Doctors at Amsterdam UMC push for a greener hospital
Healthcare accounts for seven percent of total CO₂ emissions in the Netherlands, as much as direct emissions from aviation. Anesthesiologist Niek Sperna Weiland and gynecologist Anne Timmermans showed Folia around “the hospital’s most polluting department”: the operating rooms. “Plastic hand-washing brushes turn out to be unnecessary. That saves 800 kilograms of plastic on an annual basis.”
“Do you want to change and put on a blue suit? Or put on coveralls over your clothes?” asks gynecologist Anne Timmermans before we, photographer and reporter, enter the operating room (OR). “The coveralls are thrown away afterwards.” Changing clothes, then. Wearing clogs and a disposable cap, we then walk into the OR.
From May 22 to June 16, the Amsterdam UMC is organizing Blik op Groen, a month of workshops, lectures, and tours to inspire employees, patients, and visitors to do their part for sustainability.
We meet anesthesiologist Niek Sperna Weiland, who is also wearing a blue suit, clogs, and a reusable cloth cap, one of the achievements of his Green Team OR. Since 2017, Sperna Weiland has been committed to greening the operating rooms, the hospital’s most polluting department.
Anesthetic gases
Sperna Weiland says: “The OR generates 20 to 30 percent of hospital waste. We use six times more energy than the rest of the hospital per square meter. And then there are the anesthetic gases. These are strong greenhouse gases – 500 to 7,000 times stronger than CO₂ - that end up in the atmosphere after use.”
This greening began with big steps. “Anesthetic gases have been reduced by 77 percent compared to 2017. We also reduced energy consumption by 33 percent, which was mainly a matter of turning off appliances not in use.”
Sperna Weiland is referring to the ventilation of the operating rooms. He holds a piece of paper in front of the exhaust vents that is sucked right in. “The air in this room is changed 100 an hour, even when the room is not in use. For years no one thought of turning that off.” Meanwhile, only five of the 25 operating rooms remain on standby for emergencies outside regular business hours.
And then there’s the waste. Sperna Weiland holds up a large plastic-wrapped package. “This is the basic package required for every operation as a minimum. Coats, drapes, bowls, and scissors that are thrown away after use.”
On top of that, all that waste in the OR usually ends up in one bin. At the Amsterdam UMC, that waste is now separated. “We think this is already quite revolutionary, as it doesn’t happen in very many places yet.”
Sperna Weiland continues: “We are now looking at reusable OR caps, instruments, gowns, and covering materials. Materials that are actually unnecessary are also being reviewed, such as plastic hand-washing brushes that you see in the average hospital series. That saves 800 kilos of plastic on an annual basis.”
Duckbill specula
The hospital also underwent a plastic revolution over the past 50 years. Specula, also known as duck bill specula, used to be metal but are now plastic, gynecologist Timmermans shows. “They get thrown away after one use. That’s largely for convenience since cleaning metal instruments is an elaborate logistical process.”
In addition, in the case of duckbill specula, plastic would be more comfortable because it is less cold than metal and the edges are less sharp. Still, for a large group of people, that doesn’t seem to matter, Timmermans says. “We are now at the point where we can reintroduce reusable metal duckbills in the department.”
Indeed, not all metal is reused, either. Some metal scissors are still thrown away in the hospital after being used to make just one cut. Timmermans says: “That often shocks medical students.”
Climate concerns
In fact, future doctors are still taught little about sustainability, although 70 to 80 percent of medical students would like to learn more about this topic.
“That’s not surprising,” says Timmermans, who has been appointed principal educator of sustainable care for the medical curriculum. “Students belong to the age group in which 80 percent are concerned about the climate. This is also a factor among medical students. How do I relate to that as a future doctor?”
Timmermans wants to weave sustainability increasingly into the medical curriculum. “The goal is not to make it a separate subject but to ensure that every student comes into contact with it during their studies. To achieve this, we are trying to inspire undergraduate teachers to slightly alter their teaching and engage with students.”
“Take contraception,” says Timmermans. “At the micro level, you can look at what synthetic hormones do to the environment and groundwater. At the macro level, it’s about what contraception does to gender equality and the ability to go to school.”
The second fifty percent
Sustainability awareness among employees has also increased over the past five years. For example, there are now 45 Green Teams at Amsterdam UMC and a Center for Sustainable Care that manages the Green Teams.
Yet sustainability is still not included in the hospital’s policies. The Green Deal care contains tough agreements between hospitals and the government, requiring a 49 percent CO₂ reduction in 2030 compared to 1990 and energy neutrality by 2050. Sperna Weiland comments: “But how we’re going to get there is still unclear. It’s not being managed yet.”
A 49 percent reduction by 2030 is achievable, according to Sperna Weiland. He is less optimistic about the second 50 percent to zero. “You won’t achieve that for the simple reason that our building dates from 1975.”
In addition, the Amsterdam UMC has its own gas and diesel-fired power plant that will remain in use until 2030. “That creates a relatively large amount of fossil emissions, all the lights here use gas.” This is one of the reasons Amsterdam UMC is still tops the list of Dutch hospitals with the highest energy costs per hospital bed.
Thus, sustainability still depends on the free time of doctors like Sperna Weiland and Timmermans. “We hope that we have a kind of booster function, after which the hospital will incorporate this into its processes.” Some days they are more optimistic about this than others, but the mood remains hopeful. “To reach a tipping point you don’t need 50 percent of people - 25 percent is enough.”
