A Review of the Applicability of Current Green Practices in Healthcare Facilities

Document Type : Review Article

Authors

1 Medical Physics Service, Portuguese Oncology Institute of Porto, Porto, Portugal

2 Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, Msida, Malta

3 Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland

4 Department of Electroradiology, University of Medical Science, Poznan, Poland

5 Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK

6 Radiography Department, Faculty of Health Sciences, University of Malta, Msida, Malta

7 Medical Physics and Radiobiology Group, Research Center (IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal

Abstract

Background 
Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare.

Methods   
We conducted a scoping review guided by the Arksey and O’Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022.

Results 
Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book.

Conclusion 
Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.

Keywords

References

  1. Ghisellini P, Cialani C, Ulgiati S. A review on circular economy: the expected transition to a balanced interplay of environmental and economic systems. J Clean Prod. 2016;114:11-32. doi:1016/j.jclepro.2015.09.007
  2. Rizos V, Tuokko K, Behrens A. The Circular Economy: A Review of Definitions, Processes and Impacts. Brussels: Centre for European Policy Studies; 2017.
  3. Murray A, Skene K, Haynes K. The circular economy: an interdisciplinary exploration of the concept and application in a global context. J Bus Ethics. 2017;140(3):369-380. doi:1007/s10551-015-2693-2
  4. Ellen MacArthur Foundation. Towards the Circular Economy Economic and Business Rationale for an Accelerated Transition. Ellen MacArthur Foundation; 2012.
  5. Foundation for Science and Technology (FST). Agenda Temática de Investigação e Inovação Economia Circular. Lisboa: FST; 2019. doi:34621/fct.edicoes.agendastematicas-1
  6. Circle Economy, Haigh L, de Wit M, von Daniels C, et al. The Circularity Gap Report. Amsterdam: Platform for Accelerating the Circular Economy (PACE); 2021.
  7. Stahel WR. The circular economy. Nature. 2016;531(7595):435-438. doi:1038/531435a
  8. Ellen MacArthur Foundation. Towards the Circular Economy Opportunities for the Consumer Goods Sector. Ellen MacArthur Foundation; 2013.
  9. World Health Organization (WHO). Environmentally Sustainable Health Systems: A Strategic Document. WHO Regional Office for Europe; 2017.
  10. Bosurgi R. Climate crisis: healthcare is a major contributor, global report finds. BMJ. 2019;366:l5560. doi:1136/bmj.l5560
  11. Health Care Without Harm Europe (HCWH). Health Care Climate Footprint Report. HCWH; 2019.
  12. Pichler PP, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14(6):064004. doi:1088/1748-9326/ab19e1
  13. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:7326/m18-0850
  14. Wallace M, Wray A. Critical Reading and Writing for Postgraduates. 2nd ed. Los Angeles: SAGE Publications; 2011.
  15. McGain F, Naylor C. Environmental sustainability in hospitals - a systematic review and research agenda. J Health Serv Res Policy. 2014;19(4):245-252. doi:1177/1355819614534836
  16. Pencheon D. Making health care more sustainable: the case of the English NHS. Public Health. 2015;129(10):1335-1343. doi:1016/j.puhe.2015.08.010
  17. Tomson C. Reducing the carbon footprint of hospital-based care. Future Hosp J. 2015;2(1):57-62. doi:7861/futurehosp.2-1-57
  18. Weimann E, Patel B. Tackling the climate targets set by the Paris Agreement (COP 21): green leadership empowers public hospitals to overcome obstacles and challenges in a resource-constrained environment. S Afr Med J. 2016;107(1):34-38. doi:7196/SAMJ.2016.v107.i1.12023
  19. Ryan-Fogarty Y, O'Regan B, Moles R. Greening healthcare: systematic implementation of environmental programmes in a university teaching hospital. J Clean Prod. 2016;126:248-259. doi:1016/j.jclepro.2016.03.079
  20. Langstaff K, Brzozowski V. Managing environmental sustainability in a healthcare setting. Healthc Manage Forum. 2017;30(2):84-88. doi:1177/0840470416675178
  21. Bharara T, Gur R, Duggal SD, Jena P, Khatri S, Sharma P. Green hospital initiative by a North Delhi tertiary care hospital: current scenario and future prospects. J Clin Diagn Res. 2018;12(7):DC10-DC14. doi:7860/jcdr/2018/34360.11758
  22. Voudrias EA. Healthcare waste management from the point of view of circular economy. Waste Manag. 2018;75:1-2. doi:1016/j.wasman.2018.04.020
  23. Aslan M, Yıldız A. How blameless are hospitals in climate change? An example of a province in Turkey. Environ Socio-Econ Stud. 2019;7(4):45-53. doi:2478/environ-2019-0023
  24. Salas RN, Maibach E, Pencheon D, Watts N, Frumkin H. A pathway to net zero emissions for healthcare. BMJ. 2020;371:m3785. doi:1136/bmj.m3785
  25. Blum S, Buckland M, Sack TL, Fivenson D. Greening the office: Saving resources, saving money, and educating our patients. Int J Womens Dermatol. 2021;7(1):112-116. doi:1016/j.ijwd.2020.04.013
  26. Sherman JD, Thiel C, MacNeill A, et al. The green print: advancement of environmental sustainability in healthcare. Resour Conserv Recycl. 2020;161:104882. doi:1016/j.resconrec.2020.104882
  27. Muñoz A. Reducing health care's carbon footprint--the power of nursing. Workplace Health Saf. 2012;60(11):471-474. doi:1177/216507991206001102
  28. Manzi S, Nichols A, Richardson J. A non-participant observational study of health and social care waste disposal behaviour in the South West of England. J Health Serv Res Policy. 2014;19(4):231-235. doi:1177/1355819614538780
  29. Ali M, Wang W, Chaudhry N. Application of life cycle assessment for hospital solid waste management: a case study. J Air Waste Manag Assoc. 2016;66(10):1012-1018. doi:1080/10962247.2016.1196263
  30. Ali M, Wang W, Chaudhry N, Geng Y. Hospital waste management in developing countries: a mini review. Waste Manag Res. 2017;35(6):581-592. doi:1177/0734242x17691344
  31. Capoor MR, Bhowmik KT. Current perspectives on biomedical waste management: rules, conventions and treatment technologies. Indian J Med Microbiol. 2017;35(2):157-164. doi:4103/ijmm.IJMM_17_138
  32. Barbosa FCL, Mol MPG. Proposal of indicators for healthcare waste management: Case of a Brazilian public institution. Waste Manag Res. 2018;36(10):934-941. doi:1177/0734242X18777797
  33. Zamparas M, Kapsalis VC, Kyriakopoulos GL, et al. Medical waste management and environmental assessment in the Rio University Hospital, Western Greece. Sustain Chem Pharm. 2019;13:100163. doi:1016/j.scp.2019.100163
  34. Ferronato N, Ragazzi M, Torrez Elias MS, Gorritty Portillo MA, Guisbert Lizarazu EG, Torretta V. Application of healthcare waste indicators for assessing infectious waste management in Bolivia. Waste Manag Res. 2020;38(1):4-18. doi:1177/0734242x19883690
  35. Rizan C, Bhutta MF, Reed M, Lillywhite R. The carbon footprint of waste streams in a UK hospital. J Clean Prod. 2021;286:125446. doi:1016/j.jclepro.2020.125446
  36. García-Sanz-Calcedo J, de Sousa Neves N, Fernandes JP. Assessment of the global warming potential associated with the construction process of healthcare centres. J Build Phys. 2021;44(4):309-25. doi:1177/1744259120914333
  37. Sahamir SR, Zakaria R, Omar MF, et al. Energy Efficiency Criteria for Planning and Design of Green Hospital Buildings Rating System. IOP Conference Series: Materials Science and Engineering. 2019;620:012082.
  38. Prada M, Prada IF, Cristea M, et al. New solutions to reduce greenhouse gas emissions through energy efficiency of buildings of special importance – Hospitals. Science of the Total Environment. 2020;718:137446. doi:10.1016/j.scitotenv.2020.137446
  39. Wootton R, Tait A, Croft A. Environmental aspects of health care in the Grampian NHS region and the place of telehealth. J Telemed Telecare. 2010;16(4):215-220. doi:1258/jtt.2010.004015
  40. Oliveira TC, Barlow J, Gonçalves L, Bayer S. Teleconsultations reduce greenhouse gas emissions. J Health Serv Res Policy. 2013;18(4):209-214. doi:1177/1355819613492717
  41. Holmner Å, Ebi KL, Lazuardi L, Nilsson M. Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector. PLoS One. 2014;9(9):e105040. doi:1371/journal.pone.0105040
  42. Dullet NW, Geraghty EM, Kaufman T, et al. Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants. Value Health. 2017;20(4):542-546. doi:1016/j.jval.2017.01.014
  43. Vidal-Alaball J, Franch-Parella J, Lopez Seguí F, Garcia Cuyàs F, Mendioroz Peña J. Impact of a telemedicine program on the reduction in the emission of atmospheric pollutants and journeys by road. Int J Environ Res Public Health. 2019;16(22):4366. doi:3390/ijerph16224366
  44. Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J. 2021;8(1):e85-e91. doi:7861/fhj.2020-0080
  45. Sánchez-Barroso G, González-Domínguez J, García-Sanz-Calcedo J, Sokol M. Impact of weather-influenced urban mobility on carbon footprint of Spanish healthcare centres. J Transp Health. 2021;20:101017. doi:1016/j.jth.2021.101017
  46. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11(6):e0157014. doi:1371/journal.pone.0157014
  47. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health. 2018;2(1):e27-e35. doi:1016/s2542-5196(17)30180-8
  48. Wu R. The carbon footprint of the Chinese health-care system: an environmentally extended input-output and structural path analysis study. Lancet Planet Health. 2019;3(10):e413-e419. doi:1016/s2542-5196(19)30192-5
  49. Eckelman MJ, Sherman JD, MacNeill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental-epidemiological analysis. PLoS Med. 2018;15(7):e1002623. doi:1371/journal.pmed.1002623
  50. Nansai K, Fry J, Malik A, Takayanagi W, Kondo N. Carbon footprint of Japanese health care services from 2011 to 2015. Resour Conserv Recycl. 2020;152:104525. doi:1016/j.resconrec.2019.104525
  51. Weisz U, Pichler P-P, Jaccard IS, et al. Carbon emission trends and sustainability options in Austrian health care. Resour Conserv Recycl. 2020;160:104862. doi:1016/j.resconrec.2020.104862
  52. Alshqaqeeq F, Amin Esmaeili M, Overcash M, Twomey J. Quantifying hospital services by carbon footprint: a systematic literature review of patient care alternatives. Resour Conserv Recycl. 2020;154:104560. doi:1016/j.resconrec.2019.104560
  53. Lozano R, Garcia I. Scrutinizing sustainability change and its institutionalization in organizations. Front Sustain. 2020;1:1-16. doi:3389/frsus.2020.00001
  54. European Commission directive. Directive 2008/98/EC of the European Parliament and of the Council. EC; 2008.
  55. European Commission (EC). Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: Towards a Circular Economy: A Zero Waste Programme for Europe. EC; 2014.
  56. European Commission (EC). Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: Closing the Loop - An EU Action Plan for the Circular Economy. EC; 2015.
  57. World Health Organization (WHO). WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. Geneva: WHO; 2020.
  58. Ministry of Health, Welfare and Sport. Government of the Netherlands - Sustainable Healthcare. Available from: https://www.government.nl/topics/sustainable-healthcare/more-sustainability-in-the-care-sector.
  59. Joint Research Centre (JRC). Science for Circular Economy. JRC; 2014.
  60. European Commission (EC). Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions - A Roadmap for Moving to a Competitive Low Carbon Economy in 2050. EC; 2011.
  61. United Nations. The Sustainable Development Goals Report 2019. United Nations; 2019.
  62. Berry P, Enright PM, Shumake-Guillemot J, Villalobos Prats E, Campbell-Lendrum D. Assessing health vulnerabilities and adaptation to climate change: a review of international progress. Int J Environ Res Public Health. 2018;15(12):2626. doi:3390/ijerph15122626
  63. World Health Organization (WHO). Health and Climate Change: Country Profile 2021: Malta. WHO; 2021.
  64. Ministry of Environment. Brazil: National Adaptation Plan to Climate Change - Volume II: Sectoral and Thematic Strategies. Ministry of Environment; 2016.
  65. World Health Organization (WHO). Hospital Safety Index: Guide for Evaluators. WHO; 2015.
  66. Lenzen M, Malik A, Li M, et al. The environmental footprint of health care: a global assessment. Lancet Planet Health. 2020;4(7):e271-e279. doi:1016/s2542-5196(20)30121-2
  67. United Nations. Transforming our World: The 2030 Agenda for Sustainable Development. United Nations; 2015.
  68. MacNeill AJ, Hopf H, Khanuja A, et al. Transforming the medical device industry: road map to a circular economy. Health Aff (Millwood). 2020;39(12):2088-2097. doi:1377/hlthaff.2020.01118
  69. Sherman JD, McGain F, Lem M, Mortimer F, Jonas WB, MacNeill AJ. Net zero healthcare: a call for clinician action. BMJ. 2021;374:n1323. doi:1136/bmj.n1323
  70. Barratt A, McGain F. Overdiagnosis is increasing the carbon footprint of healthcare. BMJ. 2021;375:n2407. doi:1136/bmj.n2407
  71. Mir FA, Morgan L, Houghton E. Tackling overprescribing. BMJ. 2021;375:n2539. doi:1136/bmj.n2539
  72. Taylor T, Mackie P. Carbon footprinting in health systems: one small step towards planetary health. Lancet Planet Health. 2017;1(9):e357-e358. doi:1016/s2542-5196(17)30158-4
  73. World Health Organization (WHO). WHO Global Strategy on Health, Environment and Climate Change: The Transformation Needed to Improve Lives and Wellbeing Sustainably Through Healthy Environments. Geneva: WHO; 2020.
  74. World Health Organization (WHO). Healthy Hospitals, Healthy Planet, Healthy People: Addressing Climate Change in Health Care Settings. WHO; 2009.
  75. Ibn-Mohammed T, Mustapha KB, Godsell J, et al. A critical analysis of the impacts of COVID-19 on the global economy and ecosystems and opportunities for circular economy strategies. Resour Conserv Recycl. 2021;164:105169. doi:1016/j.resconrec.2020.105169
  76. World Health Organization (WHO). Health-Care Waste. Available from: https://www.who.int/news-room/fact-sheets/detail/health-care-waste.
  77. Grimmond T, Reiner S. Impact on carbon footprint: a life cycle assessment of disposable versus reusable sharps containers in a large US hospital. Waste Manag Res. 2012;30(6):639-642. doi:1177/0734242x12450602
  78. McPherson B, Sharip M, Grimmond T. The impact on life cycle carbon footprint of converting from disposable to reusable sharps containers in a large US hospital geographically distant from manufacturing and processing facilities. PeerJ. 2019;7:e6204. doi:7717/peerj.6204
  79. European Environment Agency. Greenhouse Gas Emissions from Transport in Europe. Available from: https://www.eea.europa.eu/data-and-maps/indicators/transport-emissions-of-greenhouse-gases-7/assessment. Accessed December 15, 2020.
  80. Carino S, Porter J, Malekpour S, Collins J. Environmental sustainability of hospital foodservices across the food supply chain: a systematic review. J Acad Nutr Diet. 2020;120(5):825-873. doi:1016/j.jand.2020.01.001
  81. Economist Impact. Do No Harm: Healthcare Professionals Address Sustainability and Climate Change. Available from: https://impact.economist.com/sustainability/resilience-and-adaptation/healthcare-professional-and-climate-change.
  82. Esmaeili A, Twomey JM, Overcash MR, Soltani SA, McGuire C, Ali K. Scope for energy improvement for hospital imaging services in the USA. J Health Serv Res Policy. 2015;20(2):67-73. doi:1177/1355819614554845
  83. Ellen MacArthur Foundation. Material Economics. Completing the Picture: How the Circular Economy Tackles Climate Change. Ellen MacArthur Foundation; 2019.
  84. Das AK, Islam MN, Billah MM, Sarker A. COVID-19 pandemic and healthcare solid waste management strategy - a mini-review. Sci Total Environ. 2021;778:146220. doi:1016/j.scitotenv.2021.146220
  85. Hantoko D, Li X, Pariatamby A, Yoshikawa K, Horttanainen M, Yan M. Challenges and practices on waste management and disposal during COVID-19 pandemic. J Environ Manage. 2021;286:112140. doi:1016/j.jenvman.2021.112140

Files

History

  • Receive Date: 16 November 2021
  • Revise Date: 29 November 2022
  • Accept Date: 19 April 2023
  • First Publish Date: 07 May 2023

Share

How to cite

Statistics