The Environmental Sustainability Network (ESN) advocates, collaborates and promotes initiatives and projects related to environmental sustainability within anaesthesia, perioperative and pain medicine and is available to fellows, trainees, SIMGs and non-ANZCA members.
The Environmental Sustainability Audit Tool has been developed by the ANZCA Environmental Sustainability Working Group and was launched on World Environment Day, 5 June 2020. The tool has been created to assist departments and practitioners to develop and maintain practices that promote environmental sustainability in line with ANZCA’s professional document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice.
While there are many actions that may be undertaken to improve sustainable practice broadly within the health sector, this audit tool is designed to help identify interventions that could reasonably be considered at an individual or departmental level.
The audit tool groups activities to improve environmental sustainability under the following headings: reduce, reuse, recycle, and leadership.
In this video, ANZCA councillor Dr Scott Ma and Wollongong-based trainee anaesthetist Dr Jess Hegedus explain how the audit tool was developed and how to use it.
Visit our Environmental Sustainability Libguide to explore an extensive range of journal articles, books, links and other resources on environmental sustainability in healthcare.
We're committed to proactive and positive action that reduces our environmental footprint and aligns with the expectations and achievements of its fellows, trainees and specialist international medical graduates.
This environmental sustainability work is ongoing and the college works with building facility companies, contractors, suppliers, venues, travel agents and the healthcare industry across Australia and New Zealand to constantly look for improvements.
Sustainability in our offices
From 2015 – 2020 the college has saved approximately seven hundred and twenty reams of paper by moving subscriptions, council elections, Research Foundation appeals and Christmas cards online. That is roughly equivalent to one acre of forest, something we are very proud of.
Our offices take part in recycling programs for e-waste, printer cartridges, paper and cardboard, comingled recycling, batteries and soft plastic. ANZCA House produces its own compost from kitchen waste to nourish its iconic cottage garden. Over the past five years almost all of the Halogen down lights and fluorescent tube lighting in ANZCA House have been replaced with more energy-efficient LED light fittings.
The college invests $A5000 annually in a government approved carbon emissions offset scheme which offsets approximately 25 per cent of emissions resulting from ANZCA-related airline travel. This supports the Australian Native Reforestation ‘Yarra Yarra Biodiversity Project’ and the New Zealand Afforestation Project.
COVID-19 has led to the advent of Zoom conferencing. Replacing travel with video conferencing has had a positive impact on the environment by reducing carbon emissions as well as substantially reducing costs.
We continue to assess ways to minimise our environmental footprint and are open to new initiatives as they become available.
Sustainability at ANZCA events
As part of the college’s commitment to environmental sustainability we have eliminated printed collateral and single use plastic. We no longer print registration brochures, handbooks or pocket programs for the Annual Scientific Meetings (ASM). The volume of paper to produce the brochures and handbooks for one ASM equates to approximately eight hundred and eighty reams of paper, which is in excess of fifty trees and well in excess of an acre of forest.
The college no longer saw this as tenable and now opts for online brochures and handbooks, provides access to the ASM scientific program virtually and promotes use of the onsite mobile app. The ASM utilises digital signage and where possible single use signage has been eliminated. If printed signage is required we ensure it is printed on material that is or can be recycled.
Since 2016, items we have eliminated from events include satchels, bottled water, and paper based tickets. At the 2019 ASM in Kuala Lumpur, we worked with the venue to change their catering processes and were proud that not one single use plastic water bottle was served as part of delegate catering or speaker refreshments. Together with your support we’re committed to ensuring this is the case for future ASMs. Your support of these environmental changes has helped drive the success and strengthened the positive impact on our meeting footprint. We know working together, we will continue to do better.
Where possible we have eliminated plastic name badges and when these are required we source materials that have been treated with EcoPure®, an organic additive designed to enhance the speed of plastic decomposition in landfills. Delegates are encouraged to bring their own Keep Cups and use the water stations for re-filling water bottles.
The college upholds a commitment to host events at venues, particularly for the ASM, that have a publicly available sustainability statement. We’ve worked with venues who have their organic waste converted to fertiliser and green electricity and have unused food given to people in need and diverting food waste from landfill.
We continue to strive towards fostering a more sustainable future for our members and the community.
ANZCA is recognised by Carbon Neutral, Australia's largest biodiverse reforestation offset developer, for being carbon neutral for 2019 and offsetting 485 tonnes of carbon emissions associated with flights for that year. The offset was split into two categories:
- NZ Forestry and Pacific Islands (Solomon, Fiji, Vanuatu) avoided deforestation
- Australia (WA) Biodiverse Reforestation Carbon Credits (BRCO), Yarra Yarra Biodiversity Corridor
More information on Carbon Neutral can be found here.
Replacing disposable theatre hats with washable cloth hats has been shown as a sustainable and economically viable alternative in many hospitals. Please visit our LibGuide with studies to support this.
Here are some tips that might be useful if you would like to approach your hospital to make the change.
- Find out if a policy exists at your hospital that governs theatre attire during surgery. A first port of call should be your online policy repository (if one exists). The next best alternative is your theatre NUM or in-charge; they’re frequently intimately aware of policies and protocols.
- Gather an interested and diverse team to support you. It’s best to include anaesthetists, surgeons, theatre nurses, infection control to ensure all appropriate aspects of the problem are considered. Consider involving your hospital’s sustainability team, if one exists.
- Write an evidence based proposal, present it to your hospital executive alongside an evidence based guideline. Include some versions that have been successful.
The Australia and New Zealand College of Anaesthetists are committed to reducing the carbon footprint of anaesthesia and provide guidance on environmentally sustainable practice in anaesthesia across Australia and New Zealand.
In this section you will find information on the environmental impact of anaesthesia. Your anaesthetist will always determine the type of anaesthetic they will use based on what they believe will have the best patient outcomes for you, however you may choose to discuss this information with you anaesthetist.
This publication includes text taken from the Royal College of Anaesthetists’ (RCoA) leaflet Your anaesthetic and the environment 2022 but the RCoA has not reviewed this as a whole.
Environmental impact of anaesthesia – equipment, drugs and gases
The use of all anaesthetic equipment, drugs, gases, together with their packaging, comes with a carbon footprint. All of these require energy to develop, produce and transport.
Some items, such as face masks, are ‘single use’ to reduce the risk of passing on infections, so they need to be changed for each patient.
All anaesthetics and anaesthetic techniques require the use of electricity to power monitors and medical equipment. Some equipment is used in most procedures such as ECG sticky dots to connect your skin to the ECG heart monitor, blood pressure cuffs to measure your blood pressure, as well as cannulae placed in your veins.
Anaesthetic gases and drugs also have a direct effect on the environment. Some gases used in anaesthesia have an additional greenhouse gas effect. This means that once breathed out they continue to have a warming effect on the atmosphere for many years to come.
The ‘science’ bit
Carbon dioxide and carbon dioxide equivalence (CO2e)
The term carbon dioxide equivalency (CO2e) is used to describe the warming effect of greenhouse gas emissions in relation to that for carbon dioxide (CO2). As a rule, anaesthetic gases are 100s to 1000s times more warming than carbon dioxide. The CO2e for an anaesthetic can be calculated by multiplying the specific warming effect of the individual gas (the GWP100) by the actual mass of gas used for the anaesthetic and then breathed into the atmosphere.
The range of anaesthetic options
There is usually more than one way of giving your anaesthetic. The decision as to which is best for you for a given procedure will be discussed when you meet your anaesthetist before your procedure. This will largely depend on your clinical needs and the surgeon’s requirements for your particular surgery. Your safety during surgery is paramount therefore clinical concerns may have to override any environmental concerns.
Anaesthetic options that are better for the environment
For some procedures local anaesthetic alone can numb a part of your body for surgery or a procedure. For example, hip replacement can be undertaken with a spinal injection in which very little drug is used yet is very effective. Some operations on the arm can be performed using a nerve block, to numb the nerves in the arm. Not all procedures, though, can be undertaken with local anaesthetic alone.
Anaesthetic options with low warming effects
There are anaesthetic gases in common use that have less impact on the environment. One is called sevoflurane. An hour's anaesthetic will have the warming effect of 800–1,600g CO2, the equivalent of driving 5–10km.
Alternatively, a mix of intravenous drugs can be given by injection – this is referred to as Total Intravenous Anaesthesia or TIVA. No anaesthetic gas is used with this technique, but there is still an environmental impact of its use.
Used here with permission from the Royal College of Anaesthetists’ (RCoA) and taken from their leaflet Your anaesthetic and the environment.
Anaesthetic options with moderate warming effects
These anaesthetics are 100s of times more warming than local anaesthetic alone.
For example, if nitrous oxide (laughing gas – N2O) is used as part of your anaesthetic, it significantly increases the environmental effect of your anaesthetic. This means that using 500ml of nitrous oxide every minute for a procedure lasting an hour will warm the atmosphere by an equivalent of 16kg CO2. That is the same as driving a small car 106km. Nitrous oxide is often used in large volumes and remains in the atmosphere for 110 years, during which it continues to have a warming effect. Reducing use of nitrous oxide would lead to one of the most significant reductions in anaesthesia related CO2e.
Used here with permission from the Royal College of Anaesthetists’ (RCoA) and taken from their leaflet Your anaesthetic and the environment.
Anaesthetic options with very high warming effects
There is one gas called desflurane that is over 2,500 times more warming than carbon dioxide. That means that an hour's anaesthetic with this gas will warm the atmosphere by the equivalent of at least 30–60kg CO2, the equivalent of driving 200–400km.
Used here with permission from the Royal College of Anaesthetists’ (RCoA) and taken from their leaflet Your anaesthetic and the environment.
Why do anaesthetists use gases that are so warming?
There are characteristics of some of these gases that are beneficial for certain patients, for example those who have obesity. The choice of anaesthetic is based on your particular clinical needs as well as the surgical requirements. The type of anaesthetic gas or technique used does not affect the experience of anaesthesia. You will be asleep and pain free with any of the above general anaesthesia options.
What do anaesthetists do to reduce the impact of anaesthesia on the environment?
With the help of manufacturers, anaesthetists are reducing the wastage of anaesthetic gases. Modern anaesthetic machines and advances in equipment allow anaesthetists to safely use smaller amounts of anaesthetic gas. This reduces the wastage and therefore minimises the impact of these gases on the environment. There are also ventilation systems to remove these waste gases from the operating theatre environment.
Anaesthetists have become very conscious of the need to reduce, reuse and recycle packaging and equipment where possible and to encourage hospitals to do more.
In 2021 the Environmental Sustainability Network (ESN) was formed and advocates, collaborates and promotes initiatives and projects related to environmental sustainability within anaesthesia, perioperative and pain medicine. It is available to fellows, trainees, SIMGs and non-ANZCA members.
Read more about what ANZCA is doing to promote environmental sustainability.
This publication includes text taken from the Royal College of Anaesthetists’ (RCoA) leaflet Your anaesthetic and the environment 2022 but the RCoA has not reviewed this as a whole.