P2D388: Empowering Pediatric Surgeons to Promote Environmentally Responsible Operating Room Practices

Background: Human activities that result in the release of greenhouse gases are the main driver of climate change. Children are particularly vulnerable to the effects of climate change including weather disasters, heat stress, decreased air quality, climate-sensitive infections, and food/water security. Hospitals are major contributors to greenhouse gas emissions, and operating rooms (ORs) are the leading sources of both waste and emissions. Pediatric surgeons have demonstrated a growing awareness of the environmental impact of OR activities and expressed a desire to be leaders in reducing this impact. However, there is a lack of education and optimal strategies for environmentally responsible practices and tools to support implementation. This project aims to develop and disseminate a toolkit to support pediatric surgeons in advocating for environmentally responsible practices in the OR.

Project Description: The Advocacy Sustainability Subcommittee of the American Academy of Pediatrics (AAP) and American Pediatric Surgical Association (APSA) has initiated the development of a "Greening the OR" toolkit. The toolkit’s primer includes key facts about climate change, the environmental impact of ORs, and the effects of climate change on children's health based on a robust literature review. Additionally, the toolkit features a "Greening the OR" strategy, a list of essential team members (Figure 1), high-impact interventions (Table 1), and a collection of high-yield resources. The intent is to create a “Greening the OR” folder within the publicly accessible APSA Quality and Safety Toolkit. The primer, along with details on institutional quality improvement projects that promote environmentally responsible practices, will be available in this folder.

Discussion: Surgeons are uniquely poised to be leaders in environmental stewardship initiatives given the major impact of the delivery of surgical care. Reducing the environmental impact of the OR aligns with the overarching objective of healthcare quality improvement, which aims to enhance processes and systems to achieve better patient outcomes. The challenges encountered in implementing these initiatives are similar to those encountered in all quality improvement efforts, such as securing executive level buy-in, addressing staff perceptions and misconceptions, navigating logistical hurdles, addressing resistance to change, closing knowledge gaps, dealing with financial and time constraints, and prioritizing competing objectives. Our goal in creating and disseminating this "Greening the OR" toolkit is to provide surgeons with the tools and information they need to initiate and promote environmentally responsible practices at their respective institutions.

Conclusion: As pediatric surgeons, our mission is to safeguard present and future generations of children from harm including mitigating the negative health consequences of global warming. This toolkit will aid pediatric surgeons in promoting environmentally responsible practices and advocating for a reduction in the environmental impact of the OR within their institutions.