Positive communication Reduce inhaled anaesthetic atmospheric pollution All halogens gases are greenhouse gases Carefully choose your halogen gas Desflurane has by far the longest life span affecting the atmosphere Use N2O-free anesthesia protocol Use low flow anaesthesia as a rule. Closed circuit!! Scavenging or oxidising the inhaled anaesthetics before vented to atmosphere is the future goal 0.19 Eur 2.82 Eur 10 Eur Reduce and sorting out waste Define different kind of waste (domestic, clinical, hazardous, pharmaceutical) Waste bins: Reduce wasted (opened and unused) disposable supplies: Define different kind of waste (domestic, clinical, hazardous, pharmaceutical) Sort out the waste (most waste is domestic!) Reorganize the waste containers in the OR to favour the use of domestic waste / recycle bins Redesign pre-packaged supply kits Think before you open Refuse new disposable devices

Reduce paper waste: Post clear graphics to help sorting out the waste Learn about the waste chain in your hospital Make choices depending on your environment / waste chain Visit your waste disposable facility / incineration plant Do not print Drug waste: Reduce drug wastage: prepare drugs when needed, favour smaller drug bottles (i.e 20 ml instead of 50 ml) Do not spill drugs in the sink Recycle STEP ONE GET Informations Local regulations. Do you already have a program for recycling ? STEP TWO MEASURE Obtain some numbers about predicted amount of recyclable materials and monetary benefit for hospital.

STEP THREE FIND ALLIES Find the persons in your hospital residents, administration, engineering) Think of the way to motivate them Find local recycling company to help you that will help you (lead nurses, Make contact with your environment, recycling.. local non-profit organization involved in Make contact with local governmental organizations Plastics: Need to be not mixed with other type of waste Paper: confidential specific secure pathways information can be recycled through Medical glass can be recycled if treated by specialized companies (but not in the household glass sector). Cartons and cardboards Metals such as stainless steel, aluminium, cupper Batteries, ink cartridges Anesthesiologists responsibilities Drugs: Do not print the anaesthesia report Reduce drug wastage : 7 to 94% of the loaded drugs are waste Use pre-filled syringes when possible Do not spill drugs in the sink

Devices: Reduce wasted (opened and unused) disposable supplies Pre-condition the purchase of disposable OR equipment in the collection and recycling of the used material Choose devices depending on their life cycle Favour reusable devices Refuse devices with batteries Make sure plastic devices / wraps do not contain phtalates Energy: Turn off Lights Computers and all electronic devices Respirators and all electric devices OR lights Ventilation, temperature in the OR set at an optimal level allowing decontamination and safety Personal behaviour Be consistent and lower your environmental impact Food/beverages: Be e-green: Use a reusable mug for coffee / tea Refuse plastic silverware and dishes at work Promote organic and local food in reusable dishes Eliminate plastic bottles Reusable and washable glasses for patients and yourself More audio-video conferences