being here and I want to echo what Wayne has said about thanks to Skye for actually having us talk about this. So I was tasked with the talk of make your cath lab greener the environment will thank you. There's a little bit of overlap with some things that Mervod talked about so we'll kind of go over those quickly. I have no disclosures and just briefly want to review the environmental impact of health care and cath lab waste. We talked about this a little bit already and then identify steps to reduce the carbon footprint of the cardiac cath lab. So just to kind of come back around and remind people of the scope of the problem. Climate change is one of the greatest threats to global health in the 21st century and as physicians we should all care about that. It's not just you know direct threats or indirect and direct threats. You know you think about changing patterns of disease. I think COVID was a pretty good example of that. Food and water insecurity and vulnerable shelter. I think the biggest thing in my mind is that you know climate change is going to exacerbate the inequities between the rich and the poor. And just because of the way the carbon footprint is created you know it will have you know basically the people who have contributed least to the cause are going to experience the greatest effect of climate change. Meaning poorer countries will experience more of an effect on their daily life than you know first world countries such as the one we live in. This is just an estimated effect of climate change from Lancet back in in 2009. And the light blue so the Africa region is expected to experience about 300 times more of an impact on their disability adjusted life years. So this is time lived with disability or time lost due to premature mortality. So if you look at Africa versus developed countries such as the U.S. or Europe there's a significant difference in the impact of climate change. And health care is a big part of that. Direct emissions as Mervat mentioned are actually relatively low and the biggest area where the health care system contributes to the greenhouse gas emissions are from supply chain issues. On average the U.S. health care constitutes about five percent of the national carbon footprint and planetary greenhouse gas emissions about four to five percent of those are from health care. The U.S. health care in and of itself has a carbon footprint similar to the national carbon footprint of Italy. So just think about that. And if U.S. health care were a country it would be 14th on the list of the highest greenhouse gas emitters and health care as a whole would be fifth in the world as in terms of greenhouse gas emissions. And this is compounded by the fact that at the current trajectory health care carbon footprint is expected to triple by 2050. So as Mervat mentioned this is the time of action. So does the cath lab contribute to this? Hospitals overall disproportionately account for most of health care related waste about 70 percent and of all hospital departments cath labs and ORs are the largest contributors. Multiple factors contribute to this unnecessary waste supply chain inefficiencies as was previously mentioned. There's essentially very little to none in terms of reuse and recycling and then population growth and things that are already have been mentioned. You know the bigger thing is that if you search PubMed for cath lab environmental sustainability there is exactly one publication on PubMed and as of now no major U.S. interventional cardiology societies have practice guidelines or consensus statements to address this. So again good for Skye for having us here but I think we can do more. So supply chain issues I think I'll just skip over this because it was already mentioned but what can be done there are sort of we talked about different strategies before but I think this is actually all one sort of continuum in my mind. First we have to acknowledge issue, seek appropriate non-invasive investigations. That's bad for interventional cardiologists to say right because we want to do procedures but procedures create waste and so having appropriate non-invasive procedures first is important and then the five R concept that we'll talk a little bit about implementation and monitoring. So first acknowledging the issue as was mentioned you know this is a collaboration between clinicians, hospital administrators and actually policymakers too. We talked about how CMS reimbursement hasn't gone up and maybe this is something that should be in policy maybe more environmentally friendly locations or facilities it may see we could advocate for you know higher reimbursement or something like that just to give an incentive. Raise awareness within within the cath lab team and and you know examine potential areas for waste. In our cath lab we had some nurses come up and be like what can we do about all this garbage you know that we're throwing away. I have one case creates more garbage than my house in a week you know is what one of them said to me and so empowering the cath lab to say something as well and get involved and then collaboration and healthy competition between institutions. I think the one paper that you can find on PubMed suggested a hashtag green cath lab and I think that's a pretty good idea. So seeking appropriate non-invasive investigations although we're interventional cardiologists it is important right as cath lab volumes increase the population gets older you know waste goes up and the number of procedures is directly related to the volume of waste produced. If you think about in your own lab we all kind of have those days where there's no PCIs and everything's normal and an estimated 60 percent of elective caths in the U.S. find no obstructive coronary disease. So the first R we want to talk about is to reduce you know review the contents of your cath lab packs we all have items in our cath lab pack where you just throw it in the garbage you're like why is this even here you know we have like four cups for two meds that we put on the table or whatever and aim to sort of just start with leaner cath packs and then you can open items as you need them and if you look at your packs try and aim for a 25 to 50 percent reduction that's probably the you know most cath packs probably have that much waste. Look for alternatives to bulky packaging and this is something we would have to work with with our industry partners and you think about how stents come in a box and then there's a bag and all of these things you know and many things that we have still have paper instructions even in the era of electronics and so working with industry partners to reduce the amount of waste just within our packaging itself. In your own individual institution you could consider conducting a paper use audit to reduce overall paper waste. You know with electronic medical record these days you really shouldn't have a ton of paper and then as Mervant mentioned you know an open only to use policy so it's important to educate staff on this as well. Reusing we think about is maybe a little bit harder with a lot of things that are labeled for single use only and things like that but you could look through your cath lab and identify single use products that maybe could be replaced with reusable alternatives or things that can be re-sterilized. I know in our cath lab we started to re-sterilize and reprocess IVAS catheters and they still work you know we do it with ice you know all the time and so why not IVAS especially if you're using IVAS on on every PCI which I do. Look at not only things that we use for the procedure but patient care items that can be reused such as like pulse ox cords, blood pressure cuffs and there are even if you can't reuse them there are eco-friendly sort of recycling programs available. Consider reusable versus single use gowns this is something also that you don't really think about unless you talk about it. There was one study in Australia that a large hospital system just changed from the paper reusable gowns to cloth gowns and it reduced solid waste generation by 84 percent and greenhouse gas emissions from the individual hospital by 66 percent so a small thing that could really make a big difference. And then finally recycle this sounds really simple but it actually can be challenging in health care because everybody's concerned about biological hazard waste exposure but really we should aim to capture 100% of recyclable materials. If you think about the things that we throw away most of them are metal and plastic and those take decades if not centuries to sort of decompose if they ever do and so those are things that you can work with manufacturers about take back programs or even just try to develop a recycling program within your own institution. Simple initiatives such as a green bag for recyclable waste in the cath lab has been demonstrated to reduce overall waste by 15 percent per year at Stanford and so just having a recycling label bag in your cath lab you could actually you could at least capture the things that don't have biological hazard material on them like the packaging and those sorts of things. And then post a visual list of items that can be recycled in your cath lab and make sure that the the staff know about it hard plastics cardboard packaging from catheters and devices and then talk to your manufacturing partners about recycling take back programs. So once you sort of look at everything you know how do you implement it how do you sort of monitor it how do you make this a reality and it's I think about it a lot sort of akin to like your morbidity and mortality that you have we have morbidity mortality conference every month so you have a CQI team that has nurses physicians administrators and you basically want to quantify your baseline use and track your progress. Everybody loves to see numbers right so I think if you can say like we're here and we had this much this many pounds of waste per case and then after these initiatives now we have this you know it's an incentive for people and it gives people something to be proud of and by tracking it and measuring waste I think you can kind of get more buy-in from your staff and your administrators not only tracking the amount of waste but the cost benefits we had a nice talk about how you can sort of maximize efficiency so I won't go into that but there was a large health system in Europe that really put forth environmentally friendly initiatives and they found that by doing these things you could save an estimated five billion dollars over five years and 15 billion over 10 years in one study that was you know a very large health system but really the savings can be real. I think one thing that would really help with this would be national benchmarking and some help from our societies in terms of guidance this would allow for us to compare across institutions track progress and allow for constructive feedback and collaboration is really going to be key not only within your own institution but with interventional leadership societies manufacturing even maybe insurance providers government agencies. This is a nice slide borrowed from Bina Ahmed's editorial in JSCI last summer and just kind of outlines you know basic steps that you can take to make your cath lab greener I know it's kind of busy but really establish a sustainability team I think this is a great way for nurses and physicians to collaborate together and then kind of just go down the line with things we talked about so I'm running out of time so in conclusion you know climate change is a major threat to global health and the hospital and supply chain generate a ton of waste there are lots of opportunities in the cath lab for improvement and you know greener cath labs have environmental and financial benefits so it's something that we should all want to do. Thanks.

environmental impact

healthcare

cath lab waste

climate change

greenhouse gas emissions