Formalin is the international gold-standard fixative in pathology laboratories. However it is not the ideal one considering its deleterious effects on individuals and the environment. Complete formalin removal or even substitution does not seem possible in the near future. In this update, we present various tools allowing to integrate the use of formalin into an ecocare approach. Among them, formalin recycling according to the protocol developed by the University Hospital of Bordeaux is simple to implement and delivers rapid and significant results, allowing pathology professionals to meet the sustainable development objectives included in the France 2030 agenda.

The healthcare sector accounts for 8% of the national carbon footprint in France. It is imperative to integrate climate and environmental issues into modern healthcare management. Many health professionals are advocating for more eco-responsible care. Each caregiver can reduce the environmental and health impact of their activity, while evolving in a healthy environment. Nurses have a particular responsibility to contribute to sustainable development.

BACKGROUND: The 2015 Paris Agreement has been the first restrictive agreement in the fight against climate change. The newer generations of pathologists, who feel more anxiety due to environmental problems than their predecessors, are asked to publish research works while they are harder and harder to and in a context of demographical tensions. We wanted to measure the rise of ecology research in pathology since the Paris Agreement.
METHODS: Over a ten years study period (2013-2022), we have identified via PubMed the number of articles in which forty-three terms taken from the sustainable development vocabulary appeared in ten renowned international pathology journals, selected for their SJR index from ScimagoJr and their impact factor, plus the Annales de pathologie, and compared their means of incidence between the 2013-2015 (m1) and 2016-2022 (m2) periods. The same process has been applied for \"artificial intelligence\", \"deep learning\" and \"digital pathology\".
RESULTS: A total of 1336 articles have been identified. Only \"digital pathology\" (fromm1=8,33 to m2=23,29; p=0,010) and \"deep learning\" (fromm1=0 to m2=10,14; p=0,034) saw their incidence rise significantly. A significant decrease has been observed with \"biological\" (fromm1=70,00 to m2=56,86; p=0,020).
CONCLUSIONS: Pathology reacts to trends but research in ecology has remained in the blind spot since 2015. However there seems to be an awakening as editorials, articles and communications in congress have blossomed the last two years.

Health and medico-social establishments have every interest in embarking on corporate social responsibility for establishments: decarbonisation, compliance with regulations, attractiveness strategy, links with territorial partners, economic interest, etc. To support them, the Fédération hospitalière de France has put forward proposals to the presidential candidates, which are intended to be supported throughout Emmanuel Macron\'s new five-year term.

OBJECTIVE: While inhaled drugs are mainly used to treat chronic respiratory diseases, they are also responsible for greenhouse gas (GHG) emission. To highlight this issue, a dispensed analysis and a carbon footprint evaluation of inhalers in France have been conducted.
METHODS: A national qualitative and quantitative analysis of dispensed inhalers in community pharmacies (CP) and hospitals (H) was conducted in France for 2019. A data review from the literature led to the determination of the inhalers carbon footprint, expressed in carbon dioxide equivalent (CO2e) during the inhaler life cycle.
RESULTS: Close to 40 million inhalers were dispensed by community pharmacies and one million by hospitals in 2019. It concerned three types of inhalers: metered-dose inhalers (MDI) [CP: 49%; H: 45%], dry powder inhalers (DPI) [CP: 47%; H: 51%], and soft mist inhalers (SMI) [CP: 4%; H: 4%]. According to the literature, MDI have the highest carbon footprint, ranging from 11 to 28 kgCO2e versus less than 1 kgCO2e for DPI/SMI. In 2019, the national carbon footprint of salbutamol (MDI), the most dispensed inhaler, was estimated to be over 310 million kgCO2e (CP+H) corresponding to more than 310,000 round-trip Paris-New York.
CONCLUSIONS: This study shows the involvement of MDI in GHG emissions. Taking actions as part of a global and coordinated approach to limit their environmental impact is possible and thus is a priority.

In order to prevent human and environmental risks related to the handling of cytotoxins and cytostatics, health care institutions are implementing precautionary measures. Information and training actions for health professionals, nurses, orderlies and pharmacy assistants are also part of the system. Example with a team in Lyon.

Faced with the proliferation of stray cats in its park, the Barthélemy-Durand public health establishment in Étampes (91), in partnership with the Société protectrice des animaux, has managed to find the right balance between health safety and a pleasant animal presence for patients and caregivers. The regulated control of free and healthy cats on the hospital site also opens up possibilities for animal mediation. Sharing experience and commitment to the animal cause.

In order to be more consistent with their care giving values, a growing number of health professionals are looking for more environmentally friendly care practices. The health crisis we are going through strongly questions the footprint of care in terms of sustainable development and environmental health. Changes are possible; training courses exist to assimilate eco-actions.

At the Pitié-Salpêtrière hospital group (AP-HP, Paris), the central operating room teams embarked, in 2017, on a project to reduce the ecological impact of the procedures performed there. The results are convincing: reduction of the carbon footprint of anesthetic gases, reduction of waste and improvement of its sorting, recycling of metals. The project has spread to the other operating rooms in the hospital group, with strong support from professionals.

The initial nursing training framework offers the opportunity to build a teaching program that will lay the foundations of an eco-citizen care giving practice. With evolving content, and in light of climatic contingencies and the need to adapt to emerging pathologies, these courses must make sustainable development, associated with hygiene and safety, a new professional imperative in the care giving system.