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Surgical gowns help protect patients from exposure to microorganisms and serve as personal protective equipment for perioperative staff members. Medical textiles, including surgical gowns, are available as reusable and disposable products. Health care facility administrators and leaders who endeavor to use environmentally sustainable practices require current data for decision making. This study analyzed all activities from the extraction of fossil materials from the earth to the end-of-life disposal of reusable and disposable surgical gowns. The researchers included calculations for laundry and wastewater treatment operations and compared the environmental effects of the two surgical gown systems. The study results showed that selection of reusable gowns rather than disposable gowns reduced natural resource energy consumption (64%), greenhouse gas emissions (66%), blue water consumption (83%), and solid waste generation (84%). Perioperative nurses can use this information to assist facility leaders as they make informed decisions related to gown system selection.

Abstract Objectives Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide mitigation strategies. Methods The biopsy process at a large academic pathology laboratory was grouped into steps. Each supply and reagent was catalogued and postuse treatment noted. Energy consumption was estimated for capital equipment. Two common scenarios were considered: 1 case with 1 specimen jar (scenario 1) and 1 case with 3 specimen jars (scenario 2). Results Scenario 1 generated 0.29 kg of carbon dioxide equivalents (kg CO2e), whereas scenario 2 resulted in 0.79 kg CO2e—equivalent to 0.7 and 2.0 miles driven, respectively. The largest proportion of GHGs (36%) in either scenario came from the tissue processor step. The second largest contributor (19%) was case accessioning, mostly attributable to production of single-use disposable jars. Conclusions Applied to more than 20 million biopsies performed in the US annually, emissions from biopsy processing is equivalent to yearly GHG emissions from 1,200 passenger cars. Mitigation strategies may include modification of surveillance guidelines to include the number of specimen jars.

Objective: To aid radiologists by measuring the carbon footprint of CT scans by quantifying in-hospital and outof-hospital energy use and to assess public health impacts. Method: The study followed a standard life cycle assessment protocol to measure energy from a CT scan then expanding to all hospital electrical energy related to CT usage. In addition, all the fuel energy used to generate electricity and to manufacture the CT consumables was measured. The study was conducted at two hospitals. Results: The entire life cycle energy for a CT scan was 24–34 kWh of natural resource energy per scan. The actual active patient scan energy that produces the images is only about 1.6% of this total life cycle energy. This large multiplier to get total CT energy is a previously undocumented environmental response to the direct radiology order for a patient CT scan. The CT in-hospital energy related to idle periods, where the machine is on but no patients are being scanned and is 14–30-fold higher than the energy used for the CT image. The in-hospital electrical energy of a CT scan makes up only about 25% of the total energy footprint. The rest is generated outside the hospital: 54–62% for generation and transmission of the electricity, while 13–22% is for all the energy to make the consumables. Different CT scanners have some influences on the results and could help guide purchase of CT equipment Conclusions: The transparent, detailed life cycle approach allows the data from this study to be used by radiologists to examine details of both direct and of unseen energy impacts of CT scans. The public health (outside-the-hospital) impact (including the patients receiving a CT) needs to be measured and included.

Background: Bicomponent split microfiber reusable wipers and flat mops are innovative textiles used to hygienically clean healthcare surfaces and, hence, reduce hospital-acquired infections. Sustainability improvements are reflected as reduced energy and mass requirements over a life cycle. Methods: The environmental impacts of reusables were compared to disposable equivalents using standard life cycle assessment procedures. Results: With information from 80 hospitals, disposable flat mops and wipers were used at a higher rate than reusable counterparts; the disposable/reusable ratio was 2.3:1 for wipers and 2.5:1 for flat mop pads. Bicomponent split microfiber reusable products had lower impacts (65–95%) in all categories considered: global warming potential, natural resource energy, blue water use, and solid waste production. Discussion: Results reinforce other studies that compare reusable and disposable textile options in healthcare. Laundry energy is an important driver of energy use for reusables. The energy associated with water consumption for disposables’ supply chains is significantly greater than net water consumption for reusables laundry. Conclusions: Selecting disposables versus bicomponent split microfiber reusable flat mops and wipers increases these specific environmental life cycle assessment (LCA) impacts by 320% to 2000%, which is clearly not an environmental sustainability improvement. Group Purchasing Organizations may be barriers to hospital adoption of these reusables.

Psoriatic arthritis is a clinically heterogeneous, chronic, and progressive disease that develops in up to 30% of patients with psoriasis and is characterized by multiple and increasing joint defects caused by persistent immune-mediated inflammation. Several treatment options are available, including multiple biologic agents that inhibit specific cellular mediators of inflammation either directly or indirectly. Early detection and intervention are critical to preventing severe joint damage and pain, necessitating increased awareness and education about this disease for primary providers and nonphysician clinicians. Physician assistants and nurse practitioners, given their role in the primary care setting and within multiple specialty areas such as dermatology and rheumatology, are often the first to see patients who may have psoriatic arthritis. These healthcare providers are increasingly important in the early diagnosis and treatment of this disease. In this review, we provide an overview of psoriasis and psoriatic arthritis and discuss the multiple treatment options that are available for these patients. We also discuss ways to help recognize early joint involvement in the clinic and emphasize the role that nonphysician clinicians play in the care of patients with psoriatic arthritis.

Life Cycle Assessment (LCA) methodology evaluates holistically the environmental consequences of a product system or activity, by quantifying the energy and materials used, the wastes released to the environment, and assessing the environmental impacts of those energy, materials and wastes. Despite the international focus on environmental impact and LCA, the quality of the underlying life cycle inventory data is at least as, if not more, important than the more qualitative LCA process. This work presents an option to generate gate-to-gate life cycle information of chemical substances, based on a transparent methodology of chemical engineering process design (an ab initio approach). In the broader concept of a Life Cycle Inventory (LCI), the information of each gate-to-gate module can be linked accordingly in a production chain, including the extraction of raw materials, transportation, disposal, reuse, etc. to provide a full cradle to gate evaluation. The goal of this article is to explain the methodology rather than to provide a tutorial on the techniques used. This methodology aims to help the LCA practitioner to obtain a fair and transparent estimate of LCI data when the information is not readily available from industry or literature. Results of gate-to-gate life cycle information generated using the cited methodology are presented as a case study. It has been our experience that both LCI and LCA information provide valuable means of understanding the net environmental consequence of any technology. The LCI information from this methodology can be used more directly in exploring engineering and chemistry changes to improve manufacturing processes. The LCA information can be used to set broader policy and to look at more macro improvements for the environment.

Summary Studies investigated the patient-care (in-hospital) and outside-the-hospital energy consumptions for delivering the hemodialysis (HD) service. A life cycle inventory methodology was used for this patient-based analysis for two hospitals located in Wichita, Kansas. It was found that, for both hospitals, the actual HD machines consumed approximately 3.5 kilowatt-hours (kWh) of electrical energy per HD, only 8% to 16% of the total energy used for delivering the HD service (in hospital). This increases to 9.6 to 28.9 kWh of hospital billable energy for the whole system of HD machine, auxiliaries, and dialysis water treatment. Converting these hospital direct electrical energy values to natural resource energy (nre) then adding the cradle-to-gate natural resource energy for the manufacturing and supply chain of all the HD consumables, the total is 78 to 149 kWh nre/HD. The nre measures all the direct fuel burned to generate energy and is thus directly related to emissions to the air, water, and land and is a direct secondary impact on public health from HD. The ratio of outside-the-hospital energy to direct hospital HD electrical energy consumption is 4:1 to 7:1, so a broader base exists for improvement than just the hospital.

PURPOSE: This report proposes a life-cycle analysis (LCA)-oriented methodology for systematic inventory analysis of the use phase of manufacturing unit processes providing unit process datasets to be used in life-cycle inventory (LCI) databases and libraries. The methodology has been developed in the framework of the CO2PE! collaborative research programme (CO2PE! 2011a) and comprises two approaches with different levels of detail, respectively referred to as the screening approach and the in-depth approach. METHODS: The screening approach relies on representative, publicly available data and engineering calculations for energy use, material loss, and identification of variables for improvement, while the in-depth approach is subdivided into four modules, including a time study, a power consumption study, a consumables study and an emissions study, in which all relevant process in- and outputs are measured and analysed in detail. The screening approach provides the first insight in the unit process and results in a set of approximate LCI data, which also serve to guide the more detailed and complete in-depth approach leading to more accurate LCI data as well as the identification of potential for energy and resource efficiency improvements of the manufacturing unit process. To ensure optimal reproducibility and applicability, documentation guidelines for data and metadata are included in both approaches. Guidance on definition of functional unit and reference flow as well as on determination of system boundaries specifies the generic goal and scope definition requirements according to ISO 14040 (2006) and ISO 14044 (2006). RESULTS: The proposed methodology aims at ensuring solid foundations for the provision of high-quality LCI data for the use phase of manufacturing unit processes. Envisaged usage encompasses the provision of high-quality data for LCA studies of products using these unit process datasets for the manufacturing processes, as well as the in-depth analysis of individual manufacturing unit processes. CONCLUSIONS: In addition, the accruing availability of data for a range of similar machines (same process, different suppliers and machine capacities) will allow the establishment of parametric emission and resource use estimation models for a more streamlined LCA of products including reliable manufacturing process data. Both approaches have already provided useful results in some initial case studies (Kellens et al. 2009; Duflou et al. (Int J Sustain Manufacturing 2:80–98, 2010); Santos et al. (J Clean Prod 19:356–364, 2011); UPLCI 2011; Kellens et al. 2011a) and the use will be illustrated by two case studies in Part 2 of this paper (Kellens et al. 2011b).

PurposeTypically, the high energy required to manufacture nanomaterials is weighed against the benefits transferred to a product. Adequately establishing the environmental characteristics of a product that contains nanomaterials requires a complete methodology. The objectives of this study are to draw attentions on life cycle information and to demonstrate the methodology for the scientific assessment of the environmental benefits of using a nanomaterial in a product to extend the product life and to provide a real example for the calculations of the approach.MethodsAbout 1317 products with nanomaterials in the market were analyzed to identify the outcomes of lifetime extension by the nanomaterial additions. Five life cycle elements were quantified to establish the cradle-to-gate (CTG) life cycle footprint of a product comprised of a nanomaterial. These are the following: the life cycle of the conventional product with the usual construction and without added nanomaterial, the life cycle of the nanomaterial manufactured from CTG per kilogram of nanomaterial, the amount of nanomaterial incorporated into the product, the quantitative improvement in the product performance due to the presence of the nanomaterial (such as increased lifespan), and the incremental energy and auxiliary materials (often negligible) involved in the incorporation of the nanomaterial into the conventional productResults and discussionThe primary challenge here is to have all five of the informational pieces in order to ensure that the environmental footprint of using a nanomaterial is complete. The results can be seen for the range of products with life extension via nanomaterials, ranging from 130 to 3100%. In these cases, the higher energy to manufacture the nanomaterial is more than offset by the avoidance of manufacturing non-nanoproducts multiple times over the life extension period.ConclusionsIt was found that several nanoscale inclusions in the products greatly increased many properties of the final product along with the lifetime. Increasing the lifetime of products by adding nanoscale inclusions will thus reduce environmental and health concerns, as well as the use of virgin materials, energy consumption, landfill allocations in the long term, and product marketability.