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RESEARCH ARTICLE (Open Access)

Connecting the dots between a sustainability agenda, infection prevention and antimicrobial resistance

Branwen S. Morgan https://orcid.org/0000-0001-5318-1675 A * and Emma-Leigh Synnott https://orcid.org/0000-0001-9076-2911 B
+ Author Affiliations
- Author Affiliations

A Minimising Antimicrobial Resistance Mission, CSIRO Health and Biosecurity, Sydney, NSW, Australia.

B Monash Sustainable Development Institute, Monash University, Melbourne, Vic., Australia.




Prof. Branwen Morgan is based at CSIRO where she leads the Minimising Antimicrobial Resistance (AMR) Mission, which was co-developed with the Australian Government Department of Health and Aged Care and Department of Agriculture, Fisheries and Forestry. Her team works with national and international partners to create a sustainable One Health ecosystem that enables and accelerates the development, uptake and adoption of solutions to prevent, manage and respond to AMR in humans, animals and the environment. She is an Adjunct Professor at the University of Technology—Sydney. (Photograph by Joseph Byford.)



Dr Emma-Leigh Synnott lives and works on Whadjuk Noongar Boodja, Western Australia. She is the WA Chair for Doctors for the Environment Australia (DEA), a Senior Research Fellow and assistant lecturer atthe Monash Sustainable Development Institute (MSDI), consultant Physician in Rehabilitation Medicine, and the Medical Lead for Climate Health and Environmental Sustainability at the South Metropolitan Health Service. Emma also works closely with the Climate Justice Union (CJU) as part of the WA hub of the National Healthy Environment and Lives (HEAL) Research Network.

* Correspondence to: branwen.morgan@csiro.au

Microbiology Australia https://doi.org/10.1071/MA24025
Submitted: 17 April 2024  Accepted: 9 May 2024  Published: 23 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the ASM. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Australia’s healthcare sector accounts for up to 7% of Australia’s carbon footprint. However, the sector has broader direct and indirect environmental impacts. There’s a balance to be struck between reducing environmental impact and optimising infection prevention and control strategies, which include minimising antimicrobial resistance. The discussion covers health service demand, low carbon care, patient-centred treatment, safe medication disposal and single use medical supplies, as well as wastewater with Australian-based examples. Barriers to implementation of a sustainability agenda include an already stretched health system and a disconnect between community health, hospital systems and processes and those who have the capital, capability and resources to drive these efforts. This article explores the environmental impacts of the healthcare system and current strategies to improve sustainability through the lens of infection prevention. This includes the potential unintended negative consequences for the prevention and management of antimicrobial resistance.

Keywords: AMR, antimicrobial resistance, carbon footprint, environment, healthcare, infection prevention, One Health, pollution, sustainability.

Biographies

MA24025_B1.gif

Prof. Branwen Morgan is based at CSIRO where she leads the Minimising Antimicrobial Resistance (AMR) Mission, which was co-developed with the Australian Government Department of Health and Aged Care and Department of Agriculture, Fisheries and Forestry. Her team works with national and international partners to create a sustainable One Health ecosystem that enables and accelerates the development, uptake and adoption of solutions to prevent, manage and respond to AMR in humans, animals and the environment. She is an Adjunct Professor at the University of Technology—Sydney. (Photograph by Joseph Byford.)

MA24025_B2.gif

Dr Emma-Leigh Synnott lives and works on Whadjuk Noongar Boodja, Western Australia. She is the WA Chair for Doctors for the Environment Australia (DEA), a Senior Research Fellow and assistant lecturer atthe Monash Sustainable Development Institute (MSDI), consultant Physician in Rehabilitation Medicine, and the Medical Lead for Climate Health and Environmental Sustainability at the South Metropolitan Health Service. Emma also works closely with the Climate Justice Union (CJU) as part of the WA hub of the National Healthy Environment and Lives (HEAL) Research Network.

References

Malik A et al. (2018) The carbon footprint of Australian health care. Lancet Planet Health 2, e27-e35.
| Crossref | Google Scholar | PubMed |

Australian Institute of Health and Welfare (2018) Australia’s health 2018, Chapter 4, Section 4.2. Social determinants of health. Australia’s health series number 16. AUS 221. AIHW, Australian Government, Canberra, ACT, Australia. https://www.aihw.gov.au/getmedia/746ded57-183a-40e9-8bdb-828e21203175/aihw-aus-221-chapter-4-2.pdf.aspx

Climate and Health Alliance (2021) Healthy, Regenerative and Just. Framework for a national strategy on climate, health and well-being for Australia. CAHA, Melbourne, Vic., Australia. https://d3n8a8pro7vhmx.cloudfront.net/caha/pages/1947/attachments/original/1639623234/caha-framework-2.0-FA.pdf?1639623234

Barratt AL et al. (2022) High value health care is low carbon health care. Med J Aust 216, 67-68.
| Crossref | Google Scholar | PubMed |

Brighton & Sussex Medical School et al. (2023) Green surgery: reducing the environmental impact of surgical care (v1.1). UK Health Alliance on Climate Change, London, UK. https://www.rcseng.ac.uk/-/media/Files/GreenSurgeryReport2023.pdf

South Metropolitan Health Service, Fiona Stanley Fremantle Hospitals Group (2024) LifeFit-SurgFit. Government of Western Australia. https://fsfhg.health.wa.gov.au/Our-services/LifeFit-SurgFit (accessed 18 April 2024)

Drew J, Rizan C (2022) Living repository: HealthcareLCA Database. HealthcareLCA. https://healthcarelca.com/database (Online database, accessed 18 April 2024)

Smith M et al. (2009) Water Transformed – Australia: Sustainable Water Solutions for Climate Change Adaptation. The Natural Edge Project (TNEP), Griffith University, and Australian National University, Australia. https://eprints.qut.edu.au/85206/7/85206.pdf

Victoria Department of Health (2023) Water consumption and benchmarks. State of Victoria. https://www.health.vic.gov.au/planning-infrastructure/water-consumption-and-benchmarks (accessed 18 April 2024)

10  Selda MH et al. (2021) Treatment-based hospital wastewater characterization and fractionation of pollutants. J Water Process Eng 43, 102205.
| Crossref | Google Scholar |

11  Diorio-Toth L et al. (2023) Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids. mSystems 8, e00206-23.
| Crossref | Google Scholar | PubMed |

12  Kotsanas D et al. (2013) “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust 198, 267-269.
| Crossref | Google Scholar | PubMed |

13  Parkes LO, Hota SS (2018) Sink-related outbreaks and mitigation strategies in healthcare facilities. Curr Infect Dis Rep 20, 42.
| Crossref | Google Scholar | PubMed |

14  The National Return & Disposal of Unwanted Medicines Ltd (2024) Return unwanted medicines. https://returnmed.com.au/ (accessed 18 April 2024)

15  Riley T (2017) The return of unwanted medicines. In 42nd EHA National Conference 2017 Proceedings, 16–19 October 2017, Brisbane, Qld, Australia. Environmental Health Australia. https://www.ehaqld.org.au/documents/item/979

16  Polianciuc SI et al. (2020) Antibiotics in the environment: causes and consequences. Med Pharm Rep 93, 231-240.
| Crossref | Google Scholar | PubMed |

17  Greer SL et al. (2022) From Health in All Policies to Health for All Policies. Lancet Public Health 7(8), e718-e720.
| Crossref | Google Scholar | PubMed |

18  Department of Health and Aged Care (2023) National Health and Climate Strategy. Commonwealth of Australia. https://www.health.gov.au/sites/default/files/2023-12/national-health-and-climate-strategy.pdf

19  WHO Council on the Economics of Health for All (2023) Health for all: transforming economies to deliver what matters: final report of the WHO Council on the Economics of Health for All. World Health Organization, Geneva, Switzerland. https://www.who.int/publications/i/item/9789240080973

20  Mora C et al. (2022) Over half of known human pathogenic diseases can be aggravated by climate change. Nat Clim Chang 12, 869-875.
| Crossref | Google Scholar | PubMed |

21  Kaba HEJ et al. (2020) Thinking outside the box: association of antimicrobial resistance with climate warming in Europe – a 30 country observational study. Int J Hyg Environ Health 223(1), 151-158.
| Crossref | Google Scholar | PubMed |

22  Imlay H et al. (2023) Shorter antibiotic courses in the immunocompromised: the impossible dream? Clin Microbiol Infect 29, 143-149.
| Crossref | Google Scholar | PubMed |

23  Belkhir L (2019) Big Pharma emits more greenhouse gases than the automotive industry. In The Conversation, 28 May 2019. https://theconversation.com/big-pharma-emits-more-greenhouse-gases-than-the-automotive-industry-115285