Mitigating environmental impacts of surgical practices in a Danish health care context

Andersen, Louise Astrup

4. Term

Urban, Energy and Environmental Planning, Master

2024

2024-06-05

23

Sundhedsvæsenet står i et paradoks: Indsatser for at forbedre menneskers helbred medfører miljøpåvirkninger, som igen kan skade helbredet. Denne afhandling peger, på baggrund af nyere litteratur, på kirurgi som et lovende område til at reducere klimabelastningen. En central strategi er cirkulære omstillinger fra engangsudstyr til flergangsudstyr. Afhandlingen tager udgangspunkt i Regionshospital Nordjylland og undersøger, hvilke cirkulære omstillinger der er relevante for at gøre forbruget i operationspraksis mere bæredygtigt. For at besvare dette gennemføres en konsekvens-livscyklusvurdering (konsekvens-LCA) af en rutinemæssig laparoskopisk brokoperation (kikkertoperation), som vurderer miljøpåvirkninger fra produktion til bortskaffelse og ser på systemeffekter af ændrede valg. Derudover laves en kvalitativ kortlægning af forbrugspraksis i operationerne for at forstå, hvordan de påvirker mulighederne for cirkulære omstillinger. Resultaterne peger på, at det især er relevant at skifte engangsafdækninger og -kitler til flergangsalternativer, fordi de bidrager væsentligt til de påvirkninger, der kan skade menneskers helbred. Det anbefales også at forberede organisationen med små, trinvise cirkulære tiltag og investeringer i Sterilcentralen (SCT), som rengør og steriliserer flergangsudstyr. En større andel flergangsenheder vil lægge pres på SCT, så det bør prioriteres at sikre tilstrækkelig kapacitet i tid, personale og udstyr.

Health care faces a paradox: efforts to improve people’s health also create environmental impacts that can harm health. Based on recent literature, this thesis identifies surgery as a promising area to cut climate impacts. A key strategy is a circular shift from single-use to reusable medical devices. Using Regionshospital Nordjylland as a case, the thesis asks which circular transitions are relevant to make surgical consumption practices more sustainable. To answer this, it conducts a consequential life cycle assessment (LCA) of a routine laparoscopic hernia surgery (a minimally invasive keyhole procedure), which evaluates environmental impacts from production through disposal and considers system-wide consequences of changed choices. It also includes a qualitative assessment of current surgical consumption practices to understand how they shape opportunities for circular change. Findings indicate that switching disposable drapes and gowns to reusable alternatives is especially relevant, as these contribute notably to health-damaging impacts. The thesis further recommends preparing the organization with small, incremental circular steps and investing in the sterilization center (SCT), which cleans and sterilizes reusable items. A higher share of reusable devices will increase the workload on the SCT, making it a priority to secure sufficient capacity in time, staff, and equipment.

[This summary has been rewritten with the help of AI based on the project's original abstract]

LCA ; Impact assessment ; Health care ; Practice theory ; Single-use consumption ; Human health impact

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