Environmental Stewardship

carried into a patient room, it must be cleaned again which is wasteful. If we wash less from the start, we will use less detergent and water – ultimately reducing the energy needed to heat the water, which is a win-win all around. o We evaluated the environmental impact of linen and laundry, including laundry emulsifiers and detergents, which are chemicals that are being discharged into the water shed and require wastewater treatment, to find opportunities for alternatives. o Partner with our laundry co-op which serves all the hospitals in the Portland area including Kaiser, Legacy and OHSU so the learnings of our work will benefit the broader community. 4. Greening medical practices • To reduce hazardous pharmaceutical waste, we established a work group to address opportunities to standardize definitions of what constitutes this waste and practices around how to treat it. The group is developing best practices that can be shared across the system, although State regulations vary, so other Providence regions will need to ensure standards are adapted to meet local requirements. • Dr. Brian Chesebro has led the way in the Oregon region and nationally by shining a spotlight on the greenhouse gas emissions from anesthetic agents, and how lower emission choices are both clinically effective and less expensive. In Oregon, this effort has led to all eight hospitals being engaged: o Compared to 2016 baseline practices, we have achieved 94 percent emissions reduction and eliminated 4,760 metric tons of CO2e, which is equivalent to driving ~ 5.35 million miles in a Hummer each year and reduced costs by 66 percent and $801,000 annually in Oregon. o These efforts have expanded to four of the seven regions and are continuing to grow. • Currently looking for ways to reduce nitrous oxide as an anesthetic, which is now the biggest driver for the anesthesia emissions footprint in OR. • Nitrous oxide is extremely harmful to the earth with its global warming potential being 298 times worse than carbon dioxide. Nitrous exists in the atmosphere for over 100 years and is ozone depleting. Source. • Clinically, nitrous is used in a very different way than other anesthetics. Outside of notable exceptions such as pediatric dental sedation, Dr. Chesebro explains, nitrous is usually not necessary in clinical practice since you can achieve the same clinical outcomes with a less environmentally damaging selection. • Reducing nitrous emissions requires a partnership between clinical practices and facilities staff where the team evaluates the on-site, clinical uses of nitrous, in addition to the integrity of the facilities' infrastructure- leaking pipes, tanks, valves. The Oregon region is developing a step-by-step procedure to identify and mitigate nitrous emissions. For more information, contact Tina Landeros, Region Dir Environment of Care, Oregon region at tina.landeros@providence.org or Dr. Brian Chesebro, Medical Director, Environmental Stewardship, Oregon at brian.chesebro@providence.org. "The chemicals we use and how they are discharged into the environment is a clearly resonant theme for environmental justice. Everyone can take action at work and at home and speak for the people who are so often ignored. Reducing our chemicals of harm is one way everyone can help." – Dr. Brian Chesebro, Medical Director, Environmental Stewardship, Oregon Dr. Brian Chesebro, Medical Director, Environmental Stewardship, Oregon

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