Sustainability in medical care
The USZ takes a holistic approach to health. Our medical care and the company as a whole influence the health of the planet, for example through emissions, resource consumption or social factors. In turn, our patients benefit from a healthy environment. The fact that the USZ is committed to the health of the planet therefore makes double sense.
The path to climate-neutral anesthesia
Approximately 30,000 anesthesias are performed at the USZ every year. A variety of different procedures and anesthetics are used. Inhaled anesthetic gases such as desflurane, isoflurane and sevoflurane are powerful greenhouse gases and therefore extremely harmful to the environment. Since the beginning of 2022, there has been a directive in place in anesthesiology that limits the use of climate-damaging anesthetic gases.
Desflurane is 2,540 times, isoflurane 510 times and sevoflurane 130 times more climatically active thanCO2. For example, the environmental impact caused by seven hours of anesthesia with desflurane is equivalent to driving about 15,000 kilometers in a gasoline-powered car. In addition to desflurane, the most climate-damaging anesthetic gas, the second most harmful anesthetic, isoflurane, was also banned from the USZ operating theaters before 2022. This means that sevoflurane remains the only climate-active anesthetic gas currently used in human medicine at the USZ. In most operations, anesthetic gases can be replaced by intravenous anesthetics such as propofol, which are less harmful to the environment. The USZ has made intravenous anesthesia the standard. However, there are certain clearly defined medical indications for which inhaled anesthesia with sevoflurane is still necessary and sensible – for example after a prolonged stay in the intensive care unit and after long-term sedation with propofol.
The path to climate-neutral anesthesia
In a retrospective study conducted by staff at the Institute of Anesthesiology (IFA) (and published in the British Journal of Anaesthesia), the consumption of anesthetics such as desflurane, sevoflurane and propofol and the use of plastic syringes and tubes were analyzed. The study, which took place over a period of two years, investigated whether and to what extent switching to total intravenous anesthesia reduces both environmental impact and costs.
By completely discontinuing the use of the anesthetic gases desflurane and isoflurane as well as the very restrictive use of sevoflurane, a drastic reduction in environmental pollution was achieved. Although the consumption of Propofol and plastic syringes rose sharply at the same time, as expected, the measures implemented at the IFA resulted in an 81 percent reduction in environmental emissions.
Until now, the gases have been removed using the so-called anesthetic gas transport system. Carbon-based filters are one way of binding these gases and thus recycling them. Tests are already planned.
The changeover also led to a reduction in costs: compared to the second quarter of 2021, costs fell by 11% in the first quarter of 2023. Environmentally friendly anesthesia practices are therefore not only ecologically but also economically beneficial and contribute to the overall efficiency of the healthcare system.
Reusable instead of disposable products
“Planetary Health” educational module
In cooperation with the ZHAW, a new training module for the basic training of nursing staff, physiotherapists, occupational therapists and nutritionists was developed and implemented for the first time. Under the motto ‘Shaping the future together at the USZ’, the trainees were taught about the connections between the environment and health in face-to-face events and through an accompanying digital learning program. Over two half-days, topics such as nutrition, mobility, waste and heat were covered, with theoretical concepts illustrated by practical examples from everyday clinical practice. The aim of this educational module is to enable and encourage trainees to take a holistic view of health in the context of global environmental change.
Valuable products from social support programs
Green Team
A “Team Green” was established in the neurosurgical intensive care unit, which initially carried out a needs analysis with regard to a more environmentally friendly way of working (needs, opportunities, priorities). As a result, measures within the ICU’s sphere of influence – including disposal issues and the sustainable use of medicines – were defined and are now being implemented step by step.
Contact on the topic of sustainability in medical care
Reusable instead of disposable products
In the reprocessing unit for medical devices (AEMP) in Schlieren, the USZ cleaned, disinfected and sterilized around 4.1 million medical instruments in 2024 – from surgical clamps and forceps to endoscopes. This corresponds to an increase of 14% over the past two years. Reusable products are preferred to disposable products where possible and where it makes ecological and economic sense to do so(study on the reduction of disposable materials). Through maintenance, functional tests and quality controls, the medical devices can be maintained in good quality for a long time. Reusable products require fewer valuable raw materials and consume less energy over their entire life cycle than disposable products. They are also less affected by supply bottlenecks from external suppliers or disruptions to global supply routes. The practical handling of high-quality reusable instruments is also often better than that of cheap disposable products. The AEMP has been awarded the “ISO 13485 Medical Devices Quality Management System” certificate.
Valuable products from social support programs
After each birth, parents receive a practical changing mat as a gift from the maternity clinic. This give-away creates a link to the birth experience and is produced in the workshops of the Marktlücke social support program. The program supports unemployed women who are registered with social welfare in the process of their social integration and/or gives them the opportunity to increase their employability and make the transition to working life. The materials are produced locally; the cord, for example, is handmade in Switzerland’s oldest rope factory.
Paper drinking straws
In the past, the USZ used around 15,000 plastic straws per month. The vast majority of these are not used for therapeutic reasons or even pose a risk to patient safety (e.g. by swallowing liquids). For this reason, straws are no longer provided at the USZ whenever possible. This applies to both patients and employees. Patients who are dependent on a drinking straw will continue to receive one during their hospital stay at the USZ, but straws made of paper will be used. The USZ is endeavoring to reduce the use of drinking straws to a significant extent for the sake of the environment and to make them more sustainable. Plastic straws have been banned in the EU since 2021.
LEAF
As part of the Laboratory Efficiency Assessment Framework (LEAF, developed by University College London), in which several USZ laboratories are involved, freezers were examined more closely. By combining samples, some devices could be taken out of operation completely. For others, raising the target temperature from -85 °C to -70 °C – depending on the appliance type and the samples stored – led to energy savings of up to 30 percent. The certified laboratories were also able to implement further measures to reduce their environmental impact, for example by changing equipment settings or handling samples.
