Exploratory analysis of livestock waste treatment impacts on microbial diversity and antimicrobial resistance gene abundance.

Climate change has emerged as the single greatest contemporary threat to human health. Events such as extreme weather and heat, wildfires, spread of tropical and subtropical disease, population displacement, and other harms to physical and mental well-being are increasingly common and severe. The climate crisis demands a coordinated global response from government, industry, and environmentally sensitive sectors such as health care. The environmental footprint of the health care system is substantial. It is estimated that health care accounts for approximately 5% of total global greenhouse gas emissions. The intensive care unit (ICU) has among the highest per-patient daily resource consumption; the provision of critical care generates 88–178 kg of CO-equivalents (these emissions are equivalent to driving 360–730 km with an average gasoline-powered car) and 1.1–13.7 kg of material waste daily. While life cycle and material flow analyses have identified environmental “hot spots” in ICUs, clinicians and administrators need guidance on how to reduce the environmental impact of bedside care. Clinicians have an integral role to play in the health care climate response. Choosing Wisely Canada launched an initiative in 2013 to leverage clinicians to identify and eliminate low-value care that was harmful to patients and wasteful to the health care system. Consequently, dozens of multidisciplinary societies developed specialty-specific recommendations on tests and treatments to avoid—including five such recommendations from the Canadian Critical Care Society (CCCS). In 2023, Choosing Wisely Canada launched an iteration on this effort to encourage development of climate-conscious recommendations to provide practical evidence-based ways to reduce the climate impact of health care. In response, the CCCS convened a multidisciplinary group to develop critical-care-medicine-related Choosing Wisely Canada climate-conscious recommendations between November 2023 and May 2024.