Eco-audit of the Nail Bed Injury Treatment Pathway at a Tertiary Care Hospital

Surgery is the most energy-intensive healthcare practice contributing to climate change. Nail bed injuries are among the most frequently encountered types of hand injuries seen in emergency rooms; however, their environmental impact has yet to be elucidated. This study assessed the carbon footprint associated with nail bed injury treatment and proposed alternatives, where feasible, to mitigate its impact.

This retrospective study analyzed patients undergoing NBI treatment from August 2022 to August 2023 at the Royal Free Hospital. The carbon footprint was calculated perioperatively using process mapping. Emissions were quantified based on patient travel, imaging, energy consumption, consumables used, waste disposal, and product transportation. A survey was shared with members of the hand trauma clinic to identify the items used during the procedure.

Out of 1569 patients, 449 met the inclusion criteria. Overall pathway emissions were equal to 1333.22 kg carbon dioxide equivalents (CO₂e) annually, or 2.97 kg CO₂e per patient. The preoperative phase contributed the most to emissions (52.7%), primarily from x-ray procedures and patient travel. Hazardous infectious waste accounted for most intraoperative emissions. Survey results revealed that several items in disposable surgical packs were routinely unused, suggesting potential for waste reduction. Minimizing the products included in the surgical packages could save approximately 13.44 kg CO₂e across included patients or 46.95 kg CO₂e annually.

By promoting same-day imaging, optimizing surgical packs, and enhancing surgeon education on sustainability, healthcare institutions can reduce carbon emissions, aligning with the National Health Service's net-zero goals. Small, targeted changes in common procedures can achieve significant environmental and economic benefits.