Sustainability at Western Health - ICU

My name's Forbes McGain; I'm an Anaesthetist and Intensive Care Physician, and I've been working at Western Health for almost five years now in the Consultant position.

The longer I've been in medicine, the more I realise that sustainability isn't really just about trees, or about water or energy. It's really about so much that we do in health and that it impinges upon security and resilience and about so much of what we do.

Sustainability is a big issue; there are elements within it that might not immediately seem irrelevant to sustainability, but public health for instance, the whole area of public health, co benefits, increasing exercise, reducing weight, reducing obesity – all of those things are about sustainability.

They're just as important as reducing waste or reducing the amount of admissions to intensive care, for instance. They're all really important and there are so many different ways in which doctors can become involved in sustainability, which immediately don't appear to be related to that actual topic. Within many other areas of medicine, for instance: in cardiology, there could be strong moves to cardiologists to be involved with air pollution.

Air pollution is a very strong risk factor interestingly enough for ischemic heart disease and having arrhythmias. You could look at respiratory disease; it's fairly obvious that air pollution once again that that's important, as well as smoking. So, there are surgeons, there are whole other areas of medicine that doctors can become involved in, whether it just be dealing with how much waste you produce, trying to change that, but also much more far reaching.

Security is another interesting concept. For instance with procurement, we have long supply chains for multiple different types of disposable instruments. Although that may be relatively cheaper in some circumstances than using reusable, which are internally processed by the Central Sterile Supply Department, if you think about containment and security of supply; having instruments - metal instruments for instance – in house being reprocessed and sterilised, that has to be more secure than having a long chain of supply coming from distant countries for single use items.

We looked at a simple drug tray - one was reusable and one was disposable, and we looked at the whole lifecycle. For the reusable tray, we looked at how much time it took to wash it, how much money that would cost. We amp clamped the washer and the dryers; we found how much energy was being used; we looked at the water use; we did all that for the reusable tray and we also looked at the carbon emissions and water use for that processes.

Then we also looked at the single use tray and the amount of energy, etc that was being used to produce the single use plastics, cotton and paper, etc. And we were able to show that the reusable tray had not only cost less, which we found interesting, so lower financial cost, including labour costs, but also had lower CO₂ emissions, water use, etc.

And what was most interesting and most exciting perhaps was to see a behaviour change in the part of the anaesthetists, who were quite receptive to that study and the science behind it, and to a change of practice to revert to the reusable tray in preference to the disposable tray.

There are resources that can assist doctors and you should never feel alone. I think there are good web sources, such as the National Health Service's Sustainable Development Unit for the United Kingdom. There are also several American sites; Green in the Operating Room is another good example of that and Healthcare without Harm. So, there are some resources that are available and there certainly are, I think, also within the Department of Health.