle polyvinyl chloride, such as saline bags (cut off introducers first) and oxygen tubing (no filters or Hudson masks). Recycle aluminum gas cylinders. Recycle Kimtech Kimguard/ surgical wraps. Investigate key clinical areas with single-use electrical wires (eg, occupational therapy, intensive care units, catheter labs, dermatology) for opportunities to reduce use of such wires. Recycle appropriate hospital soft plastics (eg, syringe waste plastics, image intensifier covers, shrink wrap from pharmacy, clear plastic covers used in radiology to cover detectors). Recycle stainless steel (eg, blue-handle single-use stainless steel instruments). Recycle e-waste (eg, computers and electronic equipment, clinical vacuums, Smith+Nephew PICO/ 3M Pravena 125 systems, central sterile supply department broken equipment). Recycle wax (radiation therapists use wax to mold patient contours for radiation therapy). Recycle rubber gloves and surgical caps. Hold excess hospital/department equipment swap days. Of course, organizations are made up of people, and the support of everyone in the organization is essential to reduce the types of waste critical to the success of an environmental policy.13 Placing waste in the correct bin is vital, particularly segregating clinical waste from general waste. The article by Hayward et al9 describes how staff input has been critical during the planning and execution of their environmental plan. They actively encourage staff to contribute ideas to laboratory improvement through 1-on-1 sharing and dedicated brainstorming time at monthly or bimonthly laboratory meetings. Cultural change is needed, but it is change that most staff will embrace. Like any successful cultural change, environmental policies must have both top-down and bottom-up champions. There is a broader issue with pathology testing, as well. Evidence exists of the overuse of some pathology tests,14 but underutilization of testing also exists in some situations,15 including retesting intervals when there is no additional clinical utility. Tests are repeated because results are lost or inexperienced clinicians reorder tests looking for a change. Repeating tests can be wasteful and potentially dangerous if the perception of a change in results represents a “true” change in the course of a disease or treatment when it merely means measurement uncertainty. Defining a minimal retest interval for tests will reduce resource waste and patient risk.16 Individual pathology tests do not create a significant carbon load, but many tests are performed every day.2 Enforcing these intervals typically requires some form of decision support software, but this is an area where waste can be reduced and patient outcomes improved—an excellent application of the concept of reducing a health care organization’s environmental footprint.17 Gordon et al10,18 suggested the possibility of developing environmental sustainability–related recommendations for the Choosing Wisely program. In the accompanying editorial, Kroft19 suggested that clinical laboratory personnel, as health care providers, bear responsibility for stewardship not just of fiscal resources but also of environmental resources. The drums are beating louder each day. REFERENCES 1. Crimmins A , Balbus J, Gamble JL, et al. Executive summary . In: The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment . Washington, DC: U.S. Global Change Research Program; 2016 : 1 - 24 . Google Scholar OpenURL Placeholder Text WorldCat 2. McAlister S , Barratt AL, Bell KJI, et al. The carbon footprint of pathology testing . Med J Aust. 2020 ; 212 : 377 - 382 . Google Scholar Crossref Search ADS PubMed WorldCat 3. McAlister S , Smyth B, Koprivic I, et al. Carbon emissions and hospital pathology stewardship: a retrospective cohort analysis [published online ahead of print November 15, 2021] . Intern Med J. doi:10.1111/imj.15622. OpenURL Placeholder Text WorldCat 4. Tennison I , Roschnik S, Ashby B, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England . Lancet Planet Health . 2021 ; 5 : e84 - e92 . doi:10.1016/S2542-5196(20)30271-0. 5. Bole A , Crimmins A, Glass G, et al. Human health. In: Balbus JM, Luber G eds. Fourth National Climate Assessment. https://nca2018.globalchange.gov/chapter/14/. 2018. Accessed April 11, 2022 . 6. Lopez JB , Jackson D, Gammie A, et al. Reducing the environmental impact of clinical laboratories . Clin Biochem Rev. 2017 ; 38:3-11 . Google Scholar OpenURL Placeholder Text WorldCat 7. Tarí JJ , Molina-Azorín JF, Heras I. Benefits of the ISO 9001 and ISO 14001 standards: a literature review . J Ind Eng Manag. 2012 ; 5 : 297 - 322 . Google Scholar OpenURL Placeholder Text WorldCat 8. Lopez JB , Badrick T ; ad hoc IFCC Panel on the Environmental Responsibility of Clinical Laboratories; APFCB Laboratory Management Committee. Proposals for the mitigation of the environmental impact of clinical laboratories . Clin Chem Lab Med . 2012 ; 50 : 1559 - 1564 . Google Scholar Crossref Search ADS PubMed WorldCat 9. Hayward K , Steward M, Chisolm CD. Dermatopathology laboratory green initiatives: illuminating environmental stewardship opportunities in an era of climate change . Am J Clin Pathol. 2022 . Google Scholar OpenURL Placeholder Text WorldCat 10. Gordon IO , Sherman JD, Leapman M, et al. Life cycle greenhouse gas emissions of gastrointestinal biopsies in a surgical pathology laboratory . Am J Clin Pathol. 2021 ; 156 : 540 - 549 . doi:10.1093/ajcp/aqac062. Google Scholar Crossref Search ADS PubMed WorldCat 11. Ross J , Penesis J, Badrick T. Improving laboratory economic and environmental performance by the implementation of an environmental management system . Accredit Qual Assur. 2019 ; 24 : 319 - 327 . Google Scholar Crossref Search ADS WorldCat 12. McBrien R . Hospital waste—what can we do? https://vha.org.au/wp-content/uploads/2019/12/War-on-Waste-Renae-McBrien.pdf. 2019 . Accessed April 8, 2022 . 13. Badrick T , Kehrer S, Reid E.For the g reater good: a laboratory reduces waste, enhances efficiency and staff engagement with ISO 14001 . Quality Progress. 2013;46:24-31. 14. Braithwaite J , Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-30-10 Challenge . BMC Med. 2020 ; 18 : 1 - 8 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 15. Zhi M , Ding EL, Theisen-Toupal J, et al. The landscape of inappropriate laboratory testing: a 15-year meta-analysis . PLoS One. 2013 ; 8 : e78962 . Google Scholar Crossref Search ADS PubMed WorldCat 16. Lang T , Croal B. National minimum retesting intervals in pathology . https://www.rcpath.org/uploads/assets/253e8950-3721-4aa2-8ddd4bd94f73040e/g147_national-minimum_retesting_intervals_in_pathology.pdf. 2021. Accessed April 11, 2022 . 17. Malik A , Lenzen M, McAlister S, et al. The carbon footprint of Australian health care . Lancet Planet Heal. 2018 ; 2 : e27 - e35 . Google Scholar Crossref Search ADS WorldCat 18. Our mission . Choosing Wisely Web site . https://www.choosingwisely.org/our-mission/. Accessed April 11, 2022 . 19. Kroft SH . A different kind of laboratory stewardship . Am J Clin Pathol. 2021 ; 156 : 493 - 494 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
TI - The Role of Laboratories in Reducing the Carbon Footprint
JF - American Journal of Clinical Pathology
DO - 10.1093/ajcp/aqac056
DA - 2022-06-21
UR - https://www.deepdyve.com/lp/oxford-university-press/the-role-of-laboratories-in-reducing-the-carbon-footprint-AFeZvWX6CE
SP - 322
EP - 324
VL - 158
IS - 3
DP - DeepDyve
ER -