Sustainable Steps

Wasting energy? Contaminating the soil, water and air? Making strides toward environmental sustainability benefits not only the earth but your hospital, clients, patients, and yourself. Learn from those who are being proactive.

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Lessen Your Impact on the Planet

With veterinary hospitals still dealing with the effects of COVID, from staffing to integrating new technology and other concerns, the idea of starting environmental sustainability efforts might seem ill-timed to some.

But under the One Health idea that humans, animals, and the world we live in are inextricably interconnected, others say not only is it the right time, but it is actually overdue.

6-Water_tanks_at_Eagle_VH.jpgEagle Veterinary Hospital has 3,000-gallon water reclamation tanks that collect rainwater and air conditioning condensate that then goes through charcoal/UV filters before re-entering the hospital. Courtesy of Eagle Veterinary Hospital

Veterinary environmental sustainability is not a new idea. Kenneth Kirlin, DVM, made it his goal when he replaced an old clinic with a new Eagle Veterinary Hospital in San Antonio, Texas, in 2010. According to Garrett Eccleston, hospital manager, the building earned the US Green Building Council (USGBC) Leadership in Energy and Environmental Design (LEED) Platinum certification in 2012 for its environmental initiatives and long-lasting sustainability impact. It was the first veterinary clinic in the country to be LEED Platinum certified and may still be the only one, he noted.

But now, with signs of global climate change becoming more obvious, there is renewed interest in lessening the impact that healthcare—both human and animal—has on the earth.

The Time to Act Is Now

“It’s time we, the veterinary community, step up and take the initiative to become environmentally sustainable,” said Amanda Bloomberg, DVM, co-owner of Paws of Pleasanton Animal Hospital, Pleasanton, California. “We need to realize how our daily actions affect the world even if we feel we are such a small subset of it. Every little bit helps,” she said.

“When opening our hospital in June 2020, it was a priority to implement protocols around being as sustainable as possible. We try our hardest every day to do what’s best for our patients as well as the environment. I can only hope other hospitals will see what we have done and how simple it can be to implement the same for their practices.”

1.pngAt Colorado State University (CSU), Colleen Duncan, DVM, PhD, DACVM, DACVPM, associate professor of the Department of Microbiology, Immunology, and Pathology, acknowledged that there is a lot of interest in the topic of environmental sustainability, especially from veterinary students, younger people who are starting their own practices, and new graduates looking for employment.

However, she explained, research shows that enhanced incorporation of sustainability into veterinary medical education at all stages is needed. And she noted that veterinary teaching hospitals offer an opportunity to lead by example.

“At CSU, we are integrating sustainability into our curriculum and developing continuing education opportunities for veterinarians and their teams, especially veterinary technicians, to learn more and to get education credits on the topic,” she said.

In the early stages of planning its new veterinary hospital, CSU is looking to the International WELL Building Institute’s WELL Building Standard and USGBC LEED certification to minimize its environmental footprint, deal with its regional concerns like drought and wildfires, and best use its main local asset—300 days of sunshine a year. It hopes to focus on the sweet spot where sustainability and wellbeing meet, said Duncan.

Real-Life Examples Show the Way

At the University of Wisconsin-Madison, Flad Architects, in association with Foil Wyatt Architects and Planners, is bringing sustainability ideas to reality in the 200,000-square-foot, three-story addition and renovation of the School of Veterinary Medicine and its small animal hospital that is under construction. 

“We need to realize how our daily actions affect the world even if we feel we are such a small subset of it.”

—AMANDA BLOOMBERG, DVM, co-owner of Paws of Pleasanton Animal Hospital

The addition will use 25% recycled steel and carbon-injected concrete, divert 70% of construction waste from the landfill, and install bird-safe glazing, according to Marc Walker, Flad design principal. Many of the building’s materials have environmental product declarations or health certifications.

Ross Pinski, Flad landscape architect, said the building massing and site arrangement offer several key sustainable features. One adjacent road will be relocated and narrowed to provide a larger wildlife corridor and green space next to a nearby creek. An 18,000-square-foot green roof on the second floor of the addition will aid in stormwater management, showcase native plantings, and provide usable open space. A large courtyard space will feature native plantings and pervious paving and allow natural light into the adjacent portion of the building.

At Eagle Veterinary Hospital, boarding runs are made from recycled plastic to create a responsible, easy-to-clean surface; exam tabletops use a rubber insert “pad” for traction made of durable, easy-to-clean recycled tires; and flooring is the sealed concrete slab. All drywall is recycled gypsum, and high-efficiency heating, ventilating, and air conditioning (HVAC) units improve indoor air quality. Solar panels, LED products, high-efficiency fluorescent lights, and solar tubes/windows provide light with motion sensors in low-traffic areas.

Barriers and
Challenges Ahead

Several sources pointed to some barriers to enabling and encouraging veterinary hospitals to do the most they can. Among those challenges:

  • Most of the small plastic and glass waste—syringes and their packaging, vaccine vials, and such—are not accepted as recyclable.
  • Packaging materials from suppliers are still not as minimal as they could be.
  • There is a continuing lack of veterinary awareness of environmental impact.
  • Technology needs to be created to allow the complete capture or safe breakdown of anesthetic gas emissions.
  • Veterinary organizations need to be encouraged to add sustainable practices to their certification processes.

Its 3,000-gallon water reclamation tanks collect rainwater and air conditioning condensate that then goes through charcoal/UV filters before re-entering the hospital “cleaner than the water from the city,” according to Eccleston. It means the hospital pays only the minimum city water bill to keep the account active without really using water—$30 a month for a 10,000-square-foot building in south Texas.

“We also recycle anything we can based on local recycling rules. We have started using biodegradable pill vials available through Midwest Vet Supply and use compostable trash bags for all our trash receptacles. Our goal is to provide great service with minimal impact to the environment,” said Eccleston.

Paws at Pleasanton features motion-sensor faucets in the surgery/treatment area—more affordable and space-saving than a traditional surgery scrub sink, noted Bloomberg; fleece tie blankets instead of bath towels to reduce water and electricity usage and extend washer/dryer life; smart thermostats; and LED lighting and skylights to make use of California’s sunlight.

Cloud-based software; a veterinary app for client reminders, medication refills, and appointments; and texts instead of expensive postcard reminders reduce paper costs and phone calls for staff. And, “yes, definitely,” said Bloomberg—the efforts have meant lower costs.

Another Elephant in the Room

2.pngAny environmental effort also should include greenhouse gases. The problem in veterinary anesthesia practices is exactly the same as it is in human anesthesia practices, explained Nathaniel Kapaldo, DVM, MPH, DACVAA, assistant professor of anesthesiology, Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University.

“To facilitate a diagnostic or surgical procedure, we use volatile anesthetics such as isoflurane or sevoflurane. These gases are delivered using anesthetic circuits, which allow us to titrate the inhalant anesthetics to an appropriate effect. The volatile anesthetics are then either scavenged passively or actively away from the immediate operating theatre, then, most often, simply vented to the atmosphere.”

Historically, the role anesthetic gases play as greenhouse gases (GHGs) was not well understood. However, now many studies document that they are very potent GHGs, and Kapaldo noted that it is responsible and prudent to make real-life steps in their judicious use.

Isoflurane, the most commonly used inhaled anesthetic in veterinary medicine, persists in the atmosphere for more than three years before it may break down, he said. During just one year in the atmosphere, the global warming potential of isoflurane is six thousand times more than an equivalent amount of carbon dioxide. Additionally, because anesthetic gases reside in the atmosphere for extended durations (isoflurane: 3.2 years, sevoflurane: 1.8 years, desflurane 8.9 years), they accumulate over time, said Kapaldo.

Recipe for Better
Anesthesia Practices

Kapaldo has a particular interest in sustainability in anesthesia practice. He offered this recipe for how to calculate a minimum fresh gas flow for the maintenance phase for an anesthetized patient:

  • Estimate 5 mL/kg/min oxygen consumption for an anesthetized dog or cat.
  • Set total O2 flow to be 20% greater than this estimated oxygen consumption.
  • If a side stream capnograph or gas analyzer is used, increase total flow by 200 mL/min (50 mL/min if micro stream analyzer used).
  • Increase total flow by 50–100 mL/min to compensate for any small circuit leaks.
  • If possible, monitor inspired/expired fraction of oxygen or anesthetic. However, this is understood to be potentially costly to add to patient monitoring.

Example:

  • With capnograph in use: 10 kg dog = 50 mL/min O2 consumption + 20% (10 mL/min) + 200 mL/min + 100 mL/min = flow meter setting  360 mL/min
  • Without capnograph in use: 10 kg dog = 50 mL/min O2 consumption + 20% (10 mL/min) + 100 mL/min = flow meter setting  160 mL/min

The example flow settings are much lower than likely used routinely, respectively; however, once the anesthetic concentration has equilibrated in the circuit (initial 5 min with O2 flow at 2i4 L/min), these flows are absolutely appropriate.

Consider intravenous techniques when possible. The caveat is that intravenously used drugs are not necessarily benign either and not much is known about the impact of this drug waste on water systems. Appropriate waste/disposal of unused injectable drugs should be followed.

Ensure waste gas absorbers (activated charcoal canisters) are present on all anesthetic machines and routinely checked. These should be in use whenever an anesthetic machine is not supplied by a scavenging system, directing waste gas out of the building.

While these inhaled anesthetics now remain largely unregulated, Kapaldo suggested that that is likely to change in the coming decades. “Healthcare facilities may need to begin accounting for the amount of anesthetic gases they emit, just as other companies have to document their harmful emissions into the atmosphere.”

“It has been estimated that the healthcare sector accounts for up to 8% of the total US greenhouse gas emission,” he added. “We do not really know how big of a problem it is, but the veterinary industry likely is a very small fraction compared to human practice. But it’s becoming recognized as a big enough problem that in 2020 the American Society of Anesthesiologists initiated the ‘Inhaled Anesthetic 2020 Challenge,’ where the problem was presented and hospitals were challenged to reduce inhaled anesthetic gas waste by 50%.”

For veterinary hospitals using volatile anesthetics to anesthetize patients, Kapaldo offered this option: “Use low fresh gas flows. It’s a well-documented method to reduce unnecessary use and waste that really just involves prudent anesthetic monitoring and diligence in simply turning the oxygen flow knob down.”

4-Rendering_of_UW_Madison_addition.jpgProject rendering of aerial view of UW-Madison addition.

He encouraged veterinarians and veterinary nurses performing anesthesia to evaluate their practices by using this online calculator: https://jscalc.io/calc/H7gGXIL4tmDJHOxh.

Changing to a low fresh gas flow is an easy aspect to overlook, but there are no good reasons not to implement it. At a minimum, said Kapaldo, consider the economic benefits. A practice could easily reduce the cost to their practice for isoflurane by 50% to 75%, depending on current practices.

Take the First Steps

“Veterinary hospitals use large amounts of energy, water, and chemicals and produce significant amounts of waste, so while trying to provide the best medical treatment for clients’ pets, veterinary hospitals actually contribute to climate change, which is causing harm to their patients,” said Jacquie Hilterman, MS, MA.

She started Dogwood Consulting in Denver, Colorado, in 2020 to empower veterinary hospitals to improve their environmental impact and culture. Her five-step framework tailors offerings so that feasible sustainability solutions can be implemented at any veterinary hospital.

However, staff members first need to know why their veterinary hospital is prioritizing sustainability, Hilterman said. She recommends emphasizing the underlying values in staff meetings, in emails, and on notices in the staff lounge. When sustainability is embedded throughout the culture, employees discover their own personal reasons for commitment that lead them to create innovative solutions and improve engagement. 

For early easy wins, she suggested switching to LED bulbs, installing water-saving devices, and switching to reusable sharps containers. In addition:

  • Only purchase what is needed in proper quantities so products don’t expire.
  • Refuse single-use items like disposable ink and toner cartridges, pens, and highlighters when refillable options are available.
  • Prioritize Energy Star–rated appliances and eco-friendly products, such as Forest Stewardship Council (FSC)-certified paper products with at least 30% postconsumer waste content for all paper needs (not just copy paper). 

Bloomberg noted that a hospital does not have to pay huge amounts to gain certain certifications. They should check for local “green business” certification programs that are available at little to no cost.    

Many efforts come down to choices, she said. Recycling versus trash bin; turning off lights when a room is not in use; turning off water while handwashing; replacing appliances with more efficient ones when they fail; and using sustainable hospital cleaners like Rescue.

Don’t forget the sharps/infectious containers, said Kapaldo, noting that the CDC estimates that only 2% to 3% of what is deposited into them needs to be there. For example, packaging materials, gauze, and empty drug vials do not belong there. Unused drugs also do not belong down the sink, he said, suggesting hospitals check for services that pick up waste pharmaceuticals.

CSU offers its free online SAVE Veterinary Procurement Guide, noted Duncan. It presents:

  • An overview of existing third-party product certifications to help identify trustworthy labels and evaluate products or services
  • Sustainability policies, practices, and claims of companies servicing veterinarians
  • Opportunities to share knowledge and experience with readers of future versions of the guidebook

There is a gap in available literature about sustainability in veterinary practice, explained Duncan. However, a research team of which she was a member did a systematic literature review and extrapolated information from related fields to use as best practice guides. The team identified five physical themes (energy efficiency, water, waste, procurement, and transportation) and three behavior changes at the individual, group, and organization levels that could support veterinary hospitals in their efforts to minimize their environmental footprint. Specifics, she said, can be found in the open-access Science Direct August 2021 article: “A Systematic Review of Environmental Sustainability in Veterinary Practice.”

More Reasons to Make the Efforts

Our sources noted similar—yet unexpected—rewards from their efforts.

  • It’s often easy to begin the sustainability process by starting with something the team is passionate about. Many team members care for the environment and set the same goals for their personal lives. 
  • “Natural light does have a significant impact on morale for staff and patients,” explained Eccleston. “Many clinics were and still are very dark. I have been in clinics for 14 years, and this has been the happiest clinic for me—the majority of that is due to the windows. All that light does, in fact, reduce our electrical consumption and the solar panels contribute to that as well.”
  • Sustainability efforts often get good client feedback and support, even drawing in new clients when sustainability efforts are publicized on the hospital website and social media.
  • Hospitals with a focus on sustainability, and thus wellbeing, can be more attractive to veterinary staff seeking new employment.

We All Have a Role to Play

Danielle Scott, a May 2022 CVM graduate, will be CSU’s inaugural veterinary preventive medicine resident who will focus on sustainability. She will pursue a PhD in epidemiology and a residency to prepare her to qualify for the American College of Veterinary Preventive Medicine board certification exam.

Scott said she anticipates examining how the environment, along with its human-induced disturbances, impacts animal health and disease transmission as well as how the delivery of veterinary care can impact the environment and contribute to the changing climate.

“I think yesterday was the right time for the veterinary industry to address sustainability but now it’s more important than ever,” she said.

“I do see the start of this momentum building and feel fortunate to be supported by Nestle Purina in my efforts to steer evidence-based solutions to combat this global crisis. I think it’s important to recognize that we all have a role to play. There is a personal and collective responsibility that we must all assume if we are going to change our current trajectory toward a healthier and more sustainable future.” 

Maureen Blaney Flietner
Maureen Blaney Flietner is an award-winning freelance writer living in Wisconsin.

 

Photo credits: Photos courtesy of Eagle Veterinary Hospital; Photo courtesy of Marc Walker, design principal, Flad Architects. 

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