Klimakiller Krankenhaus und Operationen | Podcast Folge 3 mit Prof. Coburn [UKB Bonn]

We are of course in an exciting field, in an exciting field regarding sustainability, saving resources, reducing waste. Sustainable medicine can and must be very efficient and the best possible medicine. And if we don't react and our part, and everyone has to do their part, in professional life as well as in private life, and always think about doing it, if we don't do that, it will certainly be a great challenge for our future. Hello and good evening to a new edition of my MedNite video podcast, together with the UKB. My name is Dr. Tobias Weigel and today we are talking about the topic of sustainability, sustainability in medicine. We hear it in the media every day and it affects us all, whether through, for example, a flood disaster, a heating law, or also, for example, traffic jams due to climate change. We know we should, for example, use public transport instead of our own cars more often. And even on exotic superfoods we should actually do without due to the ecological footprint. So that means, for example, lentils instead of quinoa. So far so good, or so far feasible. And we can decide all of this ourselves. But what if you, dear listeners, have to go to the hospital and if you have to be operated on? We know that, first of all, about 5% of the greenhouse emissions here in Germany are attributed to the health sector. And secondly, we also know that especially narcosis gases, and we'll get to that in a moment, are among the worst climate killers in the world. So we should talk about exactly that topic today. And I'm doing that too, namely with my guest, Prof. Dr. Mark Coborn, Director of the Clinic for Anesthesiology and Operative Medicine at the UKB. Welcome, Prof. Coborn. Thank you very much. Prof. Mark Coborn was born in 1976, so we're almost the same age. Prof. Coborn spent many years at RWTH Aachen and since 2020 he has been Prof. Coborn's Chief Physician at the Universitätsklinikum Bonn. And right at the beginning of your new job here in Bonn, you also spoke about sustainability in medicine. And I once read this quote from you, how we can reduce the use of the necessary but climate-damaging narcosis gases is one of the central questions. Over 30,000 narcosis per year are carried out by you and your employees at the UKB alone. My first question would be, maybe you could briefly explain to the layperson what narcosis gases are and how they are used in operations. Narcosis gases are a part of the narcosis and they are necessary to put you to sleep. There are different types of narcosis gases. Narcosis gases have the property, they are fluorochloric hydrocarbons, which are present in the atmosphere for a very long time. As a result, they also have a very high CO2 footprint, which can be measured over many, many years. And according to the global warming potential, they are a multifaceted CO2. Back to sustainability, sustainability in medicine. What does politics look like? Politics directs and also guides us, the clinic, the clinic management. Are you encouraged and supported by politics to carry out such changes, as you just mentioned? This is a process and we have to live through the process. We have to go into discourse and there is still a lot to do here. Consciousness, and this is really very important, has been created. And it is a gradual process in anesthesia, which has only a small aspect in the medical field. We are in the hospital, that's a bigger aspect. Hospital planning, the resources for it. And I think there is a lot at stake. Sustainability must have a very central meaning, also in the sense of the patient. Sustainable medicine can also be very efficient and must be very efficient and the best possible medicine. This is not a contradiction, but a real interplay, and we have to work on that. And does politics also promote such measures, for example through funding projects or by laws, rules? Yes, we still have a lot of room for improvement. Because, for example, when we are rebuilding, the funding resources are not necessarily available to build energy-neutral hospitals, so that they are neutral. There are these technical possibilities. There are also the first hospitals worldwide that are built like this. Of course, that costs investment, but in the long run, of course, it is bearable. We also know it from everyday life, private, at home. Sustainability, and you have already hinted at it, whether at home with a heat pump or the electric car. Usually, such measures are expensive at least at the beginning. In the long run, as you said, it is bearable. In your opinion, can our health care system afford to invest in sustainability and, I would say, in bio-medicine now? Where should the money come from? No, I don't think the question is whether it can, but rather whether we have to. The aspect of sustainability can also be increased by efficiency. When I optimize processes, patient journeys, they come to the hospital and don't come to the hospital three times to have a pre-examination, maybe an operation appointment, but when I control that well, I am also sustainable, by, for example, managing the whole environment, the costs, the route, the time, all that efficiently. And that has to be our goal, best possible patient care. And this efficiency is usually sustainable. You have also worked and researched outside of Germany for a while. If you now compare a foreign health care system, maybe where you worked, with Germany, can Germany learn something from other countries? I worked for a while in England, in the NHS, and there it is a very central structure. And especially in the NHS, sustainability is a very high priority. Concepts are implemented that we absolutely support in terms of content, but which are simply assigned centrally for the hospitals and are also implemented. For example, narcosis. Certain narcosis cases have been banned in England since this year and are no longer allowed to be used. Of course, this has an advantage in the implementation, because it happens very quickly. In the federal system, which I also appreciate very much here in Germany, this is not the case. But we have recognized these issues, and politics has also recognized them, and are working on concepts to support certain things politically so that we may no longer use certain aspects, such as certain narcotic substances, in the dimension we are doing now. Professor Coborn, we always ask our guests five questions that they simply have to answer yes or no without thinking for a long time. First question. Did you already have an interest in environmental issues and sustainability as a chief physician before your time? Yes. Do you come to work by bike or public transport? Always by bike. Do you believe that we can save our planet through more conscious behavior? I hope so. Do you also buy manufactured products privately? Yes. And do you personally promote e-mobility in general? Yes. Yes, thank you very much for this answer to these questions. In short, you have already hinted at this once and so that the listeners get a better feeling, why narcotic gases are so environmentally harmful and how much, better said, does your clinic, for example, get together with 30,000 or more than 30,000 narcotics per year? Can you quantify that somehow, develop a feeling for it? I think the comparison with a car is always quite good, because you can imagine it very well. And a narcotic that takes a little longer, maybe five, six hours, can, in the cheapest case, there are also different narcotic gases, correspond to a distance of about 20 kilometers. But there are also other narcotic gases, there it is a quadruple, that's 900 kilometers. And that was also the first step, for example, that I implemented in my clinic, that we got rid of narcotic gases that have a very high global warming potential. That's why we can make just as good and just as safe narcotics, but only through this step we have been able to save over 400 tons of CO2 per year. You have already mentioned a specific measure with the narcotic gases. Can you also reuse narcotic gases, for example, recycle? That is a very important aspect. Similar to cars, we know that. These are filter options. For narcotic gases, coal filters are very suitable. These are structures that exist, that have already been developed. The question is only, how can I integrate that into the whole process? And what happens then with the trapped, trapped narcotic gas? How is it then processed again? And there are still the concrete steps in Germany, that we can really use it well in the cycle. You just mentioned the term global warming potential. And I read that from narcotic gases, the global warming potential, or the danger, is 2,500 times as great as from CO2. That is really enormous. But not only narcotic gases are environmentally harmful. I also read a report, that about 8,000 tons of waste from German hospitals can be returned to disposable devices per year. And according to the World Health Organization, WHO, which is already dealing with it, around 85% of hospital waste can be recycled. I myself am also in the operating room from time to time. I have been at our intensive care unit for almost two years. Sometimes I am really impressed, in a negative sense, how much waste we produce per patient. And I once read a number of almost 10 to 15, 17 kilos of waste per operation. Are there concrete approaches to reduce this waste? What is being done now or in the near future, perhaps also differently than two or three years ago? That is a very important aspect. You mentioned the order of magnitude per operation. We are of course in an exciting field. An exciting field in terms of sustainability, saving resources, reducing waste. The opposite is of course patient safety, hygienic requirements, the highest requirements that we have to meet. And that is the exciting field. What we are doing, and where there are very good progress, is that we are trying to make medical disposable products, which are quite important and which are partly not replaceable due to hygienic conditions, to be processed and recycled. Our operating partners are going through such processes that disposable instruments for da Vinci operations, laparoscopic operations, are collected, sterilized and then added to the recycling process. That is a huge step forward. On the other hand, we also have to look at what we can save by thinking about it, reflecting. Do we need everything? Do we need all the sets? These are also very simple measures, such as reducing light when I leave my office, driving down the computer. And you can also reflect that. There are always aspects that we can tackle very easily. The important thing is to create awareness, to think about it and see what we can do specifically. And we are very good at that. Very good. I think it is also very important to create awareness. Narcosis gas, one-way waste is basically the one thing. Each of us can do a lot ourselves and always touch our own nose. You are also at many congresses and you are also the chairman and chairman of the German Society for Anesthesiology and Intensive Medicine. And you have just told us how you are doing in the area of sustainability, because in the clinic, among your colleagues, in your opinion, is there also an awareness of sustainability there? Or do you see yourself as more of an eco-exote compared to other clinics and hospitals? We definitely have a pioneering role. We have positioned ourselves very strongly. The UKB has also positioned itself very strongly in terms of sustainability, as has our medical faculty. But awareness is growing. Every employee, every other head of the clinic, departments are realizing this. And a lot has happened in the last three years. And that is also important. Only together, if we all work on it, can we reduce the CO2 footprint, but also reduce the resources and use them effectively. You just mentioned the term awareness, which I really find very good and important. How do you specifically want to create an appropriate awareness in your clinic for more sustainability? So can you name concrete measures that affect us, your employees? Yes, that is the enthusiasm. I have formed a team, a green team, which is interprofessional. There are nurses, there are assistants, there are top doctors. I am also there myself. And together we think about what we can do on various levels, reflect and take the steps. As an example, for example, to choose the narcosis gases in such a way that we use these narcosis gases, which we definitely need and which are currently not available in large quantities, so efficiently that we have thus saved 400 tons of CO2. Another example is breathing liquid. Every body or every person, when they breathe, produces CO2 and this is collected and filtered in a narcosis. This breathing liquid is hazardous waste. We have 5 tons per clinic. And that is, for example, something that we now collect, put into the recycling process and thereby reduce hazardous waste by 5 tons. Maybe to round off, towards the end now, how do you actually see the future of our planet, especially in relation to the topic of sustainability, maybe also health systems? Well, it just depends very closely on each other. At the moment we are also seeing illnesses that we have not seen before in that dimension. The WHO assumes that at the moment about 250,000 people per year die from climate change or the consequences of climate change. I would assume that these numbers will still increase. And of course these are completely different situations. You are currently seeing the heat waves in Europe, in Southern Europe. Patients are coming to us with illnesses, with kidney failure, for example, with symptoms that we of course know, but not in that dimension and which certainly have a strong connection to climate change. And if we don't react and our part, and everyone has to do their part, in professional life as well as in private life and always think about doing this, if we don't do that, then it will certainly become a very big challenge for our future. Well, since Professor Coborn, I find it very impressive how important the topic is, how you promote it. And I think many of our listeners who may not have dealt with it before and especially the importance of sustainability in medicine may now have their eyes opened for this area for the first time. Finally, to our listeners, what personal tip do you have in relation to today's topic of sustainability? What would you like to say to our listeners? In my opinion, it is crucial that everyone contributes. You in private can reflect on your steps, your things, think about what you can do. And we in the professional field, in health care, have to offer the best possible medicine for you, but of course also make sure that it is sustainable. Yes, thank you very much, Professor Coborn, for your valuable message to our listeners. And thank you very much for being our guest today. If you liked the podcast, dear listeners, then feel free to continue the podcast. And we would be very happy to see you again next time. Thank you very much and stay loyal to us.