Equipment & Supply Chain
Making up a whopping 42% of the NHS carbon footprint and costing around £1.5 billion per year, the NHS supply chain is highly impactful. To understand best how we can reduce the carbon footprint from what we procure, we need to understand what we procure and what has the biggest impact. In 2017 the SDU did just that, identifying a priority list of items that made up 70% of the overall fiscal and carbon footprint (excluding large expensive equipment like CT scanners). The list is as follows:
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Medical Devices
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Blood sampling tubes
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Catheters, tubing and drains
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Clinical waste containers
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Clothes, caps, masks, overshoes
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CO Monitors and spirometers
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Crutches, walking sticks, and frames
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Disposable Incontinence
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Disposable medical holloware
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Bandages, dressings & gauzes
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Drapes
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Electrode gel
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Examination gloves
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Hearing aids
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Medical packs
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Medical pulp products
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Needle-free connection systems
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Patient assessment electronic devices
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Polythene aprons
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Single use surgical instruments
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Syringes & needles
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Measuring a precise carbon footprint from our supply chain would require LCAs to be performed on all items we procure. This would be very time consuming, and so the SDU estimated the carbon footprint of these items taking into account the weight and material category (plastic/electronic). The weight was then multiplied by the number of items procured and a carbon factor ( kgCO2e/kg material).
Looking at this list we can see that many items are single use. Due to concerns related to iatrogenic transmission of pathogens, items that used to be reusable are now single use. Not only does this create alot of waste, the carbon footprint from the manufacture and subsequent transport can often out weigh this.
Food & Catering
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Baby feeding products
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Beverages
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Tableware and light equipment
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Confectionery
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Food
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Looking at this list can you think of ways to reduce the carbon footprint from the supply chain?
The carbon footprint from PPE supplied to the health and social care sector in England in the first 6 months of the pandemic is estimated to be
106,478 tonnes CO2e (Rizen et al 2020.)
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COVID-19 has seen a significant increase in the use of single use items such as PPE. In Rizen et al's paper looking into the impact of PPE in the first 6 months of COVID in England they noted that gowns had a carbon footprint 3 times greater, than the second most impactful, the face shield. They noted that the carbon footprint could be significantly reduced (by 75%) with the following measures; UK manufacture (by 12%), eliminating gloves in lieu of hand washing (by 45%), reusable gowns and gloves (by 10%) and maximal recycling (by 35%).
In airway management the switch to single use items was largely driven by concerns that proteinaceous materials such as prions can remain on equipment post sterilization. Iatrogenic transmission of Creutzfeldt-Jakob Disease (CJD) is rightly a concern with over 250 cases occurring worldwide, with 6 of those being linked to contaminated equipment (Eckelman et al, 2012). However, all equipment was neurosurgical with all cases occurring pre-1976 before the routine implementation of modern sterilization procedures. No iatrogenic infection of any type has been linked to reusable laryngeal mask airways (LMA), yet we have moved away from the reusable device to a single-use alternative with a carbon footprint that is two-thirds greater (Eckelman et al, 2012). The switch to disposable laryngoscope blades followed, with disposable handles not far behind with carbon footprints 7 and 20 times that of their reusable counterpart (Sherman et al 2018).
We are now moving firmly into the realm of the video laryngoscope. We need to take advantage of this change to procure products with wipe clean reusable systems in lieu of their disposable counterparts.
