Veteran's Affairs Office of Inspector General Review of VA Sustainability Plan

The Veterans Health Administration (VHA) has begun implementing the 2022 VA Sustainability Plan, aiming to align with federal environmental goals outlined in Executive Order 14057. This process has involved VA acknowledgement of the healthcare sector as a major contributor to U.S. pollution as well as recognition of the potential impact the VHA can make as a leader in improving the sustainability in healthcare. The OIG reviewed three key areas: inhalational anesthetics, waste management, and the use of ethylene oxide for sterilization. Inhalational anesthetics, particularly nitrous oxide and desflurane, contribute significantly to greenhouse gas emissions, while waste management is hindered by the preference for single-use medical devices. The use of ethylene oxide, a hazardous sterilant, has reportedly been phased out in VHA facilities. VHA’s Green Environmental Management System (GEMS) plays a crucial role in sustainability efforts by employing full-time GEMS managers and multidisciplinary committees at each VA medical center, but is currently overburdened, limiting its effectiveness. The VHA does appear to track waste production and has seen a 6% increase in diverted waste, but remains opposed to FDA-approved multiple-use approaches to some single-use items. The review highlights the need for more robust implementation strategies, including incorporating environmental stewardship into workforce training and reassessing the role of GEMS managers to effectively support sustainability goals. Recommendations include enhancing staff education on sustainability and exploring alternatives to high-impact anesthetics.