sustainability - Lamp Online

Alice Suttie CNS works in a surgical hospital in Sydney – but she has some doubts about the extensive use of gloves. Do you agree? We’d especially like to hear from other theatre nurses – but all nurses and midwives too.

I listened to the information being passed on at one of our theatre meetings not so long ago … and it got me thinking. The topic was ACORN Standards relating to double gloving for surgery and the recommendation that green gloves be used under cream or white gloves to make it easier to spot tears or loss of glove integrity. My mind filled with stories from my colleagues who had recently returned from a trip to the Solomon Islands: how little they have compared to our wealthy first world private hospital and our wealthy first world decision-making bodies!

At what point do we, instead of making rules about gloves, actually pause and consider the privilege of having sterile gloves and disposable gloves at all? Is making recommendation standards based on such utter inequality justified – even where efforts are made to get supplies to the poorest nations? Or should standards be based on something that can be achieved in less than ideal circumstances so that there may be a better distribution of funding? If our standards were based on what’s achievable for countries that don’t have first world wealth, would we be able to maintain a standard of practice that has both cost savings and the possibility of better use of resources – a more equitable distribution?

Is it appropriate to make standards based on double gloving and colour coding? In asking if it’s appropriate, I question our actions deeply in terms of the environmental impact. My own hospital is making progress with recycling, but we have yet to begin talking about reducing waste. Do we really need to flood the environment with so many pairs of used gloves? How many nurses have any idea what happens to gloves once they are tossed away to be burnt or added to landfill? How long do they last in the environment? How toxic are the fumes if they are incinerated? What is their impact on the people who live near their disposal sites – on the birds, the animals, the plants and insect life?

I mentioned my thoughts to one doctor in the tearoom and he agreed with my sentiments, noting that he had volunteered on one of the island countries off our coast where a circular has been passed around asking people to please refrain from wearing sterile gloves unless it was absolutely necessary. And here we have standards recommending two pairs, colour-coded!

When our standards are produced, I know the process is rigorous and has various guidelines that need to be adhered to. However, I suspect those guidelines are not inclusive of environmental impact, judging by the ever-increasing number of recommendations steering us away from reusable items (material drapes have been targeted, along with our washable cloth caps, in theatre). I am deeply troubled about this trend as I don’t think it is taking the precarious nature of our time on this planet into account. Healthcare is going to need some very deep rethinking as we move into an increasingly unstable and uncertain future. We cannot continue to make decisions that ignore the situation of other nations or the environment as if we aren’t all connected – because, like it or not, we are.

Previously on Nurse Uncut:

Useful info on hospital sustainability:

NSW nurses Libby and Bella braved Denmark in winter to discuss sustainability in healthcare – and along the way sampled many delicious croissants!

Libby tells the story: I could begin this article by alarming you with facts from the growing body of evidence which links climate change and health. I could depress you with statistics on the rising rates of cardiovascular, respiratory, water-borne and mental health disease as a direct consequence of climate change. But that would be tedious.

I could talk to you about some of the reasons the health of the Australian population is at great risk, due to social, environmental and geographic factors exacerbated by minimal and inadequate engagement to date by government to address and formulate a climate change policy.

I don’t need to tell you any of that, as most of us, especially healthcare workers, are beginning to realise our world is changing and are trying to understand how these global changes are affecting our health, our behaviour and ultimately our future. I won’t tell you any of that.

I could, rather, tell you a little story of an adventure by my colleague Bella and I on the other side of the world. We were on a quest to learn more about the links between climate change and health. Here are some of the lessons we learnt.

Lesson 1: Riding a bicycle in icy wind in 50 layers of clothing is tricky.

Copenhagen (pronounced co-pen-hay-gen, not, as we were informed at the airport, co-pen-haaar-gen) in October/November is cold! It’s really really cold. Armed with our best thermal underwear, pom-pom beanies and puffy jackets, Bella and I disembarked from the plane ready to tackle the windy city like locals … on bicycle. We had arrived in Denmark to attend CleanMed Europe 2016, Europe’s leading conference on sustainability in healthcare, attended by 250 delegates from 26 countries across five continents.

Interested stakeholders met to network and develop knowledge on the latest in sustainable healthcare. As an equally important research topic, we had travelled 15,702km to sample every delicious, buttery, freshly-baked croissant we could fit into our mouths.[Right, Bella with pastries – yum!]

We had previously commenced a successful quality initiative program in our northern NSW Intensive Care Unit, fed up with the ever-growing quantities of potentially recyclable material discarded to landfill. In Europe, we discovered that the Capital region of Denmark has set an ambitious target of becoming carbon neutral by 2025, then completely fossil-free by 2050!

A big lesson we learnt was that great achievements can be made with a supportive, insightful government that formulates policies in collaboration with relevant stakeholders. We also quickly learnt that Danes are not only impeccably well dressed, but they also, very importantly, make great pastry!

Lesson 2: There is a serious global drive to transform policy to adapt the way healthcare is delivered in order to reduce its impact on the environment – and Australia is lagging behind.

Throughout both the developed and developing world, health care providers are presented with similar issues and obstacles – hospitals are a dirty business. Often the largest industry in any region, the way hospitals view and manage their waste, energy, water, product procurement, food and transport directly impacts on the environment. The health of the environment directly correlates to the health of its community. By formulating policies that drive a cleaner, greener, healthier, more responsible industry, government can create real momentum for change. Denmark demonstrated to us this very real potential for large industry, including healthcare, to become leaders in sustainability. For example, 42 percent of electricity in Denmark is fuelled by wind farms (incidentally, a lot less offensive on the eye than an open cut mine). Less than one percent of Copenhagen’s garbage makes it into landfill, being either reused to make energy or recycled. About 45 percent of all trips to work are currently made by bicycle, supported by government ride-to-work schemes and the development of super bike highways. Seventy-five percent of riders are even committed enough to ride throughout the winter, possibly the most astonishing fact!

The healthcare sector in the Capital Region of Denmark is further committed to offsetting carbon emissions (and also to just making their patients happier) through sourcing organic locally-grown food and preparing delicious, actually nutritious patient meals. One hospital even made their own organic jam on-site (at no extra cost I must add)! No mass-produced, sugar-filled chocolate-flavoured dessert or jelly cup in sight! In terms of sustainable building, plans are well underway for a new hospital to be constructed in 2020, according to stringent environmental and sustainability guidelines.

Lesson: Sadly, Australia is lagging behind.

Bella and I flew home to serve our jelly cups to patients, solo driven cars, dirty coal-fuelled power and angry drivers forcing us on our bicycles back into the ditch. Oh how we miss those wonderful bicycle lanes! [Right, Libby kisses her freezing bike.]

But I do need to remind myself it’s not all doom and gloom Down Under. There are many wonderful programs dotted about the country making ground-breaking progress in sustainability in healthcare. With these programs, such as the humble recycling initiative in our own ICU, there comes a slow but steady raising of awareness. To our surprise, we have witnessed this in our very own hospital. Others have begun to show interest and staff from the wards have come to marvel at the wonder of our glorious shiny recycling bins. Executive is now interested in standardising recycling throughout the entire hospital!

With this in mind, it has never been a better time for the Framework for a National Strategy on Climate, Health and Well-being for Australia. Maybe it will take a while before we have super bike highways and homemade organic jam, but it’s a great place to start the dialogue.

Lesson 3: We can make real change if we all work together.

At the risk of sounding like a clichéd bumper sticker, this message was delivered at conference with genuine enthusiasm and left me almost wishing we would all hold hands and group-hug it out. Almost.

Founder of Healthcare Without Harm Gary Cohen closed the conference with a moving plenary, leaving us all with a renewed sense of positivity. His simple vision was of a low carbon, toxic-free, technologically-sustainable future for healthcare. Cohen encouraged us to expand our role as healers, healing communities and healing the planet, not just individuals. He urged us to challenge the status quo and work together for a more sustainable healthcare. I am not ashamed to admit I had a tear in my eye, as I realised suddenly how proud I was of Bella and myself (maybe it was too many glasses of fine local wine). We had travelled to the other side of the world in search of answers. Although we returned with a sense of urgency, we also felt better equipped to tackle our own challenges back home, through learning from our European colleagues and their successes.

My friend in Europe is yet to convince me that climate change is great, because apparently due to global warming he doesn’t have to ride his bicycle through as much snow every winter. I’m not convinced. I’m pretty sure a changing planet is bad, really really bad, and that our health is more dependent on it than we are yet to realise.

Previously on Nurse Uncut:

Do nurses really need to use so many gloves?

Libby: Two nurses, bikes, croissants and sustainability in healthcare