The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial.

Background: The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial.

Australian and Canadian clinicians' views and application of 'carbon health literacy': a qualitative study.

Background: Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care.

Staff satisfaction with reusable surgical drapes.

Background: Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products.

A narrative review of personal protective equipment gowns: lessons from COVID-19.

This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals.

A qualitative exploration of barriers, enablers, and implementation strategies to replace disposable medical devices with reusable alternatives.

Hospitals use many single-use devices that produce more waste and greenhouse gas emissions than reusable devices; operating theatres alone are responsible for up to a third of hospital waste. We explored barriers and enablers to replacing disposable devices with reusable alternatives in operating theatres by use of interviews, the Theoretical Domains Framework, and theory-informed behaviour change techniques. 19 stakeholders were interviewed at a large tertiary hospital in Melbourne, Australia, and 53 barriers and 44 experience-based or intuition-based enablers were identified.

The carbon footprint of total knee replacements.

Objective Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use.

Interventions to reduce low-value care in intensive care settings: a scoping review of impacts on health, resource use, costs, and the environment.

Purpose: Low-value care is common in intensive care units (ICUs), unnecessarily exposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare's carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs.

Methods: We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles.

Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study.

Background And Aims: Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.

Variations of nitrous oxide procurement per public hospital bed between Australian states and territories: A cross-sectional analysis.

We aimed to identify variations in nitrous oxide (NO) procurement between Australian states and territories per public hospital bed by undertaking a cross-sectional analysis of NO procurement data for all Australian public hospitals from 1 January 2017 to 30 June 2022. Data were obtained from state and territory departments of health. All Australian public hospitals across six states and two territories were included.

The Carbon Footprint of Peritoneal Dialysis in Australia.

Key Points: Automated peritoneal dialysis (APD) had a higher carbon impact than continuous ambulatory peritoneal dialysis (CAPD). This was due to higher emissions from the manufacture and disposal of APD consumables, and their higher weight, meaning greater transport emissions. Polyvinyl chloride recycling can partially mitigate peritoneal dialysis–associated emissions.

Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre.

Background: The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined.

Method: We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre.

Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle assessment.

Background: Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.

How environmental impact is considered in economic evaluations of critical care: a scoping review.

Purpose: Health care is a major contributor to climate change, and critical care is one of the sector's highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care.

Violence in intensive care: a point prevalence study.

Violence in the intensive care unit (ICU) is poorly characterised and its incidence is largely extrapolated from studies in the emergency department. Policy requirements vary between jurisdictions and have not been formally evaluated. A multisite, single-time point observational study was conducted across Australasian ICUs which focused on the incidence of violence in the previous 24 hours, the characteristics of patients displaying violent behaviour, the perceived contributors, and the management strategies implemented.

Exploring anaesthetists' views on the carbon footprint of anaesthesia and identifying opportunities and challenges for reducing its impact on the environment.

A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system.