Environmental health is of principal importance to human health, yet healthcare is one of the largest contributing industries to pollution.
As Dr. Jodi Sherman points out in her lecture “Environmental and Public Health Considerations,” available now for CME credit through AudioDigest, “We cannot have well patients on a sick planet.” This means it’s in the best interest of all members of the healthcare delivery team to reduce pollution, and the easiest way to do that is to reduce waste. In her presentation, Dr. Sherman takes a closer look at barriers to accomplishing this goal and some potential solutions to pharmaceutical waste.
Pharmaceutical agents are cleared through the kidney, and drug metabolites are ultimately excreted in the urine. Unsurprisingly, there are levels of pharmaceuticals in drinking water, with higher concentrations near hospitals and nursing homes. Little is known about the impact of said metabolites on people, animals and the environment, although particular agents such as propofol are known to have environmental toxicity. As of now, there is minimal oversight of pharmaceutical waste.
Pollution isn’t limited to the urine-excreted metabolites that ultimately land in our water. All stages of pharmaceutical production play a role in pollution. According to Dr. Sherman’s talk, for example:
- Pollution from the U.S. healthcare sector is increasing despite overall pollution in the U.S. trending downward.
- The healthcare sector is responsible for 10% of greenhouse gas emissions in the U.S.
- If the U.S. healthcare sector were an independent nation, it would rank 13th in the world for greenhouse gas emissions.
- The U.S. healthcare sector is responsible for 10% of smog formation.
- The U.S. healthcare sector is responsible for 9% of respiratory disease that’s caused by particulate matter and ozone-depleting effects.
- 614,000 disability-adjusted years of life are lost due to healthcare pollution.
Causes of IV drug waste
While inhaled anesthetics are the largest contributor to pollution, conservative estimates based on chart review have demonstrated that 30% to 80% of the 20 most frequently used intravenous drugs are wasted.
There are multiple factors that contribute to IV drug waste, including:
- Oversized vials and regulations: The Centers for Disease Control and Prevention passed a regulation in 2010 that all vials should be single-use, so even vials that were deemed multi-use can only be used in one case. Even single-use vials are likely to have more medication than necessary for one patient.
- Contamination: An inadvertent mix of “clean” and “dirty” material often occurs.
- Over-preparation: Emergency pharmaceuticals are usually available in the operating room in case of negative outcomes.
- Expiration: Pharmaceutical agents in the operating room are meant to be thrown away within 60 minutes, a different timeline than for those same agents that are stored in a pharmacy.
Barriers and solutions to waste reduction
Dr. Sherman explains that three barriers to waste reduction are the monopoly of the syringe market, regulatory agencies and their current policies and perceived cost.
However, solutions to pharmaceutical waste reduction have also been proposed. These include:
- Appropriate-sized vials.
- Splitting vials.
- Refrigeration and stability testing to extend shelf life.
- Cost analytics.
- A clean workspace.
- Appropriate gauging of needs.
Dr. Sherman describes an analysis at Yale University where the amount of waste from the 20 most frequent anesthetics was calculated to be approximately 25,000 mL of drug wasted per month. They found that if they split the agents in the pharmacy, they were able to reduce waste to 7,000 mL of drug per month. When extrapolated over the course of the year, this waste is equivalent to the carbon footprint of driving around the planet twice. It’s worth noting that this analysis accounts for the use of 20 agents at one hospital over the course of the year, and this same analysis found that conservation efforts could ultimately save $1.8 million per year for the hospital.
Environmental health is important, yet as the healthcare sector grows, its contribution to pollution increases at an unchecked rate. While the specific impact is still mostly unknown, some preliminary information has begun to suggest how pollution impacts health outcomes. Waste reduction strategies are necessary to decrease the burden of healthcare sector pollution, and although these strategies require initial financial buy-in, the health and monetary benefits are worthwhile.