DISINFACTS | Special edition 2023

21 PRACTICE Sustainability in healthcare facilities: Status quo and future challenges Sustainability reporting As hospitals contribute to enabling all people to live as healthy a life as possible and to promote their well-being, they fulfill the United Nations Sustainable Development Goal "Health and Well-being" per se [1]. However, as shown in the article "CO2 emissions in the healthcare system" (pp. 4-5), emissions of climate-damaging gases in the healthcare sector are significant, accounting for a total of 4.4% of global emissions [2]. Therefore, in order to mitigate climate change, hospitals will also be required to become significantly more sustainable in the future. Currently, one in two hospitals has already established sustainability as a corporate goal, but so far only one in four hospitals is planning specific sustainability measures [3]. However, as the legal requirements will soon change, a rethink is imminent. What are the regulatory challenges facing large facilities starting in 2025? According to the new EU directive on Corporate Sustainability Reporting (CSRD), all European companies with more than 500 employees and more than 40 million euros in sales will have to collect their greenhouse gas footprint from 2026 onwards for the financial year 2025 in order to prepare an annual sustainability report [4]. Since quite a few healthcare facilities meet these requirements, they will also have to deal with data collection and reporting. In order not to lose the overview or even bury one's head in the sand, background knowledge on the obligations of hospitals and the required contents of the reports is helpful. What areas need to be reported on? In order to determine one's own greenhouse gas footprint, to be able to report on it and to develop a sustainability strategy, the first step is to categorise the various areas in which greenhouse gases are produced directly or indirectly. The standard for this is the so-called “Greenhouse Gas (GHG) protocol”, which divides emissions into three scopes [5]. While Scope 1 only includes direct emissions from the hospital's own combustion – e.g., from gasoline for the ambulances – Scope 2 includes indirect emissions from the purchase of grid-based energy for heating or electricity. Scope 3 includes other indirect emissions from processes caused, for example, by purchased medical products References 1. https://unric.org/de/17ziele/sdg-3/ (accessed 08.06.2023) 2. Karliner J, Slotterback S (2019) Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf (accessed 21.06.2023) 3. BDO/DKI-Studie Grünes Krankenhausmanagement: Es braucht ein Umdenken (2022) https://www.dki.de/sites/default/files/2023-02/BDO_DKI_Studie_2022-5. pdf (accessed 21.06.2023) 4. https://www.csr-in-deutschland.de/DE/CSR-Allgemein/CSR-Politik/CSR-in-derEU/Corporate-Sustainability-Reporting-Directive/corporate-sustainability-reporting-directive-art.html (accessed 08.06.2023) 5. World Resources Institute and World Business Council for Sustainable Development (2004) The Greenhouse Gas Protocol. https://ghgprotocol.org/sites/ default/files/standards/ghg-protocol-revised.pdf (accessed 08.06.2023) 6. Einführung Klimamanagement – Schritt für Schritt zu einem effektiven Klimamanagement in Unternehmen. https://www.ihk-muenchen.de/ihk/Klimapolitik/ Klimamanagement-Schritt-für-Schritt-einführen_GCN.pdf (accessed 08.06.2023) 7. Singh H et al. (2022) Mandatory Reporting of Emissions to Achieve NetZero Health Care. N Engl J Med 387: 2469-2476. https://doi.org/10.1056/ nejmsb2210022 and consumables. Although Scope 3 typically accounts for the largest share of the carbon footprint - approximately 60% of total emissions in healthcare [6] - these emissions are also the most difficult to measure and must be partially estimated. While the GHG Protocol considers the reporting of Scope 3 emissions optional due to overlap with other companies, the most significant Scope 3 emissions for each company should be reported according to the CSRD [4, 5]. Figure modified based on [7]. CO2 = carbon dioxide; FCKW = chlorofluorocarbon; GHG = Greenhouse Gas Protocol; IT = Informatio technology; N2O = nitrous oxide; HFC = hydrofluorocarbon; PFC = perfluorocarbon; SF6 = sulfur hexafluoride. • Catering • Services • Medical Devices • Medicines • Water • Energy supply, e.g., through gas stations • Business trips by employees indirect emissions • Commuting of employees • Manufacturing processes of purchased products, chemicals, gases • Waste • IT • Constructing • Freight Transport direct emissions • Facilities • Anesthetics • Vehicle Fleet • e.g., through purchased electricity indirect emissions • Movement of patients and visitors Outside the scope of the GHG Protocol HFCs CO2 PFCs SF6 N2O Methan FCKW Scope 3 Scope 1 Scope 2