Heart, Lung and Circulation

Environmental Sustainability in the Cardiac Catheter Laboratory

Published:August 11, 2022DOI:
      The health care sector contributes to nearly 5% of global carbon emissions with the exponential growth of medical waste posing a significant challenge to environmental sustainability. As the impact of climate change on individuals and population health becomes increasingly more apparent, the health care system’s significant impact on the environment is also raising concerns. Hospitals contribute disproportionately to health care waste with the majority arising from resource intensive areas such as operating theatres and cardiac catheter labs (CCL). Despite the growing volume of cardiac procedures worldwide, initiatives to reduce waste from CCLs has received limited attention, overlooking opportunities for significant reduction in operational costs and carbon footprint. We aim to raise awareness of the current landscape of waste management in CCLs. We identify areas of resource optimisation and highlight practical strategies and frameworks employed elsewhere in health care to reduce waste. Importantly, we hope to empower health care workers in CCLs to make a meaningful change to their practice and contribute towards a more sustainable future.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Atwoli L.
        • Baqui A.H.
        • Benfield T.
        • Bosurgi R.
        • Godlee F.
        • Hancocks S.
        • et al.
        Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.
        Lancet. 2021; 398: 939-941
        • Ferronato N.
        • Torretta V.
        Waste mismanagement in developing countries: a review of global issues.
        Int J Environ Res Public Health. 2019; 16: 1060
        • Eckelman M.J.
        • Sherman J.
        Environmental impacts of the U.S. health care system and effects on public health.
        PLoS One. 2016; 11: e0157014
        • World Health Organization
        Environmentally sustainable health systems: a strategic document. 2017 [cited 2022 1 April 2022].
        (Available from:)
        • Doctors for the Environment Australia
        Net zero carbon emissions: responsibilities, pathways and opportunities for Australia's healthcare sector.
        (Available from)
        • Malik A.
        • Lenzen M.
        • McAlister S.
        • McGain F.
        The carbon footprint of Australian health care.
        Lancet Planet Health. 2018; 2: e27-e35
        • Wyssusek K.H.
        • Keys M.T.
        • van Zundert A.A.J.
        Operating room greening initiatives - the old, the new, and the way forward: a narrative review.
        Waste Manag Res. 2019; 37: 3-19
        • Kwakye G.
        • Brat G.A.
        • Makary M.A.
        Green surgical practices for health care.
        Arch Surg. 2011; 146: 131-136
        • van Straten B.
        • van der Eijk A.
        • Horeman T.
        A circular healthcare economy; a feasibility study to reduce surgical stainless steel waste.
        Sustain Prod Consum. 2021; 27: 6
        • Al-Hijji M.A.
        • Lennon R.J.
        • Gulati R.
        • El Sabbagh A.
        • Park J.Y.
        • Crusan D.
        • et al.
        Safety and risk of major complications with diagnostic cardiac catheterization.
        Circ Cardiovasc Interv. 2019; 12: e007791
        • Hasan S.E.
        Public awareness is key to successful waste management.
        J Environ Sci Health A Tox Hazard Subst Environ Eng. 2004; 39: 483-492
        • Choosing Wisely Australia
        More is not always better when it comes to healthcare.
        (Available from)
        • Greenwood J.P.
        • Ripley D.P.
        • Berry C.
        • McCann G.P.
        • Plein S.
        • Bucciarelli-Ducci C.
        • et al.
        • CE-MARC2 Investigators
        Effect of care guided by cardiovascular magnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates: the CE-MARC 2 randomized clinical trial.
        JAMA. 2016; 316: 1051-1060
        • Kagoma Y.K.
        • Stall N.
        • Rubinstein E.
        • Naudie D.
        People, planet and profits: the case for greening operating rooms.
        CMAJ. 2012; 184: 1905-1911
        • Bein T.
        • Koch S.
        • Schulz C.
        What's new in intensive care: environmental sustainability.
        Intensive Care Med. 2021; 47: 903-905
        • Albert M.G.
        • Rothkopf D.M.
        Operating room waste reduction in plastic and hand surgery.
        Plast Surg (Oakv). 2015; 23: 235-238
        • Stall N.M.
        • Kagoma Y.K.
        • Bondy J.
        • Naudie D.
        Surgical waste audit of 5 total knee arthroplasties.
        Can J Surg. 2013; 56: 97-102
        • Hauora A.T.
        Bay of Plenty District Health Board (BOPDHB). Environmental sustainability | Kaitiakitanga. 2021 [cited 2022 1 April].
        (Available from:)
        • Ahmadi E.
        • Masel D.T.
        • Metcalf A.Y.
        • Schuller K.
        Inventory management of surgical supplies and sterile instruments in hospitals: a literature review.
        Health Syst (Basingstoke). 2019; 8: 134-151
        • Vozzola E.
        • Overcash M.
        • Griffing E.
        An environmental analysis of reusable and disposable surgical gowns.
        AORN J. 2020; 111: 315-325
        • Milasinovic D.
        • Wijns W.
        • Ntsekhe M.
        • Hellig F.
        • Mohamed A.
        • Stankovic G.
        Step-by-step manual for planning and performing bifurcation PCI: a resource-tailored approach.
        EuroIntervention. 2018; 13: e1804-e1811
        • Tsung B.
        Green team in the cath angio lab.
        (Available from)
        • Dijkstra H.
        • van Beukering P.
        • Brouwer R.
        Business models and sustainable plastic management: a systematic review of the literature.
        Journal of Cleaner Production. 2020; 258
        • Charlesworth K.E.
        • Stewart G.J.
        • Sainsbury P.
        Addressing the carbon footprint of health organisations: eight lessons for implementation.
        Public Health Res Pract. 2018; 28
        • Reed G.W.
        • Tushman M.L.
        • Kapadia S.R.
        Operational efficiency and effective management in the catheterization laboratory: JACC Review Topic of the Week.
        J Am Coll Cardiol. 2018; 72: 2507-2517
        • Tennison I.
        • Roschnik S.
        • Ashby B.
        • Boyd R.
        • Hamilton I.
        • Oreszczyn T.
        • et al.
        Health care's response to climate change: a carbon footprint assessment of the NHS in England.
        Lancet Planet Health. 2021; 5: e84-e92
      1. Managing and responding to climate risks in healthcare.
        ([cited 2020 4 November]; Available from:)
        • Kmietowicz Z.
        NHS hits target on reducing carbon emissions.
        BMJ. 2016; 352: i587
        • Wilson S.M.
        • Prasan A.M.
        • Virdi A.
        • Lassere M.
        • Ison G.
        • Ramsay D.R.
        • Weaver J.C.
        Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.
        EuroIntervention. 2016; 12: e939-e947