Enhancing Medical Cold Chain In India To Promote Sustainable Health Systems
This is a Guest Blog by Mr. Jesal Doshi, Deputy CEO, B Medical Systems
Sustainability is becoming a priority for all organisations, across all industries. It becomes more critical in the healthcare sector as sustainability plays a crucial role in improving, maintaining or restoring societal health and welfare.
According to the World Health Organization (WHO), an environmentally sustainable health system can curtail the negative impacts on the environment and identify opportunities to restore and improve it for the well-being of current and future generations.
Even though they have several components, sustainability in health systems revolves significantly around emissions, with the medical cold chain being a key contributor. Hospitals, laboratories, and other medical or research institutions commonly use cold chains in their daily operations and, these products being very energy-intensive, they typically lead to significant CO2 emissions.
Temperature sensitivity, the medical cold chain, and emissions
Temperature plays a crucial role in molecular dynamics as it can affect the stability of many compounds. The higher the temperature, the more the thermal energy can increase the chances of chemical compositions breaking and more stable ones forming. In the medical world, high temperatures can lead to irreversible changes within molecules found in various medications, thereby reducing their effectiveness.
The same can happen to many vaccines and samples, such as blood, as they are biological products that are thermosensitive in nature. If they get exposed to inappropriate temperatures, important components they are made of can degrade, thus diminishing their potency. Once this happens, the clinical and research utility of these biologicals is lost. Therefore, it is critical to maintain vaccines, medicines, and biological samples protected from temperature variations and safely store and transport them across their supply chain networks.
The medical cold chain, the network of medical-grade refrigerators, freezers, and transport solutions designed to always keep biologicals at their intended temperature throughout their distribution process, is the natural solution. Even though these solutions play a crucial role in maintaining the intended temperature required by many biologicals, they are also some of the most energy-consuming devices in the healthcare industry. Furthermore, as several of these units use non-green refrigerants, they run the risk of resulting in harmful emissions affecting the environment.
Until a few decades ago, the use of chlorofluorocarbons (CFCs) and hydrochlorofluorocarbons (HCFCs) based refrigerants was common in refrigerating solutions across the world. These refrigerants, known now for their significant Ozone Depletion Potential (ODP) and Global Warming Potential (GWP), eventually came under scrutiny due to the severe damage they were causing to the ozone layer and their greenhouse effect. Because of this, in time, these products started to be phased out. During the same period, a new refrigerant emerged – the Hydrofluorocarbon (HFC) refrigerant. As these new gases had no measurable effect on the ozone layer, they quickly found widespread applications, but it rapidly became evident that these were potent greenhouse gases with a global warming effect up to 23,000 times greater than carbon dioxide (CO2).
With HFCs becoming the fastest-growing source of greenhouse emissions worldwide, the international community triggered several regulations around HFCs and the use of refrigerants with high GWP, paving the way for the adoption of natural refrigerants. Of these regulations, the most prominent are the US SNAP program and the EU F-Gas regulations. Even though more manufacturers of these devices have started switching to green gas and natural refrigerant models, several cold chain products continue to harm the environment because their emissions still exist.
Sustainability challenges encountered by hospitals
Hospitals are at the centre of many clinical activities such as surgeries, blood transfusions, treatments, and more. They need to preserve many different types of biologicals such as medicines, vaccines, and various types of samples, which are often thermosensitive. To achieve this, they require an extensive cold chain to meet the many different temperature requirements of all these thermosensitive specimens. Because of this, hospitals are at the centre of discussions regarding how high-quality care can be given in the most sustainable and climate-friendly manner. Moreover, today’s healthcare systems are under tremendous pressure from the pandemic as new requirements add to the existing demands for good healthcare services and the constraints of disproportionate funding. These factors push hospitals to turn to sustainable solutions that can deliver the lowest cost of operations in the most reliable and environmentally friendly way possible. In short, it’s all about how hospitals can create a healthier future for the communities while addressing environmental concerns. Understanding the cold chain requirements of a healthcare system and ensuring that the solutions employed are energy-efficient, reliable, and use green refrigerants can bring more than one advantage to hospitals and other healthcare institutions.
One of the other aspects that need to be considered while designing sustainable infrastructure is the operational cost. Often, to reduce the upfront purchase costs, several procurement departments opt for cheaper products. However, these products might feature high energy consumption and higher costs associated with HVAC (Heating, Ventilation, and Air Conditioning), resulting in a significantly higher Total Cost of Ownership (TCO) during the product’s lifespan. Moreover, products of mediocre quality can result in frequent breakdowns/repairs that can further add to the cost of ownership and in extreme cases, lead to the premature replacement of the cold chain device and the procurement of new ones.
Ultra-Low Freezers – the need of the hour
One of the most energy-intensive medical refrigeration products is the Ultra-Low Freezer (ULT), which is typically employed for the long-term storage of samples with temperatures reaching as low as -86°C. Biologicals stored within these devices range from genetic materials such as DNA and RNA to cell and tissue samples. Moreover, new advances in vaccine research related to COVID-19 have expanded the use of these products to include the storage of thermosensitive mRNA vaccines as well, making them essential for immunisation campaigns around the world. This is why hospitals worldwide have started deploying them in large quantities when only years before, these devices would be used almost exclusively in a laboratory setting.
Due to the extreme temperatures they need to reach, Ultra-Low Freezers can consume as much energy as an average family household and, because of this high energy consumption, the CO2 emission potential is high. In some instances, an Ultra-Low Freezer and its related HVAC system can produce up to 100 tons of CO2 in its life span.
However, if designed with panels insulated with polyurethane foam, a thick insulating layer will form, minimising the heat conduction through the cabinet walls. Moreover, gaskets made of silicon lips and foam can also provide strong sealing and good thermal insulation, while having internal aluminium doors can reduce cold air loss and heat conduction when the outer door is open. Finally, the use of green refrigerants by these units can further enhance their cooling efficiency. These refrigerants are comparatively inexpensive to manufacture and are known for their long-term availability, driving up their cost-effectiveness for hospitals and healthcare institutions.
Sustainable innovation is the key to the future
The modern world is changing rapidly, demanding continuous innovation to solve ever more challenging issues. However, this progress is not worth achieving if it means meeting our needs by compromising the ability of future generations to meet theirs. Therefore, governments, companies, and individuals need to take action to curb their impact on the environment. In the medical cold chain field, manufacturers need to create sustainable refrigeration solutions that allow medical and research professionals to continue their efforts without increasing CO2 emissions. They need to introduce certified energy-efficient devices and constantly innovate to help build sustainable healthcare systems worldwide.