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Just as our environment—the air, earth, and sea—impacts us all, we have an impact on our environment. Carbon emissions and climate change are increasingly on the forefront of everyone’s mind, and there is little in our world that doesn’t in some way impact climate change—including healthcare and laboratory medicine.

Healthcare is a huge sector of the American marketplace; in the U.S., healthcare facilities contribute around 10 percent of all CO2 equivalent emissions.1 According to James Connelly, CEO of My Green Lab, laboratories are resource-intensive spaces that use up to 10 times the energy and four times the water of a typical commercial office building; they also produce 12 billion tons of plastic waste a year. It stands to reason that “green” policy initiatives within the healthcare sector in general and the laboratory space in particular could result in positive changes in greenhouse gas emissions and positively impact climate change. Today’s laboratories need to see such policies—as Dr. Steven H. Kroft, MD, MASCP, wrote in a recent AJCP editorial—as a different kind of laboratory stewardship.2

Assessing your carbon footprint

While exactly how much carbon emision comes from clinical laboratories is unknown, it’s safe to assume it is a significant number. And whatever the number is, it’s impacting the health and safety of the communities the laboratory serves. As Ilyssa Gordon, MD, PhD, associate professor of pathology at Cleveland Clinic puts it, “The greenhouse gas emissions we produce contribute to the indirect health burdens of climate change. As we go about delivering healthcare with a mandate to do no harm, we must identify ways to deliver that care with a smaller environmental footprint.”

So, how can the laboratory do that? The most accurate way to go about this is to perform life cycle assessment studies on processes. A life cycle assessment (LCA) is a standardized method of analyzing the carbon impact of a product or service during its lifetime. It answers the question, from beginning to end, how much carbon emission does this product or service produce? A typical life cycle assessment includes these four steps:

• Define the goal and scope of the project. The narrower the scope—for instance, the environmental cost of running a CBC on a particular analyzer or gastrointestinal biopsies—the simpler the analysis will be.
• Building inventory. This can include, but isn’t limited to: consumables, chemicals, electricity/energy usage of analyzers, staff travel to and from work, and waste management.
• Evaluate the potential environmental impacts. Essentially, crunch the numbers from all data.
• Interpretation. What does all this data mean?

With a narrowed scope, laboratories can really focus on what’s coming into the system, what’s going out, and create an appropriate model. Cassandra Thiel, PhD, assistant professor at NYU Langone Health, points out, “We’re essentially creating a model of the system so we can estimate the greenhouse gases. We must include all of the different products involved, all of the energy expended—from raw material extraction to disposal—we have to account for all of that. These types of analyses are simpler to perform if we make the scope very narrow.” While even a “simplified” LCA is an arduous, time-consuming project, performing one can help laboratories find the hotspots in processes to target for mitigation strategies.

Small changes, big results

If time or resources aren’t available to perform LCAs for labs specifically, then existing studies point to small changes, which if made over the entire industry can make a big difference in the long run. For example, it’s not necessary to calculate the CO2 equivalent for every test to install bike racks near the laboratory to encourage those employees who live close enough to ride their bikes to work. Rather, evaluate workloads and corresponding schedules; can staff shifts be changed from eight- to 10- or even 12-hour shifts over fewer days to decrease the number of times staff members commute to work? Would it be feasible to open satellite phlebotomy stations for rural laboratories, for instance, to limit the amount of time patients spend in a car? Is purchasing as “circular” or “green” as possible? (Meaning, buying recycled products and recycling them when they’re done.) Don’t run the water the entire time slides are being stained.

According to My Green Lab’s Mr. Connelly, an important concept when creating a greener laboratory space is to question everything. “We engage folks in the process of asking why. Why do we leave the lights on 100 percent of the time? Why don’t we close fume hoods when not in use? Is there equipment we leave running that we could turn off overnight? Why do we keep this freezer at negative 80 degrees, when negative 70 degrees would maintain sample integrity?” Asking these kinds of questions, and changing these sorts of behaviors can have a significant impact on environmental footprints.

Use your voice

It can sometimes feel powerless when it comes to what sort of supplies are purchased for the lab but in fact, the opposite is true. “Laboratory professionals and pathologists can put pressure on the market,” says Dr. Gordon. “Start conversations with your reps and suppliers and let them know you’re interested in recycled, reusable, or biodegradable solutions.” Just knowing there’s a market share to be had can compel companies to develop these kinds of products. “Just because some lab supplies are single-use doesn’t mean we can’t influence the sustainability of the manufacturing and shipping process,” notes Mr. Connelly.

Consultations are yet another way for laboratory staff to use their voice to reduce waste in the clinical laboratory sector. “We’re the ultimate consultant in terms of helping the clinical care team understand which test is the best one to order,” says Dr. Gordon. “We can add algorithms to our online ordering system to put a ‘soft stop’ of sorts before someone can order a high-emissions laboratory test, for example, and suggest other tests that might give them the answer they need with a lower environmental cost.”

Climate change is a global concern, and making personal changes can seem insignificant when faced with the monumental problem at hand. Even so, clinical laboratories worldwide can enact green policy initiatives that, in the aggregate, stand to make a real impact to carbon footprints and therefore climate change. Pathology and laboratory medicine can lead the charge in the healthcare sector to make the laboratory space as green as possible.

References

1. Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014. https://doi.org/10.1371/journal.pone.0157014
2. Steven H Kroft, MD, A Different Kind of Laboratory Stewardship, American Journal of Clinical Pathology, 2021; aqab008, https://doi.org/10.1093/ajcp/aqab008