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Santa Clara Valley Healthcare Undertakes Major Climate Initiative

SANTA CLARA COUNTY, CALIF. — The health care industry in the United States accounts for 8.5-10% of our country’s greenhouse gas emissions.

Santa Clara Valley Healthcare (SCVH) is doing its part to change that. 

Last year, amid a worsening global climate crisis, the organization signed a federal Health Sector Climate Pledge to dramatically reduce the carbon footprint at its three hospitals – Santa Clara Valley Medical Center, O’Connor Hospital and St. Louise Regional Hospital – and many clinics. The pledge calls for SCVH to reduce its carbon emissions by at least 50% by 2030 and achieve net-zero emissions by 2050.

To achieve this goal, the organization formed the Santa Clara Valley Healthcare Climate Action Collaborative, one of several important sustainability initiatives within the County of Santa Clara. The County as a whole has committed to being carbon-neutral by 2030 and is working to electrify County buildings and vehicles, improve recycling and reduce waste.

“We have a responsibility as a county government to lead in the area of sustainability not just in terms of policy but also in terms of our operations,” said County Executive James R. Williams. “And because we are such a large health care system, and health care is a space where there are a lot of emissions, we have an opportunity to really step up to this challenge and be a national and international leader.”

Call to action 

The idea for the Climate Action Collaborative began with Dr. Lauren Lalakea, chief of head and neck surgery at Valley Medical Center.

Lalakea had been feeling anxious about the climate crisis, but she was unsure how to help. 

“We all want the world and our communities to be safe and stable, and climate change is a threat to that,” Lalakea said. “So, like anybody else, I’m having my worries, and thinking what can I do about it?”

A doctor holds open a waste receptacle.
Dr. Lauren Lalakea discusses Santa Clara Valley Healthcare's practice of sterilizing and reusing a growing number of tools and equipment. 

When she learned how much the health care industry contributes to climate change, she said, the lightbulb went off. She began thinking of climate change in terms of health, particularly how it affects the health of the community that SCVH serves. Most patients at SCVH qualify for Medi-Cal, the state of California’s health care program for low-income residents. People with limited resources are more likely to suffer from the effects of climate change, such as air pollution and extreme weather events.

“This is directly in our lane as far as what we have pledged to do as physicians – do no harm. If we are truly about better health for all, then we need to reduce the public health harm our carbon footprint is creating,” said Lalakea. “We have to clean up our own house here in health care if we’re all going to have a sustainable and survivable planet.”

Lalakea gathered support from colleagues and pitched SCVH leadership on signing the Health Sector Climate Pledge. She is now “physician champion” for the collaborative, helping the initiative reach its goals. The collaborative made significant progress in 2023 during the first year of implementation and has its sights on bigger goals in 2024.

Three of the areas where the collaborative is focused are hospital operating rooms, food service, and outpatient clinics.

Operating rooms

Operating rooms were an obvious area for the collaborative to concentrate, not just because Lalakea is a surgeon, but because they use a lot of energy and produce loads of waste.

“For any health care system looking to cut their carbon footprint, the operating room is a natural place to begin,” said Lalakea. “The operating room usually burns way more energy – three to six times the energy per square foot of other areas of the hospital – and produces way more waste. Usually, about a third of hospital waste comes from the operating rooms.”

In coordination with Dr. Joanna Staunton and Cindy Harmer, who oversee the Valley Medical Center and O’Connor Hospital operating rooms, respectively, the collaborative has made significant improvements in several areas, including anesthetic gasses. They determined the pipes that transport nitrous oxide to operating rooms allow much of the gas to escape into the environment. To fix this problem, O’Connor Hospital has decommissioned its nitrous oxide pipes and started using gas canisters instead. Valley Medical Center and St. Louise Regional Hospital are in the planning phase to do the same.

Meanwhile, they figured out they could be more efficient when administering gas to patients. Anesthesiologists have lowered gas flow rates so that patients are still given the same amount of anesthetic gas, but less wasted gas is released into the environment.

In addition, Valley Medical Center operating rooms have eliminated one type of anesthetic gas, desflurane, that is a potent greenhouse gas, and reduced the use of nitrous oxide, which accounts for about 6 percent of greenhouse gasses in the atmosphere worldwide. 

Staff have also improved the use of “red bag waste,” also known as regulated medical waste. Hospital bins lined with red bags are meant for items that could be infectious, such as bandages and gauze, gloves and gowns, and any items containing blood or other fluids.

The collaborative discovered that staff had gotten in the habit of throwing trash in these bins that didn’t belong there. Disposing of red bag waste is a costly and energy-intensive process. It must be either heated before going to a landfill or simply incinerated. Operating rooms reduced the amount of waste in red bags by more than 50% in 2023 and plan to improve on that number in 2024.

Besides anesthesia and regulated medical waste, the team has cut down on single-use materials and supplies. Valley Medical Center has replaced disposable sheets for operating tables with ones that can be washed and safely reused, which Lalakea estimates will prevent 20,000 pounds of waste per year and save the hospital $100,000 annually. They also switched to reusable surgical jackets, which will eliminate about 4,000 pounds of waste per year.

SCVH has also expanded the reuse of certain operating-room equipment. The hospitals contract with Stryker, a Fremont-based medical technology company, to sterilize and repackage implements such as electrocardiogram (EKG) leads, or electrodes; harmonic shears, which are used to cut and seal tissue; and hover mats, which hospital staff use to transfer patients from one bed to another.

Extending the life of operating-room tools saved SCVH more than $1 million in 2023 and kept 37,000 pounds of waste out of the landfill.

“Green projects are not only good for the environment but also good for the County’s budget,” said Lalakea. “And we like that.”

The organization is expanding the service with Stryker in 2024, while further reducing red bag waste. Lalakea and her team are also working to remove unnecessary equipment from sterilized packs and convert to reusable sharps containers, among other goals. 

Food and nutrition

There is a big connection between eating healthfully and addressing climate change. Santa Clara Valley Healthcare recognizes that food grown locally and sustainably is better for you and better for the environment.

That ethos is reflected in the Good Food Purchasing Program, which has guided the food procurement process at SCVH since 2022. Jocelyn Dubin, lead public health nutritionist with the County Public Health Department, is spearheading the implementation of the program in all three County hospitals.

“Roughly 30 percent of climate change is due to what we eat,” Dubin said. “If we can really look at what we’re eating, what we’re serving, we can make a huge impact on making our climate sustainable.”

Menu board shows options at a hospital.
The board in the cafeteria at St. Louise Regional Hospital displays the lunch menu.

When it comes to the food served to patients, staff and visitors, SCVH has begun putting plants front and center. The organization is pulling back from meat, particularly red meat, and focusing on fruits and vegetables that are fresh and local – delivered within 48 hours of being harvested.

When they do serve red meat, it increasingly comes from a company that provides beef from within 500 miles of the hospital and contains no antibiotics or added hormones. The cattle are raised using regenerative farming practices, which involves rotating the plots of land where cattle graze to avoid depleting the soil. 

County hospitals are also incorporating “Universal Meals,” which are vegan and free of the top nine allergens, including gluten and peanuts. 

“Food is medicine, when used appropriately, not just for us but for the planet,” Dubin said. “The more plant-based our foods are, the friendlier it is to the environment.”

SCVH is pioneering its new approach to food at St. Louise Regional Hospital. On a recent afternoon at the Gilroy hospital, the cafeteria served a lunch consisting of tri-tip with homemade chimichurri, parsnip puree and roasted red beets. There were two Universal Meal options: smoky potato soup and mushroom stroganoff.

St. Louise is cutting down on sodas, offering water, flavored water and other sugar-free drinks instead. On this day, food service staff had set out a large glass container of water filled with strawberries, cucumber slices, and sprigs of mint.

“Oh, you made the beautiful water again!” a nurse told a member of the food service team. “I like the beautiful water.” 

Food service staff across SCVH are also cutting down on plastic waste, eliminating plastic bottles in favor of ones made of glass, aluminum, cardboard or plant-based materials. 

This year, the hospital system aims to add Universal Meals to the inpatient menu and continue to decrease food waste, while continuing to improve purchasing policies to favor fruits, vegetables and whole grains over red and processed meats. 

Outpatient clinics

SCVH Climate Action has generated a groundswell of support at many of the organization’s outpatient clinics. 

Dr. Jennifer Tong, chief experience officer for SCVH, is the administration’s point person for the collaborative. She has been inspired by the enthusiasm for the initiative that she’s seen among frontline staff.

“This is really a grassroots effort that our leadership is supporting,” said Tong, “as opposed to our leadership coming in and saying, ‘Okay, everyone must work on this.’ It’s really been rewarding to see the staff get excited about this and feel like they can actually make a difference.”

Clinics have improved their recycling practices, while identifying ways to reduce waste, particularly when it comes to paper and printer toner, under the guidance of Dr. Jennifer Djafari, a pediatrician who specializes in medical informatics. Clinic staff are giving patients the option of printing out their after-visit summaries, instead of printing them automatically, and encouraging patients to sign up for My Health Online, a patient portal that includes the summaries and other vital information.

They are also encouraging doctors and nurses not to waste disposable plastic gloves with a “Use Gloves Wisely” campaign led by Esther Tablang, a registered nurse who helps manage the clinics at the Valley Specialty Center. There are some cases where physicians and staff must wear the disposable gloves, for their safety and that of the patient. In other instances, such as checking a patient’s blood pressure, they’re not necessary. The Use Gloves Wisely campaign will expand to other hospital and clinics in coming months.

By being more conscientious about when to use gloves, the Plastic Surgery Clinic and Otolaryngology Clinic have already reduced glove use by 25-30%. Lalakea estimates these clinics alone are on track to save about 500 pounds of waste per year.

Clinic goals for 2024 include switching out metered-dose inhalers with dry-powder inhalers when appropriate for patients with respiratory conditions. Metered-dose inhalers use hydrofluorocarbons as propellants to dispense the spray. These compounds act as powerful greenhouse gasses when released into the atmosphere.

Other goals include reducing waste when printing sticker labels for things like blood samples, among many other ideas.

Looking ahead

As SCVH Climate Action heads into its second year of implementation, hospital staff and leadership are developing ways to measure the initiative’s progress. They are creating internal and external websites to track their goals and completing a greenhouse gas emissions inventory.

The organization is also tackling a major project: replacing the gas-powered chiller, or air-conditioning unit, at Valley Medical Center with an electric unit.

There’s a lot to do in a short amount of time, which is one of the reasons why climate work is so daunting. Tong takes solace in knowing she is working with people who are used to tackling hard problems.

“In the moments when this work seems overwhelming,” she said, “I remind myself that I’m surrounded by colleagues who are capable of great things, and this is just one more really important, complicated endeavor that we’ve embarked on.”