PCI and the Planet

Ahmed, Journals and Presentations / 06.10.20200 comments

The arteries had been recanalized, the Swan- Ganz catheter was in place to help guide clinical decisions, a temporary venous pacer was faithfully generating 80 impulses a minute, and the hemodynamic support device was unloading the sickened muscle. The patient had shown up on the verge of death and now was leaving the cath lab critically ill, but stable. The teamwork was remarkable despite the 4am hour and as I took my lead apron off to document the last three hours of effort, I looked around to see what was left behind… blood, sweat and bins full of trash and plastic containers.

For those who believe in science, it is impossible to deny the innumerable ways humanization is contributing to the destruction of the planet. The culmination of years of irresponsible consumption has paved the way for climate change and with it, weather-related disaster after disaster. Unprecedented flooding, entire towns reduced to ashes by raging fires, droughts bad enough to cripple economies, and rampant destruction of the oceans are some of the reasons climate change has been described as the greatest threat to the human civilization in the 21st century. Generations are up in arms about all that needs to be done and that isn’t being done. From afar, the cause-and-effect link between bottomless utilization of non-renewable resources, uncontrolled CO2 production, and climate change is clear (to most). But how we as a human race, country, state, community, family, and individual can affect the overdue change is anything but clear.

Like other major economic sectors, the global healthcare industry is massive and makes an un- healthy contribution to all that ails the planet. It consumes large quantities of natural resources, spews significant amounts of greenhouse gases into the atmosphere, and generates hundreds of tons of waste each year. Hospital systems are big structures that not only have a large physical footprint, but an ecologic one to match. Every step of healthcare delivery within the walls of hospitals consumes resources and for too long, we have not stopped to think about what it leaves behind. And more importantly, why should we as healthcare providers concern ourselves with the unintended ecologic footprint created as we take care of our patients?

For one, given the large size of the healthcare system (U.S. and globally), a sustainability effort can be very impactful. We as interventional cardiologists like high- yield results and in this case, even small corrections will come with big gains. Second, prioritizing ways to make the system and process more efficient and less wasteful will yield cost savings. Financial incentives to be greener are plentiful, including reducing waste (spending less), increased energy savings, and minimizing productivity losses due to a healthier work force. And though the larger-scale corrections such as regenerative architectural design (buildings that are resource generators rather than consumers) will take time and cost up front, there is no denying the long-term benefits of lower/non-polluting practices and the resulting impact on economic growth. Third, it should be clear that the health of the human race is intricately related and dependent on a healthy planet. If our priority is our patients, then we have to factor in the health of the planet. Pollution-related illness represents 25% of diseases worldwide and even small steps in the direction of lowering emissions will improve the health quality of the population as a whole.

There are many in healthcare who are concerned, and many more who have not made the connection between healthcare and its contribution to climate change and why it needs us to lead the charge for change. It can be easily assumed that what we do as providers serves a means to an end. Patients are the priority, and all else is a necessary and required part of the process. But there are countless ways we can improve our footprint while we best treat our patients. To that end, for those of us who are part of teams working in cath labs, our efforts have to begin where we work (Table 1).

Starting a sustainability assessment in the cath lab should focus on reducing (minimalist cath procedure), re-using (replacing single-use prod- ucts with instruments that can be sterilized), and recycling. An assessment along the entire utilization chain can help identify ways to limit landfill waste, increase recyclables, and reduce use of unnecessary products. Educating everyone in the lab and hospital system about the existing recycling chain, examin- ing materials that are non-essential, and replacing essential materials with sterilizable options to limit inclusion of single-use products are a few ways to have immediate impact.

We, as part of a cath lab team, go above and beyond to treat, rescue, and save each individual patient. What we need now is commitment to equally consider planet care as we give patient care. Similar to applying the best evidence to guide our clinical practice, we are at a point where we also have to consider delivering the best care with the smallest footprint. It must start where we work and with the expectation that our systems of care as a whole will prioritize the health of our planet, permitting us to continue to take the best possible care of our patients.

Table 1. Ten Steps for a ‘Greener’ Cath Lab and Minimalist Cath Procedure.

  1. Evaluate current sustainability plan at the hospital and identify a sustainability team in charge of hospital-wide initiatives to reduce, reuse, and recycle.
  2. Build a Cath Lab Green Team (cath lab manager, cath lab staff, fellows).
  3. Learn about existing pathways of waste removal from the cath lab. Quantify (by weight) how much is currently going to landfill and recycling (if in place), in order to establish a baseline.
  4. Establish a plan to recycle in the cath lab. This includes identifying what the hospital program recycles. All qualifying rigid plastic and paper packaging materials should be kept clean and disposed at the time of being removed from sterile packaging and placed in the appropriate bin.
  5. Inquire about recycling take-back programs through manufacturing companies.
  6. Educate all cath lab staff, providers, and trainees about the steps to recycling and about what can and cannot be recycled.
  7. Ask waste management to assist with providing appropriate type and numbers of recycling bins for the cath lab.
  8. Review contents of existing cath packs and attempt to make ‘lean cath packs’.
  9. Replace single-use metal or plastic items (scalpels, plastic clips, clamps, forceps) with materials/instruments that can be re-sterilized.
  10. Plan to weigh weekly recyclable and landfill output over the next month and compare to baseline. Conduct an audit to ensure proper chain of waste management from the cath lab.

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