Sustainability is not just about reducing emissions but reducing wastefulness and anyone in HTM can contribute to that goal with the right mindset.

By Steven Martinez

“Sustainability” is a vague term that can mean different things to different people. For some, sustainability might mean environmentally beneficial initiatives like lowering carbon emissions and reducing power consumption. For others it could mean creating an HTM shop that runs efficiently both in terms of productivity and cost-effectiveness. But the best way to think about sustainability might be to simply say it’s the conscious act of reducing wastefulness.

The United Nations defined sustainability in 1987 as, “meeting the needs of the present without compromising the ability of future generations to meet their own needs.” But while the UN’s stated goals are probably too lofty for a single healthcare facility to plan for or concern itself with, the idea of meeting the needs of the present without being wasteful could be a useful benchmark for HTM shops to pursue.

Running a healthcare facility is an expensive endeavor, with millions spent on medical equipment, maintenance, and electricity. (Think suburban neighborhood.) And while an HTM professional might not be privy to all the financial decisions that management is making, reducing waste is an initiative that doesn’t have to come from the top.

How Small Decisions Can Impact Sustainability

Paul Kelley, CBET, AAMIF, has spent a long career doing what he could to improve and advance the biomed field, including furthering the cause of sustainability. He started the local chapter of the California Medical Instrumentation Association in the Bay Area, joined the Association for the Advancement of Medical Instrumentation (AAMI) Technology and Maintenance Council, and worked on the EQ 56 and EQ89 standards. He started AAMI’s sustainability standards committee and served as the director of biomedical engineering and sustainability for Washington Hospital Healthcare System in Fremont, Calif., where he lead the facility’s green initiatives.

To Kelley, even one person can positively impact sustainability in the HTM field. “So much of the stuff in hospitals that HTM can influence is disposable, is not repairable, is polluting, and has a huge environmental footprint,” says Kelley. “And we’re involved in so many different aspects that if people really want to, they can help guide that.”

While we often think of sustainability in the largest terms, reducing tons of emissions and waste, even small decisions can make a difference. Kelley recalls an instance where a supplier was trying to promote new, disposable EKG lead wires to the hospital. Their pitch was that by using disposable, single-use lead wires the hospital could improve its infection control. But the premise didn’t sit right with Kelley.

“They were pushing that on the basis that it was better for infection control and that it was going to cut down on this high rate of infection, and that made no sense to me,” says Kelley. “I’ve never seen a study that said people were getting infected because of these probes.”

Nurses either cleaned the EKG wires after each use or discarded them if they became too messy. Still, the wires could be used multiple times before wearing out, so switching to single-use disposable wires would significantly increase waste, Kelley says. He then went to his hospital’s infection control team and asked them if the disposable lead wires would impact infection control.

“Our infection control people said, ‘No, that’s insane,’” says Kelley. “So, because I was looking at it from the environmental standpoint, the hospital not only saved money, but we also saved a ton, literally, of trash.”

How Healthcare Fits into Sustainability

By some estimations, the healthcare sector contributes 4%-5% of all greenhouse gas emissions worldwide and 8.5% of emissions in the U.S. The average in-patient hospital consumes 31 kWh of electricity per square foot. So, while a healthcare facility might not have a giant smokestack blowing particles into the atmosphere at each location, their draw on the power grid is substantial.

One thing that helped Kelley pursue sustainability initiatives was having a supportive hospital CEO. Not that everyone is as fortunate, he acknowledges. For many HTM professionals, asking management to make decisions without obvious financial benefits is a tough sell, Kelly says.

Still, complying with government regulations may skew hospital brass one way. In the past two decades, state and federal governments have increasingly emphasized environmentally friendly and sustainable practices in both private and public sectors, Kelley explains.

“I think it’s getting easier nowadays because there are more rules and regulations that are pushing that way,” says Kelley. “There’s more awareness from customers—so I think for most places, it’s easier to push it forward if you do your homework.”

He recommends finding initiatives that are either cost neutral or something that will reduce costs. No matter how small or annoying to some, getting into a mindset of reducing waste can make an impact, Kelley says. This can take the form of recycling paper or changing the size of font used at the hospital to save ink toner. After all, he says, smart, seemingly minor changes really add up when expanded to an entire hospital or system.

At Kelley’s hospital, they used disposable sharps containers that were incinerated along with scissors and needles once they were full. They eventually adopted reusable containers so that instead of being burned along with the sharps, the plastic containers would be emptied, sterilized, and returned to the hospital.

“We calculated that our plastic bins that we were buying for one year was 9.4 tons of plastic just in that first year,” says Kelley. “We had to triple check the numbers because it didn’t make sense to me. The plastic adds up quickly.”

Kelley says he had a poster in his office that summarized both the problem and absurdity of sustainability in the 21st century. The poster reads, “It’s pretty amazing that our society has reached the point where the effort to extract oil from the ground, ship it to a refinery, turn it into plastic, shape it appropriately, truck it to a store, buy it, and bring it home is considered to be less effort than what it takes to just wash the spoon when you’re done with it.”

Getting Everyone on the Same Page

While a single change can certainly make an impact, from a larger perspective, the industry approach to sustainability is still fractured and uneven, some say.

Michael Ahmad, a consultant and clinical engineering professor at Marquette University in Milwaukee, approaches the problem of sustainability from a broader point of view, emphasizing the role of buy-in from everyone, both from within and outside a healthcare facility.

“You need the right professionals to run the program within a hospital,” says Ahmad. This could be from facilities, from clinical engineering, food service, and others. There are so many that could be involved.”

Ahmad came from the engineering side of the medical equipment industry, designing CT scanners for Philips and X-ray equipment for Siemens Healthineers. He says that to truly improve hospital sustainability, healthcare leaders must collaborate with manufacturers to ensure equipment is designed in line with sustainability goals.

“Without having manufacturers give you equipment that is green and eco-friendly, you will waste your time,” says Ahmad. “Imagine you have a diesel car, and you want to create a nice environment, but all you do is clean it every day. You take it to the carwash. You make it shiny, and you shine the tires, thinking that this will make it greener and more eco-friendly.”

Unfortunately, this mentality is counterproductive, Ahmad says. “It’s not going to make any difference because the engine itself is still polluting the air every day,” he says.

As an engineer, Ahmad sees sustainability as a problem that requires research and development (R&D). He envisions healthcare providers compiling a team of environmentally conscious experts and working alongside manufacturers and service providers to create plans for increased sustainability. The plan can begin with things like installing solar panels, replacing sliding doors with revolving doors, or finding more efficient methods of heating and air conditioning.

The point is, involving everyone so sustainability isn’t a piecemeal effort from thousands of different facilities. Even if certain methods are less successful, bringing all industry stakeholders together to brainstorm the problem could generate new ideas, Ahmad says.

“Having all stakeholders around one table, having an interdisciplinary team working on the green environment,” he says. “That’s the first step toward succeeding in this initiative.”

While trying to move a whole industry to become more sustainable can seem like a Sisyphean task for any one person or institution, any effort that goes to it is ultimately better than none, says Ahmad.

He relates the task to when he had to think outside the box in 2020. When the pandemic first hit, hospitals suddenly experienced a shortage of ventilators as scores of sick people flooded ICUs. Ahmad was working for healthcare support services provider ABM at the time, and says he spoke with the Joint Commission daily to find a way to connect multiple people to a single ventilator.

“Even if it wasn’t doable, at least we were thinking out of the box,” recalls Ahmad. “Just by thinking that there is a way to do it and trying to get it done—whether it succeeds or fails—that’s what R&D is all about. Having the R&D background, I failed 99 times before I succeeded one time. But that’s the right way to do it.”