Environmentally Sustainable Practices in the Operating Room: A French Nationwide Cross-Sectional Survey of Anaesthesiologists and Nurse Anaesthesiologists

Abstract

Objective: In France, healthcare facilities account for 7% of greenhouse gas emissions and 3.5% of total waste generation. Operating rooms generate 30% of hospital waste and hence should be a primary focus of environmental sustainability initiatives. The aim of this study was to evaluate environmentally sustainable anaesthesiology practices in France in 2020 and understand the barriers to their adoption. Methods: An anonymous survey of 28 questions was published online. The website did not record participants’ IP addresses. The survey’s link was sent by email to anaesthesiologist and anaesthesia nurse members of the French Society of Anesthesia and Intensive Care Medecine (SFAR), in February and June 2020. The survey was closed in August 2020. Results: Of the 10 877 recipients, 1092 (10%) responded to the questionnaire. Waste sorting was organized in 69% of respondents’ workplaces (691/1007), and 90% (793/879) of respondents stated that they most often followed the instructions. Sixty-five percent (659/1007) of respondents avoided using the most polluting anaesthetic gases. Thirty-nine percent of respondents (417/1064) had already received environmental sustainability training and 73% (705/972) stated that they wanted more training. The main barriers to the adoption of recycling identified by respondents were staff training (by 70% of respondents, 691/993), budget constraints (66%, 652/993), and a lack of administrative support (60%, 602/993). Conclusion: French anaesthesiologists and anaesthesia nurses who responded to the survey are environmentally aware and want to improve sustainable practices in the operating room. More widespread adoption could be achieved by offering training to all healthcare professionals and administrative staff and by creating local environmental focus groups to coordinate actions.

Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework

“…In Petre et al . 75 , participants felt that there was a lack of institutional or departmental support for sustainability measures and either no clear mandate from leadership in the hospital or no mandate at all, and these findings were repeated in other studies 60 , 68 – 70 , 73 , 78 . Leppänen et al .…”

“…Often, studies did not differentiate between roles when reporting determinants of behaviour. Many studies did not report the specific role or specialty of the participants; of those that did, eight involved anaesthetists and associated healthcare workers 60 , 62 , 66 , 67 , 73 , 75 , 78 , 80 , and one study for each of the specialties of cataract related healthcare 63 , obstetrics and gynaecology 77 , ear nose and throat 69 , and ophthalmology 64 . A further study reported the department of each participant, with 11 specialties included, such as vascular surgery, trauma and orthopaedics, and plastic surgery 70 .…”

“…Twelve studies aimed to investigate general knowledge, attitudes, and behaviours around sustainability in the workplace 60 , 64 , 66 – 72 , 75 , 77 , 78 . Eight were focused on specific areas of sustainability, either recycling or waste reduction/management or both 61 – 63 , 65 , 73 , 74 , 76 , 79 , and the remaining study investigated anaesthesia 80 .…”

“…‘Availability of financial resources’ was a further barrier within this domain (6 studies; 29%). In these studies, participants noted that their hospitals did not have the funding or budget to research or implement programmes to improve sustainability 62 , 68 , 70 , 73 , 75 , 78 . ‘Equipment design’ was referenced as a barrier in three studies (14%).…”

Strategies for Achieving Sustainable Anesthesia: Insights from Austrian Experts—A Qualitative Interview Study

“…To tackle this issue, the formation of multidisciplinary teams dedicated to environmental sustainability within hospitals or hospital networks could provide a partial solution. These "green teams" have to receive specialized training on theoretical, practical, and regulatory aspects of sustainability and would work to enhance staff awareness and improve communication on these issues among the various stakeholders [39]. Due to the various negative environmental impacts of perioperative medicine already described here, it is pivotal that anesthesiologists must be represented in such teams.…”