Evaluación del impacto ambiental y criterios de sostenibilidad para la adquisición de los inhaladores en dosis fija en un hospital público

Abstract

Introduction: Fixed or medium dose inhalers (MDI) are medications that contain the active ingredients and excipients in a propellant gas. This common gas is a hydrofluorocarbon, a potent greenhouse gas defined as a chemical controlled by its global warming potential (GWP) The pharmacy service of the Ushuaia Regional Hospital (SFHRU) has implemented sustainable public purchases since 2019. In that context within this the present work is developed.

Objectives: Evaluate MDI studying supply chain, valve and gas in its formulation. Calculate its emissions according to their propellant. Define sustainability criteria for MDIs within the SFHRU and analyze non-propellant alternatives on the market.

Materials and Methods: Cross-sectional, observational and descriptive study of all the MDI that were purchased by the SFHRU in the year 2020. Emissions were calculated as CO2 equivalent (CO2eq). The quantity and global warming potential of the propellant and identified valve were determined as sustainability criteria (SC), for the same active principle. Alternatives were sought in the market in AlfaBeta®.

Results: 11 medicinal specialties from four national laboratories with commercial presentations and medical samples (MM) were analyzed. Admissions were for: hospital acquisition, national maternal and child program, and MM from a laboratory. Of the seven drugs evaluated, four were in the Pharmacotherapeutic Guide (GFT). All had 1,1,1,2-tetrafluoroethane or HFC-134a as a propellant in different amounts, except one that was combined with 1,1,1,2,3,3,3-heptafluoro-propane (Apaflurane) or HFC- 227ea. Emissions per unit varied from 4.43 to 19.31 kg of CO2eq depending on the type of gas, amount per dose and presentation. The emission estimate for the total number of units analyzed was 25.42 tons of CO2eq (76.1% inputs from the program, 17.6% from the SFHRU and 6.3% from the MM, according to origin). As CS, it was possible to positively weight the same active ingredient that has less and less PCG, and it could not be weighted by the valve. Of the GFT inputs, only one has alternatives on the market without propellant.

Conclusions: It was possible to determine the characteristics of the MDI in terms of propellant. The contribution of the emissions was calculated correlating the type and quantity of gas that each one possesses, and determined the distribution of the environmental impact according to the origin in the supply chain. CS can be defined for future acquisitions, to reduce the environmental impact of the hospital despite the fact that there are not many alternatives on the market.