UCSF Sustainability Stories

Robert Hood, January 2022

Seema Gandhi, MD: Reducing Greenhouse Gas Emissions and Waste in UCSF Operating Rooms and Beyond

The World Federation of Societies of Anesthesiologists estimates that healthcare is responsible for nearly five and 8.5 percent of total global and domestic greenhouse gas (GHG) emissions in the US, respectively. The inhaled anesthetic agents used during surgeries are potent GHGs and contribute 51 percent of the operating rooms (ORs) emissions. Less than five percent of anesthetic agents are metabolized by patients, with the vast majority of the anesthetic gases being routinely vented into the atmosphere as GHGs.

As an anesthesiologist and the Medical Director of Sustainability at UCSF Health, Seema Gandhi, MD, is at the forefront of healthcare sustainability – and she’s making a difference. “When comparing 2020 with 2018, UCSF has decreased emissions from inhaled anesthetics by 729.4 metric tons of CO2,” she said. “That’s the equivalent of taking 159 cars from the streets of San Francisco.”

Gandhi trained in India, the United Kingdom, and the U.S., which provides her with a unique global perspective. “Witnessing the high-cost, wasteful practices in US healthcare compared to other countries has motivated me to advocate for more sustainable and evidence-based practices.”

Over the past seven years, Gandhi has given numerous grand rounds on healthcare sustainability and the environmental impacts of anesthesia, engaged colleagues to eliminate desflurane, an anesthetic gas with the highest global warming potential, and spearheaded a multidisciplinary team to implement a Clinical Decision Support (CDS) tool for the adoption of low flow anesthesia practices. 

“It is evident that there are more sustainable alternatives that are clinically safe in our practices. After the education to address knowledge gaps and the implementation of the CDS tool that led to sustainable behavioral changes, our emissions from anesthesia are the lowest in the nation and almost equivalent to European nations,” she said.

Reducing Waste in Operating Rooms

When it comes to greening UCSF’s operating rooms, Gandhi’s efforts don’t stop at greenhouse gases. Healthcare waste is a significant issue due to the increasing adoption of single-use products and medical devices, contributing to the 30 to 70 percent of hospital waste generation that comes from the operating room. Gandhi was awarded a Zero Waste grant in 2017 from the City and County of San Francisco for her efforts to reduce waste in clinical spaces and she received the Caring Wisely grant from the UCSF Center for Healthcare Value in 2020 for reducing waste in operating rooms.

The funding helped establish programs in the OR for recycling and single-use device reprocessing, an FDA-approved process for devices labeled ‘single-use’ to be reused, and implemented reusable isolation gowns, gel products for patient positioning, and additional sustainability-driven practices. The reduction in single-use products has allowed UCSF Health to successfully divert 72 tons of landfill waste during the grant period, as well as increase supply chain resilience at UCSF amid the global supply chain disruption.

Sustainability Curriculum

Gandhi has also undertaken the efforts to engage and share our best practices in clinical sustainability with other UC health systems. She is a strong advocate for incorporating sustainability and cost awareness education into the core curriculum. With the engagement and support from the UCSF team, the anesthesia departments in the other four UC health systems have also reduced their desflurane usage and are set to launch versions of the CDS tool at the end of 2021 to lower their anesthetic gas emissions.

Her ongoing projects include energy utilization and carbon emission mapping for UCSF operating rooms; identifying opportunities for reducing the energy usage for Heating, ventilation, and air conditioning (HVAC) and creating an equipment shutdown checklist during off-peak hours in the OR; implementing more reusable alternatives such as surgical gowns and other sterile textile products; and creating sustainability workgroups for the Intensive Care Units (ICUs), Emergency Department, and Inpatient-care unit to expand the focus of our sustainability efforts beyond the perioperative care area.

In addition to the many sustainability initiatives currently underway at UCSF, Gandhi believes it is critical to incorporate sustainability-focused quality improvement education and initiatives into the medical student and resident curriculum, and to work with our industry partners to identify solutions for more sustainable products with less toxic chemicals, less packaging, and higher rates of reprocessing. Through a multi-faceted and persistent approach, Gandhi is helping to steer UCSF Health towards a sustainable and healthier future.