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Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review. Int J Technol Assess Health Care 2022; 38:e84. [PMID: 36510398 DOI: 10.1017/s0266462322003282] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas - HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost-benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.
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52
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Le NNT, Hernandez LV, Vakil N, Guda N, Patnode C, Jolliet O. Environmental and health outcomes of single-use versus reusable duodenoscopes. Gastrointest Endosc 2022; 96:1002-1008. [PMID: 35718068 DOI: 10.1016/j.gie.2022.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory life cycle assessment comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs). METHODS We evaluated 3 duodenoscopes: conventional RDs, RDs with disposable endcaps, and SDs. The primary outcomes were impacts on climate change and human health, complemented by multiple environmental impacts. RESULTS Performing ERCP with SDs releases between 36.3 and 71.5 kg of CO2 equivalent, which is 24 to 47 times greater than using an RD (1.53 kg CO2) or an RD with disposable endcaps (1.54 kg CO2). Most of the impact of SDs comes from its manufacturing, which accounts for 91% to 96% of its greenhouse gas emission. The human health impact of RDs becomes comparable with the SD lower bound if disposable endcaps or other design modifications can reduce serious infection rates below a target rate of 23 cases per year (.0046%). CONCLUSIONS Although SDs may provide incremental public health benefit compared with RDs, it comes at a substantially higher cost to the environment. As infection rates continue to decrease from more regimented cleaning protocols and enhanced designs such as disposable endcaps to facilitate cleaning, the negative impact to human health from contaminated RDs could be comparable with SDs.
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Affiliation(s)
- Nguyen Nhat Thu Le
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Lyndon V Hernandez
- Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nimish Vakil
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nalini Guda
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Casey Patnode
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; Quantitative Sustainability Assessment, Department of Environmental and Resource Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
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Drew J, Christie SD, Rainham D, Rizan C. HealthcareLCA: an open-access living database of health-care environmental impact assessments. Lancet Planet Health 2022; 6:e1000-e1012. [PMID: 36495883 DOI: 10.1016/s2542-5196(22)00257-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative. In this Personal View, we present an interactive, open-access database designed to support this effort. Functioning as a living repository of environmental impact assessments within health care, the HealthcareLCA database collates 152 studies, predominantly peer-reviewed journal articles, into one centralised and publicly accessible location, providing impact estimates (currently totalling 3671 numerical values) across 1288 health-care products and processes. The database brings together research generated over the past two decades and indicates exponential field growth.
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Affiliation(s)
- Jonathan Drew
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
| | - Sean D Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - Daniel Rainham
- School of Health and Human Performance and the Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Chantelle Rizan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
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McAlister S, Morton RL, Barratt A. Incorporating carbon into health care: adding carbon emissions to health technology assessments. Lancet Planet Health 2022; 6:e993-e999. [PMID: 36495894 DOI: 10.1016/s2542-5196(22)00258-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
At the UN Climate Change Conference 26 in Glasgow, 50 countries committed to low-carbon health services, with 14 countries further committing to net-zero carbon health services by 2050. Reaching this target will require decision makers to include carbon emissions when evaluating new and existing health technologies (tests and treatments). There is currently, however, a scarcity of data on the carbon footprint of health-care interventions, nor any means for decision makers to include and consider carbon emission health-care assessments. We therefore investigated how to integrate carbon emissions calculated by environmental life cycle assessment (LCA) into health technology assessments (HTA). HTAs are extensively used in developing clinical and policy guidelines by individual public or private payers, and by government organisations. In the first section we explain the methodological differences between environmentally extended input-output and process-based LCA. The second section outlines ways in which carbon emissions calculated by LCA could be integrated with HTAs, recognising that HTAs are done in several ways by different jurisdictions. International effort and processes will be needed to ensure that robust and comprehensive carbon footprints of commonly used health-care products are freely available. The technical and implementation challenges of incorporating carbon emissions into HTAs are considerable, but not unsurmountable. Our aim is to lay foundations for meeting these challenges.
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Affiliation(s)
- Scott McAlister
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Health Policy, Faculty of Medicine, Dentistry & Health Sciences, The University or Melbourne, Melbourne, VIC, Australia.
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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55
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Sittig DF, Sherman JD, Eckelman MJ, Draper A, Singh H. i-CLIMATE: a "clinical climate informatics" action framework to reduce environmental pollution from healthcare. J Am Med Inform Assoc 2022; 29:2153-2160. [PMID: 35997550 PMCID: PMC9667163 DOI: 10.1093/jamia/ocac137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
Addressing environmental pollution and climate change is one of the biggest sociotechnical challenges of our time. While information technology has led to improvements in healthcare, it has also contributed to increased energy usage, destructive natural resource extraction, piles of e-waste, and increased greenhouse gases. We introduce a framework "Information technology-enabled Clinical cLimate InforMAtics acTions for the Environment" (i-CLIMATE) to illustrate how clinical informatics can help reduce healthcare's environmental pollution and climate-related impacts using 5 actionable components: (1) create a circular economy for health IT, (2) reduce energy consumption through smarter use of health IT, (3) support more environmentally friendly decision-making by clinicians and health administrators, (4) mobilize healthcare workforce environmental stewardship through informatics, and (5) Inform policies and regulations for change. We define Clinical Climate Informatics as a field that applies data, information, and knowledge management principles to operationalize components of the i-CLIMATE Framework.
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Affiliation(s)
- Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Environmental Sciences, Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut, USA
| | - Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Andrew Draper
- Health Data Informatics and Analytics, University of Denver, HCA Continental Division, GreenCIO.org, Denver, Colorado, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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56
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Environmental Sustainability in the Orthopaedic Operating Room. J Am Acad Orthop Surg 2022; 30:1039-1045. [PMID: 36007200 DOI: 10.5435/jaaos-d-22-00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
Hotter global temperatures and increasingly variable climate patterns negatively affect human health, with a wide recognition that climate change is a major global health threat. Human activities, including those conducted in the orthopaedic operating room (OR), contribute to climate change by generating greenhouse gases that trap infrared radiation from the earth's surface. This review provides an overview of the environmental effect of the orthopaedic OR and efforts to address environmental sustainability in the OR. These concepts are presented with a particular focus on patient safety and cost savings because roll-out of these efforts must be conducted with a pragmatic and patient-centered focus. Orthopaedic surgeons have an opportunity to lead efforts to improve environmental sustainability in the OR and thus contribute to efforts to curb climate change.
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57
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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58
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Ji L, Wang Y, Xie Y, Xu M, Cai Y, Fu S, Ma L, Su X. Potential Life-Cycle Environmental Impacts of the COVID-19 Nucleic Acid Test. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:13398-13407. [PMID: 36053337 PMCID: PMC9469759 DOI: 10.1021/acs.est.2c04039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 05/10/2023]
Abstract
Massive diagnostic testing has been performed for appropriate screening and identification of COVID-19 cases in the ongoing global pandemic. However, the environmental impacts of COVID-19 diagnostics have been least considered. In this paper, the environmental impacts of the COVID-19 nucleic acid diagnostics were assessed by following a full cradle-to-grave life-cycle approach. The corresponding life-cycle anthology was established to provide quantitative analysis. Moreover, three alternative scenarios, i.e., material substitution, improved waste treatment, and electric vehicle (EV)-based transportation, were further proposed to discuss the potential environmental mitigation and conservation strategies. It was estimated that the life cycle of a single COVID-19 nucleic acid diagnostic test in China would lead to the emission of 612.9 g CO2 equiv global warming potential. Waste treatment, as a step of life cycle, worsen the environmental impacts such as global warming potential, eutrophication, and ecotoxicity. Meanwhile, diesel-driven transportation was considered as the major contributor to particulate air. Even though COVID-19 diagnostics are of the greatest importance to end the pandemic, their environmental impacts should not be ignored. It is suggested that improved approaches for waste treatment, low-carbon transportation, and a reliable pool sampling strategy are critical for the achievement of sustainable and green diagnostics.
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Affiliation(s)
- Ling Ji
- School
of Economics and Management, Beijing University
of Technology, Beijing 100124, China
| | - Yongyang Wang
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Yulei Xie
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Ming Xu
- School
for Environment and Sustainability, University
of Michigan, Ann Arbor, Michigan 48109, United States
- Department
of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Yanpeng Cai
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Shengnan Fu
- College
of Life Science and Technology, Beijing
University of Chemical Technology, Beijing 100029, China
| | - Liang Ma
- China-Japan
Friendship Hospital, Beijing 100029, China
| | - Xin Su
- College
of Life Science and Technology, Beijing
University of Chemical Technology, Beijing 100029, China
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59
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Maloney B, McKerlie T, Nasir M, Murphy C, Moi M, Mudalige P, Naser NE, Duane B. The Environmental Footprint Of Single versus Reusable Cloths For Clinical Surface Decontamination: A Life Cycle Approach. J Hosp Infect 2022; 130:7-19. [PMID: 36115619 DOI: 10.1016/j.jhin.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
Global sustainability is a major health concern facing our planet today. The healthcare sector is a significant contributor to environmentally damaging activity. Reusable cloths should be considered as an environmentally friendly alternative to the predominantly used single-use surface wipes in cleaning and disinfection of environmental surfaces in healthcare settings. To understand its feasibility, a rapid review of current policies on surface decontamination in healthcare settings was conducted. A life cycle impact assessment (LCIA) was then carried out to compare the impact of reusable cotton and microfibre cloths versus conventional single-use cloths, with three compatible disinfectants. Seven countries were included in the rapid review of policies. For the LCIA, inputs, outputs, and processes across the life cycle were included, using EcoInvent database v3.7.1 and open LCIA software. Sixteen European-recommended environmental impact categories and eight human health categories were considered. Infection prevention policies examined do not require single-use wipes for cleaning and disinfection. The disinfectant with the highest environmental impact was isopropyl-alcohol. The most environmentally-sustainable option for clinical surface decontamination was the microfibre cloth when used with a quaternary ammonium compound. The least environmentally sustainable option was cotton with isopropyl-alcohol. Impacts were primarily attributed with the use of the disinfectant agent and travel processes.
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Affiliation(s)
- Brian Maloney
- School of Dental Science, Trinity College Dublin, Dublin, Ireland.
| | - Taylor McKerlie
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Malaika Nasir
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Caroline Murphy
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Michelle Moi
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Pavanee Mudalige
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | | | - Brett Duane
- Trinity College Dublin, Department of Child and Public Dental Health, Dublin, Ireland
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Lichter KE, Baniel CC, Anderson J, Bhatia R, Frick MA, Thiel CL, Gandhi S, Sarria GR, Bagshaw HP, Petereit D, Chino J, Grover S, Singer L, Hsu IC, Mohamad O. Environmentally sustainable brachytherapy care. Brachytherapy 2022; 21:712-717. [PMID: 35794032 PMCID: PMC9997716 DOI: 10.1016/j.brachy.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
| | - Claire C Baniel
- Department of Radiation Oncology, Stanford University, Palo Alto, CA
| | | | - Rohini Bhatia
- Department of Radiation Oncology and 334 Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - Melissa A Frick
- Department of Radiation Oncology, Stanford University, Palo Alto, CA
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Seema Gandhi
- Department of Anesthesia, University of California San Francisco, San Francisco, CA
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Palo Alto, CA
| | | | - Junzo Chino
- Department of Radiation Oncology, Duke Cancer Center, Durham, NC
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, PA
| | - Lisa Singer
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA
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61
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Duane B, Ashley P, Ramasubbu D, Fennell-Wells A, Maloney B, McKerlie T, Crotty J, Johnstone M, Wilmott S. A review of HTM 01-05 through an environmentally sustainable lens. Br Dent J 2022; 233:343-350. [PMID: 36028700 PMCID: PMC9412769 DOI: 10.1038/s41415-022-4903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.
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Hubbard RM, Williams GW, Gautam NK. The Environmental Effects of Anesthesia: A Wider View. Anesth Analg 2022; 135:e11. [PMID: 35839503 DOI: 10.1213/ane.0000000000006056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Richard M Hubbard
- Department of Anesthesiology, University of Texas Health Science Center at Houston, Houston, Texas,
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63
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Lichter KE, Anderson J, Sim AJ, Baniel CC, Thiel CL, Chuter R, Collins A, Carollo E, Berg CD, Coleman CN, Abdel-Wahab M, Grover S, Singer L, Mohamad O. Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care. Int J Radiat Oncol Biol Phys 2022; 113:915-924. [PMID: 35841919 PMCID: PMC10024638 DOI: 10.1016/j.ijrobp.2022.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/28/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Katie E Lichter
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Justin Anderson
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Austin J Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Claire C Baniel
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Robert Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Amy Collins
- Health Care Without Harm, Reston, Virginia; Department of Emergency Medicine, MetroWest Medical Center, Framingham, Massachusetts
| | - Erin Carollo
- Loyola University Chicago-Stritch School of Medicine, Chicago, Illinois
| | | | - C Norman Coleman
- Radiation Research Program, National Cancer Institute, Bethesda, Maryland
| | - May Abdel-Wahab
- Division of Human Health, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, Pennsylvania
| | - Lisa Singer
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Osama Mohamad
- Department of Radiation Oncology, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
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Comparing the environmental impact of reusable and disposable dental examination kits: a life cycle assessment approach. Br Dent J 2022; 233:317-325. [PMID: 36028697 DOI: 10.1038/s41415-022-4912-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/06/2022] [Indexed: 11/08/2022]
Abstract
Introduction The global climate crisis has increased the emphasis placed on the sustainability and environmental consequences of our actions. The dental examination accounts for a large portion of dentistry's carbon footprint, more specifically, the production, sterilisation, transport, use and disposal of the dental examination kit. An attributional life cycle assessment (LCA) was carried out to compare the impact of a reusable stainless-steel examination kit and that of a disposable plastic examination kit.Materials and methods All inputs, outputs and processes across the life cycle were accounted for using Ecoinvent database v3.7.1 and openLCA software. Impacts were considered across 16 European-recommended environmental impact categories and eight human health impact categories.Results The disposable kit performed worse across all categories of ecological and human health harm. Categories with most notable impact were climate change, metal-mineral and fossil fuel resource depletion and water scarcity. Impacts were primarily attributable to material processing, instrument production and sterilisation procedures.Conclusion Healthcare is responsible for a significant proportion of greenhouse gas emissions. The single-use examination kit poses greater ecological and human health threat than does the reusable examination kit; this aligns closely with related research in the field. The dentist seeking to adopt more environmentally-conscientious practices should consider using a reusable, stainless-steel examination kit.
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65
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Boberg L, Singh J, Montgomery A, Bentzer P. Environmental impact of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies. PLoS One 2022; 17:e0271601. [PMID: 35839237 PMCID: PMC9286249 DOI: 10.1371/journal.pone.0271601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/03/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Climate change is one of the 21st century’s biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed countries. About 15 million laparoscopic procedures are performed annually worldwide and single-use medical equipment is increasingly used during these procedures. Little is known about costs and environmental footprint of this change in practice. Methods We employed Life Cycle Assessment method to evaluate and compare the environmental impacts of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies at three hospitals in southern Sweden. The environmental impacts were calculated using the IMPACT 2002+ method and a functional unit of 500 procedures. Monte Carlo simulations were used to estimate differences between trocar systems. Data are presented as medians and 2.5th to 97.5th percentiles. Financial costs were calculated using Life Cycle Costing. Results The single-use system had a 182% higher impact on resources than the reusable system [difference: 5160 MJ primary (4400–5770)]. The single-use system had a 379% higher impact on climate change than the reusable system [difference: 446 kg CO2eq (413–483)]. The single-use system had an 83% higher impact than the reusable system on ecosystem quality [difference: 79 PDF*m2*yr (24–112)] and a 240% higher impact on human health [difference: 2.4x10-4 DALY/person/yr (2.2x10-4-2.6x10-4)]. The mixed and single-use systems had a similar environmental impact. Differences between single-use and reusable trocars with regard to resource use and ecosystem quality were found to be sensitive to lower filling of machines in the sterilization process. For ecosystem quality the difference between the two were further sensitive to a 50% decrease in number of reuses, and to using a fossil fuel intensive electricity mix. Differences regarding effects on climate change and human health were robust in the sensitivity analyses. The reusable and mixed trocar systems were approximately half as expensive as the single-use systems (17360 € and 18560 € versus 37600 €, respectively). Conclusion In the Swedish healthcare system the reusable trocar system offers a robust opportunity to reduce both the environmental impact and financial costs for laparoscopic surgery.
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Affiliation(s)
- Linn Boberg
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Lund, Sweden
- * E-mail:
| | - Jagdeep Singh
- Centre for Environmental and Climate Science, Faculty of Science, Lund University, Lund, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences Malmö, Division of Surgery, Lund University, Malmö, Sweden
| | - Peter Bentzer
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Lund, Sweden
- Department of Anesthesia & Intensive Care Helsingborg Hospital, Helsingborg, Sweden
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Pegg M, Rawson R, Okere U. Operating room waste management: A case study of primary hip operations at a leading national health service hospital in the United Kingdom. J Health Serv Res Policy 2022; 27:255-260. [PMID: 35635489 DOI: 10.1177/13558196221094488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This research examines current waste management within an operating room at a large United Kingdom National Health Service (NHS) hospital. The study measured the volume and type of waste produced for primary hip operations (PHOs) and estimated the total waste produced across the United Kingdom by the procedure. METHODS Three PHOs were audited to measure and compare the waste volumes generated. RESULTS The average volume of waste per surgical procedure was 10.9 kg, consisting of clinical (84.4%), recyclable (12.8%) and bio-bin (2.8%) waste. This research also found that single-use devices contribute significantly to operating room waste. In addition, it was estimated that there is a missed opportunity to reduce clinical waste volume in each procedure, where approximately 15% of clinical waste disposal consisted of visibly clean recyclable waste material, including cardboard and plastics. CONCLUSIONS It was estimated that in the NHS approximately 1043 tonnes of waste is produced annually by PHOs alone. A significant volume of this waste could be prevented through improved recycling and reduced use of single-use devices.
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Affiliation(s)
- Melissa Pegg
- Research Student, School of Built and Natural Environment, College of Science of Engineering, 2939University of Derby, UK
| | - Rebecca Rawson
- Lecturer, School of Built and Natural Environment, College of Science of Engineering, 2939University of Derby, UK
| | - Uchechukwu Okere
- Academic Lead, School of Built and Natural Environment, College of Science of Engineering, 2939University of Derby, UK
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Qin RX, Velin L, Yates EF, El Omrani O, McLeod E, Tudravu J, Samad L, Woodward A, McClain CD. Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100407. [PMID: 35243461 PMCID: PMC8881731 DOI: 10.1016/j.lanwpc.2022.100407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Five billion people lack access to surgical care worldwide; climate change is the biggest threat to human health in the 21st century. This review studies how climate change could be integrated into national surgical planning in the Western Pacific region. We searched databases (PubMed, Web of Science, and Global Health) for articles on climate change and surgical care. Findings were categorised using the modified World Health Organisation Health System Building Blocks Framework. 220 out of 2577 records were included. Infrastructure: Operating theatres are highly resource-intensive. Their carbon footprint could be reduced by maximising equipment longevity, improving energy efficiency, and renewable energy use. Service delivery Tele-medicine, outreaches, and avoiding desflurane could reduce emissions. Robust surgical systems are required to adapt to the increasing burden of surgically treated diseases, such as injuries from natural disasters. Finance: Climate change adaptation funds could be mobilised for surgical system strengthening. Information systems: Sustainability should be a key performance indicator for surgical systems. Workforce: Surgical providers could change clinical, institutional, and societal practices. Governance: Planning in surgical care and climate change should be aligned. Climate change mitigation is essential in the regional surgical care scale-up; surgical system strengthening is also necessary for adaptation to climate change.
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69
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Rouvière N, Chkair S, Auger F, Alovisetti C, Bernard MJ, Cuvillon P, Kinowski JM, Leguelinel-Blache G, Chasseigne V. Ecoresponsible actions in operating rooms: A health ecological and economic evaluation. Int J Surg 2022; 101:106637. [PMID: 35487421 DOI: 10.1016/j.ijsu.2022.106637] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/26/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the current context of climate change, actions must be taken to improve the hospital's ecological footprint, particularly in the operating room, which is a major consumer of medical devices. METHODS This prospective pilot study assessed the ecological and economic impacts of sustainable actions targeting medical devices designed by a multidisciplinary working group and implemented in the 24 operating rooms of a University Hospital over one year. The ecological analysis was based on the life cycle assessment method and categorized in seven impacts. The economic impact was assessed by a micro-costing analysis and divided in four main expense items: human and material resources, logistics, and waste management. RESULTS In total, 13 actions were implemented with the aim of reducing waste volume, improving waste sorting, and increasing eco-responsible purchases. In one year, these 13 actions allowed avoiding the emission of 203 tons eq CO2. The environmental and human toxicity benefits were 707.8 and 156.2 tons of 1.4 dichlorobenzene, respectively. Concerning non-renewable resources, these actions avoided the extraction of 9 tons of oil (petroleum) and 610 kg of copper per year. These actions led to a land occupation reduction of 1071.3 m2year and to water saving of 552 m3. From the economic side, the implementation of these actions brought a gain of €3747.9 for the first year and of €5188.2 for the following years. CONCLUSION The integration of sustainable measures in operating rooms leads to important ecological benefits and also generating savings. This more eco-responsible approach should be considered in all healthcare establishments that generate a significant annual volume of waste.
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Affiliation(s)
- N Rouvière
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - S Chkair
- UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - F Auger
- Primum Non Nocere Agency, Beziers, France
| | - C Alovisetti
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - M J Bernard
- Department of General Surgery, University Hospital of Nîmes, Nîmes, France
| | - P Cuvillon
- Department of Anesthesiology and Critical Care, University Hospital of Nîmes, Nîmes, France
| | - J-M Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France
| | - G Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France
| | - V Chasseigne
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France.
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Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologe 2022; 119:567-576. [PMID: 35451609 PMCID: PMC9024069 DOI: 10.1007/s00347-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Großbritannien.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Großbritannien.
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Schulz
- Deutsche Allianz Klimawandel und Gesundheit, Berlin, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Chang X, Zhao Y, Li Y, Bai T, Gao J, Zhao C. Cost-Effectiveness of Life Cycle Cost Theory-Based Large Medical Equipment. Appl Bionics Biomech 2022; 2022:8045401. [PMID: 35469214 PMCID: PMC9034952 DOI: 10.1155/2022/8045401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to use the life cycle cost theory to analyze the efficiency of large medical equipment in hospitals, so as to implement life cycle cost (LCC) management and solve the current problems in hospitals. The analysis model of cost benefit of large medical equipment is established, and the cost-effectiveness of 4 large medical equipment between 2019 and 2021 is investigated and analyzed. In terms of the data in each information system of hospitals, the utilization of large medical equipment is quantitatively evaluated and analyzed by life cycle theory. The results show that the Revolution 256 row has the highest revenue of 113.29%. The annual depreciation of Signa 3.0 T HDxt is the highest, amounting to 4,160,000 yuan. However, there is lack of quality control and preventive maintenance of most equipment during use. The cost and benefit of large medical equipment in hospitals are analyzed, which demonstrates that Signa 3.0 T HDxt shows better effectiveness. Too high hospital warranty cost reflects the weak maintenance strength of hospital engineering technicians. The fundamental point of the maintenance and management of large medical equipment is to strengthen the performance evaluation of medical engineering technicians.
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Affiliation(s)
- Xiaoyi Chang
- State-Owned Assets Management, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yongqiang Zhao
- School of Modern Post, Xi'an University of Posts & Telecommunications, Xi'an 710061, China
| | - Yuebin Li
- State-Owned Assets Management, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ting Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jungang Gao
- Radiology Department (PET/CT), The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Chao Zhao
- State-Owned Assets Management, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
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Choi BJ, Chen CL. The Triple Bottom Line and Stabilization Wedges: A Framework for Perioperative Sustainability. Anesth Analg 2022; 134:475-485. [PMID: 35180164 PMCID: PMC9556165 DOI: 10.1213/ane.0000000000005890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a narrative review of environmental sustainability aimed at perioperative clinicians. The review will familiarize readers with the triple bottom line framework, which aims to align the goals of delivering high-quality patient care, promoting environmental sustainability, and improving the financial position of health care organizations. We introduce the stabilization wedges model for climate change action adopted for the perioperative setting and discuss areas in which perioperative leaders can make sustainable choices. The goal of this review is to increase awareness among perioperative physicians of the environmental impacts of surgical and anesthetic care, promote engagement with sustainability efforts as a topic of professional concern for our specialty, and inspire new research in perioperative environmental sustainability.
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Affiliation(s)
| | - Catherine L. Chen
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco
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Magrini C, Dal Pozzo A, Bonoli A. Assessing the externalities of a waste management system via life cycle costing: The case study of the Emilia-Romagna Region (Italy). WASTE MANAGEMENT (NEW YORK, N.Y.) 2022; 138:285-297. [PMID: 34920244 DOI: 10.1016/j.wasman.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/25/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
Effective and efficient urban waste management systems (WMSs) are a cornerstone for a sustainable society. Life cycle costing (LCC) provides a useful framework for the joint analysis of economic and environmental impacts of a WMS, by considering both financial and external costs. The present study applies the methodology of societal LCC to the WMS of the Italian region of Emilia-Romagna to provide a case study on how the available information on waste flows and budget costs of a real WMS can be used to obtain an estimate of the total cost of waste management, including externalities. The results evidence that the main source of negative externality in the analyzed WMS is the transportation of waste, with only a minor role of external burdens due to incinerators and landfills. However, the positive externality resulting from recycling more than compensates those impacts, leading to a net external benefit associated to the WMS. The contribution of both uncertain unit external costs and environmental benefits imputable to recycled materials to the overall uncertainty of the result is systematically investigated by parametric uncertainty analysis. The most critical parameters in determining the sensitivity of the result are the monetary values attributed to primary energy consumption and CO2 emissions, together with assumptions on energy savings related to recycling. Eventually, it is shown how the developed LCC model can be used as decision-support tool to preliminarily investigate the implications of alternative management options on the financial and external costs of the WMS.
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Affiliation(s)
- Chiara Magrini
- Department of Civil, Chemical, Environmental and Materials Engineering, Alma Mater Studiorum - University of Bologna, via Terracini 28, 40131 Bologna, Italy.
| | - Alessandro Dal Pozzo
- Department of Civil, Chemical, Environmental and Materials Engineering, Alma Mater Studiorum - University of Bologna, via Terracini 28, 40131 Bologna, Italy
| | - Alessandra Bonoli
- Department of Civil, Chemical, Environmental and Materials Engineering, Alma Mater Studiorum - University of Bologna, via Terracini 28, 40131 Bologna, Italy
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White SM, Shelton CL, Gelb AW, Lawson C, McGain F, Muret J, Sherman JD. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia 2022; 77:201-212. [PMID: 34724710 PMCID: PMC9298028 DOI: 10.1111/anae.15598] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.
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Affiliation(s)
- S. M. White
- Department of AnaesthesiaUniversity Hospitals Sussex NHS Foundation TrustBrightonUK
| | - C. L. Shelton
- Department of AnaesthesiaWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK,Lancaster Medical SchoolFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - A. W. Gelb
- Department of Anesthesia and Peri‐operative CareUniversity of California San FranciscoSan FranciscoCAUSA
| | - C. Lawson
- Royal Victoria InfirmaryNewcastle upon TyneUK
| | - F. McGain
- Departments of Anaesthesia and Intensive CareWestern HealthMelbourneVic.Australia,Department of Critical CareUniversity of MelbourneMelbourneVic.Australia
| | - J. Muret
- Departments of Anaesthesia and Intensive CareInstitut CuriePSL Research UniversityParisFrance
| | - J. D. Sherman
- Yale School of Medicine and Associate Professor of Epidemiology in Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
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Rizan C, Bhutta MF. Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy. Surg Endosc 2022; 36:4067-4078. [PMID: 34559257 PMCID: PMC9085686 DOI: 10.1007/s00464-021-08728-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/06/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated. METHODS We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis of products, taking into account unit cost, decontamination, and disposal costs. RESULTS The environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than single-use equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1756 g vs 7194 g CO2e per operation) and saved an estimated 1.13 e-5 DALYs (disability adjusted life years, 74% reduction), 2.37 e-8 species.year (loss of local species per year, 76% reduction), and US $ 0.6 in impact on resource depletion (78% reduction). Scenario modelling indicated that environmental performance of hybrid instruments was better even if there was low number of reuses of instruments, decontamination with separate packaging of certain instruments, decontamination using fossil-fuel-rich energy sources, or changing carbon intensity of instrument transportation. Total financial cost of using a combination of hybrid laparoscopic instruments was less than half that of single-use equivalents (GBP £131 vs £282). CONCLUSION Adoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and also save money.
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Affiliation(s)
- Chantelle Rizan
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK ,Brighton and Sussex Medical School, Brighton, UK ,Centre for Sustainable Healthcare, Oxford, UK ,Royal College of Surgeons of England, London, UK
| | - Mahmood F. Bhutta
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK ,Brighton and Sussex Medical School, Brighton, UK ,BMA Medical Fair and Ethical Trade Group, British Medical Association, London, UK
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Reducing the Environmental Impact of Sterilization Packaging for Surgical Instruments in the Operating Room: A Comparative Life Cycle Assessment of Disposable versus Reusable Systems. SUSTAINABILITY 2021. [DOI: 10.3390/su14010430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The widespread use of single-use polypropylene packaging for sterilization of surgical instruments (blue wrap) results in enormous environmental pollution and plastic waste, estimated at 115 million kilograms on a yearly basis in the United States alone. Rigid sterilization containers (RSCs) are a well-known alternative in terms of quality and price. This paper deals with two research questions investigating the following aspects: (A) the environmental advantage of RCS for high volumes (5000 use cycles) in big hospitals, and (B) the environmental break-even point of use-cycles for small hospitals. An in-depth life cycle assessment was used to benchmark the two systems. As such a benchmark is influenced by the indicator system, three indicator systems were applied: (a) carbon footprint, (b) ReCiPe, and (c) eco-costs. The results are as follows: (1) the analyzed RSC has 85% less environmental impact in carbon footprint, 52% in ReCiPe, and 84.5% in eco-costs; and (2) an ecological advantage already occurs after 98, 228, and 67 out of 5000 use cycles, respectively. Given these two alternative packaging systems with comparable costs and quality, our results show that there are potentially large environmental gains to be made when RSC is preferred to blue wrap as a packaging system for sterile surgical instruments on a global scale.
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Mechanical testing of the deflection and ultimate strength of metal and plastic disposable laryngoscope blades. Can J Anaesth 2021; 69:393-395. [PMID: 34910288 DOI: 10.1007/s12630-021-02156-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/28/2021] [Accepted: 10/02/2021] [Indexed: 10/19/2022] Open
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78
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Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments. Br J Surg 2021; 109:200-210. [PMID: 34849606 PMCID: PMC10364739 DOI: 10.1093/bjs/znab406] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to estimate the carbon footprint and financial cost of decontaminating (steam sterilization) and packaging reusable surgical instruments, indicating how that burden might be reduced, enabling surgeons to drive action towards net-zero-carbon surgery. METHODS Carbon footprints were estimated using activity data and prospective machine-loading audit data at a typical UK in-hospital sterilization unit, with instruments wrapped individually in flexible pouches, or prepared as sets housed in single-use tray wraps or reusable rigid containers. Modelling was used to determine the impact of alternative machine loading, opening instruments during the operation, streamlining sets, use of alternative energy sources for decontamination, and alternative waste streams. RESULTS The carbon footprint of decontaminating and packaging instruments was lowest when instruments were part of sets (66-77 g CO2e per instrument), with a two- to three-fold increase when instruments were wrapped individually (189 g CO2e per instrument). Where 10 or fewer instruments were required for the operation, obtaining individually wrapped items was preferable to opening another set. The carbon footprint was determined significantly by machine loading and the number of instruments per machine slot. Carbon and financial costs increased with streamlining sets. High-temperature incineration of waste increased the carbon footprint of single-use packaging by 33-55 per cent, whereas recycling reduced this by 6-10 per cent. The absolute carbon footprint was dependent on the energy source used, but this did not alter the optimal processes to minimize that footprint. CONCLUSION Carbon and financial savings can be made by preparing instruments as part of sets, integrating individually wrapped instruments into sets rather than streamlining them, efficient machine loading, and using low-carbon energy sources alongside recycling.
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Affiliation(s)
- Chantelle Rizan
- Ear, Nose and Throat Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,BSMS Teaching Building, Brighton and Sussex Medical School, Brighton, UK.,Research Department, Royal College of Surgeons of England, London, UK
| | - Rob Lillywhite
- Department of Life Sciences, University of Warwick, Coventry, UK
| | - Malcolm Reed
- BSMS Teaching Building, Brighton and Sussex Medical School, Brighton, UK
| | - Mahmood F Bhutta
- Ear, Nose and Throat Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,BSMS Teaching Building, Brighton and Sussex Medical School, Brighton, UK
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Pioche M, Lambin T, Rivory J. Let's urgently engage ourselves in "greening" endoscopy to address ecological issues! Endosc Int Open 2021; 9:E1752-E1753. [PMID: 34790539 PMCID: PMC8589551 DOI: 10.1055/a-1546-8975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Mathieu Pioche
- Endoscopy Unit – Digestive Disease Department, Edouard Herriot Hospital, Lyon, France
| | - Thomas Lambin
- Adult Gastroenterology, Lille University Hospital, Lille, France
| | - Jérôme Rivory
- Endoscopy Unit – Digestive Disease Department, Edouard Herriot Hospital, Lyon, France
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80
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Regulating Environmental Impact of Medical Devices in the United Kingdom—A Scoping Review. PROSTHESIS 2021. [DOI: 10.3390/prosthesis3040033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical devices are highly regulated to ensure safety and efficacy of the products and minimize the risk of harm to users and patients. However, the broader impacts of these devices on the environment have scarcely been questioned until recently. The United Kingdom National Health Service intends to achieve a “net zero” emissions service by 2040 and has identified specific targets to achieve through this process. However, medical device manufacturers do not see sufficient incentives to invest in reducing greenhouse gas emissions unless enforced by legislation. Furthermore, there is little evidence on the legislation required to reduce emissions from medical devices. This study addresses the relationship of medical device regulations and the environmental impact of the devices throughout their lifecycle. A scoping review was conducted on academic literature on the topic, followed by a critical review of the current medical device regulations and associated guidelines in the United Kingdom. The challenges to regulating environmental impact of medical devices were identified under seven themes. These challenges were contextualized with the National Health Service target of achieving zero emissions by 2040. The review indicates that current guidelines support single-use disposal of devices and equipment as the best approach to prevent pathogen transmission and landfilling and incineration are the most used waste management strategies. Manufacturers need to be guided and educated on reducing their emissions while ensuring the development of safe and effective devices.
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81
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Senay E, Bernstein A, Shephard P, Salas R, Rizzo A, Sherman J, Richardson L, Butts G, Marwah H, Solomon C, Galvez M, Thanik E, Pezeshki G, Zajac L, Lee A, Sheffield P, Wright R. Improving Patient Outcomes in the Dual Crises of Climate Change and COVID-19: Proceedings of the Third Annual Clinical Climate Change Meeting, January 8, 2021. J Occup Environ Med 2021; 63:e813-e818. [PMID: 34354022 PMCID: PMC8842883 DOI: 10.1097/jom.0000000000002345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The tremendous global toll of the COVID-19 pandemic does not fall equally on all populations. Indeed, this crisis has exerted more severe impacts on the most vulnerable communities, spotlighting the continued consequences of longstanding structural, social, and healthcare inequities. This disparity in COVID-19 parallels the unequal health consequences of climate change, whereby underlying inequities perpetuate adverse health outcomes disproportionately among vulnerable populations. As these two crises continue to unfold, there is an urgent need for healthcare practitioners to identify and implement solutions to mitigate adverse health outcomes, especially in the face of global crises. To support this need, the 2021 Clinical Climate Change Conference held a virtual meeting to discuss the implications of the convergence of the climate crisis and COVID-19, particularly for vulnerable patient populations and the clinicians who care for them. Presenters and panelists provided evidence-based solutions to help health professionals improve and adapt their practice to these evolving scenarios. Together, participants explored the community health system and national solutions to reduce the impacts of COVID-19 and the climate crisis, to promote community advocacy, and foster new partnerships between community and healthcare leaders to combat systemic racism and achieve a more just and equitable society.
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Affiliation(s)
- Emily Senay
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aaron Bernstein
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA
- Boston Children’s Hospital, Boston, MA
| | | | - Renee Salas
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | | | - Jodi Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
- Department of Epidemiology in Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Population Health Science & Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Butts
- Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Maida Galvez
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grant Pezeshki
- New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Lauren Zajac
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Lee
- Departments of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Mount Sinai Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
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82
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Affiliation(s)
- Alexandra Barratt
- Wiser Healthcare and School of Public Health, University of Sydney, Australia
| | - Forbes McGain
- Department of Anaesthesia and Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, University of Melbourne, Australia; School of Public Health, University of Sydney, Australia
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83
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Lee R, Nader D. Practical environmental considerations in anesthesia practice. J Clin Anesth 2021; 79:110522. [PMID: 34598863 DOI: 10.1016/j.jclinane.2021.110522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Lee
- Department of Anesthesiology, University at Buffalo, United States.
| | - D Nader
- Department of Anesthesiology, University at Buffalo, United States
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84
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Grimmond TR, Bright A, Cadman J, Dixon J, Ludditt S, Robinson C, Topping C. Before/after intervention study to determine impact on life-cycle carbon footprint of converting from single-use to reusable sharps containers in 40 UK NHS trusts. BMJ Open 2021; 11:e046200. [PMID: 34580089 PMCID: PMC8477330 DOI: 10.1136/bmjopen-2020-046200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To compare global warming potential (GWP) of hospitals converting from single-use sharps containers to reusable sharps containers (SSC, RSC). Does conversion to RSC result in GWP reduction? DESIGN Using BS PAS 2050:2011 principles, a retrospective, before/after intervention quantitative model together with a purpose-designed, attributional 'cradle-to-grave' life-cycle tool, were used to determine the annual greenhouse gas (GHG) emissions of the two sharps containment systems. Functional unit was total fill line litres (FLL) of sharps containers needed to dispose of sharps for 1-year period in 40 trusts. Scopes 1, 2 and 3 emissions were included. Results were workload-normalised using National Health Service (NHS) national hospital patient-workload indicators. A sensitivity analysis examined areas of data variability. SETTING Acute care hospital trusts in UK. PARTICIPANTS 40 NHS hospital Trusts using RSC. INTERVENTION Conversion from SSC to RSC. SSC and RSC usage details in 17 base line trusts immediately prior to 2018 were applied to the RSC usage details of the 40 trusts using RSC in 2019. PRIMARY OUTCOME MEASURE The comparison of GWP calculated in carbon dioxide equivalents (CO2e) generated in the manufacture, transport, service and disposal of 12 months, hospital-wide usage of both containment systems in the 40 trusts. RESULTS The 40 trusts converting to RSC reduced their combined annual GWP by 3267.4 tonnes CO2e (-83.9%); eliminated incineration of 900.8 tonnes of plastic; eliminated disposal/recycling of 132.5 tonnes of cardboard and reduced container exchanges by 61.1%. GHG as kg CO2e/1000 FLL were 313.0 and 50.7 for SSC and RSC systems, respectively. A sensitivity analysis showed substantial GHG reductions within unit processes could be achieved, however, their impact on relevant final GWP comparison varied <5% from base comparison. CONCLUSIONS Adopting RSC is an example of a sustainable purchasing decision that can assist trusts meet NHS GHG reduction targets and can reduce GWP permanently with minimal staff behavioural change.
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Affiliation(s)
| | - Anna Bright
- Sustainability West Midlands, Birmingham, UK
| | - June Cadman
- Waste Management & Environmental Services, Rotherham NHS Foundation Trust, Rotherham, UK
| | - James Dixon
- Sustainability, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Sally Ludditt
- Health, Safety and Environmental, Derbyshire Support and Facilities Services Limited, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Clive Robinson
- Sustainable Development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Clare Topping
- Energy and Sustainability, Northampton General Hospital NHS Trust, Northampton, UK
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85
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Gordon IO, Sherman JD, Leapman M, Overcash M, Thiel CL. Life Cycle Greenhouse Gas Emissions of Gastrointestinal Biopsies in a Surgical Pathology Laboratory. Am J Clin Pathol 2021; 156:540-549. [PMID: 33822876 DOI: 10.1093/ajcp/aqab021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide mitigation strategies. METHODS The biopsy process at a large academic pathology laboratory was grouped into steps. Each supply and reagent was catalogued and postuse treatment noted. Energy consumption was estimated for capital equipment. Two common scenarios were considered: 1 case with 1 specimen jar (scenario 1) and 1 case with 3 specimen jars (scenario 2). RESULTS Scenario 1 generated 0.29 kg of carbon dioxide equivalents (kg CO2e), whereas scenario 2 resulted in 0.79 kg CO2e-equivalent to 0.7 and 2.0 miles driven, respectively. The largest proportion of GHGs (36%) in either scenario came from the tissue processor step. The second largest contributor (19%) was case accessioning, mostly attributable to production of single-use disposable jars. CONCLUSIONS Applied to more than 20 million biopsies performed in the US annually, emissions from biopsy processing is equivalent to yearly GHG emissions from 1,200 passenger cars. Mitigation strategies may include modification of surveillance guidelines to include the number of specimen jars.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, and Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Michael Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Cassandra L Thiel
- Department of Population Health, NYU Langone Health, New York, NY, USA
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86
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Rublee C, Bills C, Theron E, Brysiewicz P, Singh S, Muya I, Smith W, Akpevwe OE, Ali LA, Dauda E, Calvello Hynes E. Outcomes of a Climate Change Workshop at the 2020 African Conference on Emergency Medicine. Afr J Emerg Med 2021; 11:372-377. [PMID: 34367899 PMCID: PMC8326188 DOI: 10.1016/j.afjem.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/15/2021] [Accepted: 05/09/2021] [Indexed: 11/08/2022] Open
Abstract
A changing climate will have demonstrable effects on health and healthcare systems, with specific and disproportionate effects on communities in Africa. Emergency care systems and providers have an opportunity to be at the forefront of efforts to combat the worst health effects from climate change. The 2020 African Conference on Emergency Medicine, under the auspices of the African Federation for Emergency Medicine, convened its first ever workshop on the topic of climate change and human health. Structured as a full day virtual course, the didactic sections were available for both live and asynchronous learning with more than 100 participants enrolled in the course. The workshop introduced the topic of the health effects of climate as they relate to emergency care in Africa and provided a forum to discuss ideas regarding the way forward. Lectures and focused discussions addressed three broad themes related to: health impacts, health care delivery, and advocacy. To our knowledge, this is the first workshop for health professionals to cover topics specific to emergency care, climate change, and health in Africa. The results of this workshop will help to guide future efforts aimed at advancing emergency care approaches in Africa with regard to medical education, research, and policy. African relevance Climate-related extreme weather events are adversely affecting health and health care delivery in African countries. African organisations, cities, and nations have taken positive steps to adapt and build climate resilience. There are opportunities for emergency care professionals and scholars to continue to expand, and lead, climate and health education, research, and policy initiatives on the continent.
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87
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Comparison of the strength of various disposable videolaryngoscope blades. Can J Anaesth 2021; 68:1651-1658. [PMID: 34405354 DOI: 10.1007/s12630-021-02069-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Breaking of disposable blades during emergency endotracheal intubation has been reported. Breakage can cause serious injury and foreign body ingestion. We aimed to measure and analyze the strength characteristics of different disposable videolaryngoscope blades with the application of an upward-lifting force. METHODS We measured the strength of four disposable videolaryngoscope blades (C-Mac® S Video laryngoscope MAC #3, Glidescope GVL® 3 stat, Pentax AWS® PBlade TL type, and King Vision® aBlade #3) using the fracture test. The strength of 12 samples of each type of disposable videolaryngoscope blade was measured using an Instron 5,966 tensile tester by applying an upward-lifting force. RESULTS After the fracture test using C-Mac, Glidescope GVL, Pentax AWS, and King Vision, the number of deformed blades were 0, 12, 3, and 7, respectively, and the number of broken blades were 12, 0, 9, and 5, respectively. The mean (standard deviation) maximum force strengths of Pentax AWS, C-Mac, King Vision, and Glidescope GVL blades were 408.4 (27.4) N, 325.8 (26.5) N, 291.8 (39.3) N, and 262.7 (3.8) N, respectively (P < 0.001). CONCLUSION Clinicians should be aware of the varied strength characteristics of the four types of disposable videolaryngoscope blades when they are used in endotracheal intubation.
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88
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Abstract
BACKGROUND The climate crisis is the most serious threat to global health in the twenty-first century. In western countries 5-10% of all greenhouse gas emissions originate from the healthcare sector and the main contributing factors are energy-intense departments (intensive care units, operating suits and prehospital emergency services). OBJECTIVE The aim of this review is to provide background knowledge and practical ideas to achieve climate-neutral hospitals. MATERIAL AND METHODS Narrative review with information on the topics of (I) volatile anesthetics as greenhouse gases, (II) energy supply in hospitals and (III) solid waste management. RESULTS AND CONCLUSION (I) Volatile anesthetics are highly potent greenhouse gases, especially desflurane has a major global warming potential. Total intravenous anesthesia (TIVA) with propofol or regional anesthetic techniques have a much lower impact on the climate. (II) Using sustainable energy sources as well as initiating energy sparing techniques, such as light-emitting diodes (LED) and motion sensors, can reduce CO2 emissions. (III) Waste can be managed by the reduce, reuse, recycle, rethink and research concept. Doctors should actively contribute to reach the climate goals.
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Affiliation(s)
- S Koch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - S Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland
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89
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Drew J, Christie SD, Tyedmers P, Smith-Forrester J, Rainham D. Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:76001. [PMID: 34251875 PMCID: PMC8274692 DOI: 10.1289/ehp8666] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/30/2021] [Accepted: 06/11/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change. Paradoxically, health care provision is a significant driver of environmental pollution, with surgical and anesthetic services among the most resource-intensive components of the health system. OBJECTIVES This analysis aimed to summarize the state of life cycle assessment (LCA) practice as applied to surgical and anesthetic care via review of extant literature assessing environmental impacts of related services, procedures, equipment, and pharmaceuticals. METHODS A state-of-the-science review was undertaken following a registered protocol and a standardized, LCA-specific reporting framework. Three bibliographic databases (Scopus®, PubMed, and Embase®) and the gray literature were searched. Inclusion criteria were applied, eligible entries critically appraised, and key methodological data and results extracted. RESULTS From 1,316 identified records, 44 studies were eligible for inclusion. The annual climate impact of operating surgical suites ranged between 3,200,000 and 5,200,000 kg CO2e. The climate impact of individual surgical procedures varied considerably, with estimates ranging from 6 to 1,007 kg CO2e. Anesthetic gases; single-use equipment; and heating, ventilation, and air conditioning system operation were the main emissions hot spots identified among operating room- and procedure-specific analyses. Single-use equipment used in surgical settings was generally more harmful than equivalent reusable items across a range of environmental parameters. Life cycle inventories have been assembled and associated climate impacts calculated for three anesthetic gases (2-85 kg CO2e/MAC-h) and 20 injectable anesthetic drugs (0.01-3.0 kg CO2e/gAPI). DISCUSSION Despite the recent proliferation of surgical and anesthesiology-related LCAs, extant studies address a miniscule fraction of the numerous services, procedures, and products available today. Methodological heterogeneity, external validity, and a lack of background life cycle inventory data related to many essential surgical and anesthetic inputs are key limitations of the current evidence base. This review provides an indication of the spectrum of environmental impacts associated with surgical and anesthetic care at various scales. https://doi.org/10.1289/EHP8666.
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Affiliation(s)
- Jonathan Drew
- Department of Surgery (Division of Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean D. Christie
- Department of Surgery (Division of Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Tyedmers
- School for Resource and Environmental Studies, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jenna Smith-Forrester
- Department of Surgery (Division of Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Rainham
- School of Health and Human Performance and the Healthy Populations Institute, Dalhousie University, Halifax, Nova Scotia, Canada
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90
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Lee AWL, Neo ERK, Khoo ZY, Yeo Z, Tan YS, Chng S, Yan W, Lok BK, Low JSC. Life cycle assessment of single-use surgical and embedded filtration layer (EFL) reusable face mask. RESOURCES, CONSERVATION, AND RECYCLING 2021; 170:105580. [PMID: 33814723 PMCID: PMC8009732 DOI: 10.1016/j.resconrec.2021.105580] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND The outbreak of the COVID-19 pandemic has led to an unprecedented amount of face mask consumption around the world. The increase in face mask consumption has brought focus to their environmental impact. To keep up with the increased demand for face masks, different variations of reusable face masks such as the embedded filtration layer (EFL) reusable face mask have emerged in the market. This study quantifies the environmental impact of the EFL reusable face mask and the single-use surgical face mask. METHODS The life cycle assessment (LCA) study of the entire value chain from cradle-to-grave is applied to each face mask. Both face masks are evaluated over 1 functional unit (FU) of 31 12-h days for a single person. The ReCiPe method with the Hierachist perspective was applied. A total of nine impact categories as well as the generated waste of each face mask are evaluated. RESULTS The results show that for 1 functional unit, the use of single-use surgical face mask and EFL reusable face mask will contribute 0.580 kg CO2-eq and 0.338 kg CO2-eq to climate change and generate 0.004 kg and 0.0004 kg of waste respectively. CONCLUSION Comparing both face masks, the EFL reusable face mask will have a lower emission of at least 30% in terms of the generated waste and the impact categories considered, except for water depletion, freshwater eutrophication, marine eutrophication, and human toxicity.
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Affiliation(s)
| | | | - Zi-Yu Khoo
- Singapore Institute of Manufacturing Technology, Singapore
| | - Zhiquan Yeo
- Singapore Institute of Manufacturing Technology, Singapore
| | - Yee Shee Tan
- Singapore Institute of Manufacturing Technology, Singapore
| | - Shuyun Chng
- Singapore Institute of Manufacturing Technology, Singapore
| | - Wenjin Yan
- Singapore Institute of Manufacturing Technology, Singapore
| | - Boon Keng Lok
- Singapore Institute of Manufacturing Technology, Singapore
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91
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Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med 2021; 40:100907. [PMID: 34153533 DOI: 10.1016/j.accpm.2021.100907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste. METHODS We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed. RESULTS We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions. CONCLUSION Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.
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Affiliation(s)
- Thibault Reynier
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France
| | - Mathilde Berahou
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France.
| | - Hélène Beloeil
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
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92
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A Roadmap for Environmental Sustainability of Plastic Use in Anesthesia and the Perioperative Arena. Anesthesiology 2021; 135:729-737. [PMID: 34237126 DOI: 10.1097/aln.0000000000003845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room. Ann Surg 2021; 273:1108-1114. [PMID: 33630452 DOI: 10.1097/sla.0000000000004755] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country. SUMMARY OF BACKGROUND DATA Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns.1 As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions2; if it were itself a nation, US healthcare would rank 13th globally in emissions.3 As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards.4 Further, ORs and labor/delivery suites produce 50%-70% of waste across the hospital.5,6 Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change "the biggest global health threat of the 21st century" and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients.7. METHODS/RESULTS We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings, and highlight resources for clinicians interested in pursuing this work. CONCLUSION Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.
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94
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Hoyler MM, White RS, Mack PF, Kelleher DC. Environmental report cards in anesthesia care: A quality metric for patients, providers and institutions. J Clin Anesth 2021; 73:110355. [PMID: 34058695 DOI: 10.1016/j.jclinane.2021.110355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Marguerite M Hoyler
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Robert S White
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Patricia Fogarty Mack
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Deirdre C Kelleher
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
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95
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Rizan C, Bhutta MF. Strategy for net-zero carbon surgery. Br J Surg 2021; 108:737-739. [PMID: 33963828 DOI: 10.1093/bjs/znab130] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Affiliation(s)
- C Rizan
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,BSMS Sustainable Healthcare Group, Brighton and Sussex Medical School, Brighton, UK
| | - M F Bhutta
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,BSMS Sustainable Healthcare Group, Brighton and Sussex Medical School, Brighton, UK
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96
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Ewbank C, Stewart B, Bruns B, Deckelbaum D, Gologorsky R, Groen R, Gupta S, Hadley M, Harris MJ, Godfrey R, Jackson J, Leppäniemi A, Malone DL, Newton C, Traynor MD, Wong EG, Kushner AL. Introduction of the Surgical Providers Assessment and Response to Climate Change (SPARC2) Tool: One Small Step Toward Reducing the Carbon Footprint of Surgical Care. Ann Surg 2021; 273:e135-e137. [PMID: 33214422 DOI: 10.1097/sla.0000000000004367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Clifton Ewbank
- University of California San Francisco Benioff Children's Hospital Oakland, Department of Surgery, Oakland, CA
- University of California San Francisco East Bay Surgery Program, Department of Surgery, Oakland, CA
| | - Barclay Stewart
- University of Washington, Department of Surgery, Seattle, WA
| | - Brandon Bruns
- University of Maryland, Department of Surgery, Baltimore, MD
| | - Dan Deckelbaum
- McGill University, Department of Surgery, Montreal, Quebec, Canada
| | - Rebecca Gologorsky
- University of California San Francisco East Bay Surgery Program, Department of Surgery, Oakland, CA
| | - Reinou Groen
- Alaska Native Medical Center, Department of Obstetrics and Gynecology, Anchorage, AK
| | - Shailvi Gupta
- University of Maryland, Department of Surgery, Baltimore, MD
| | - Megan Hadley
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark J Harris
- University of Utah, Department of Anesthesiology, Salt Lake City, UT
| | - Richard Godfrey
- University of California San Francisco East Bay Surgery Program, Department of Surgery, Oakland, CA
| | - Jordan Jackson
- University of California San Francisco East Bay Surgery Program, Department of Surgery, Oakland, CA
| | - Ari Leppäniemi
- Helsinki University Hospital, Department of Surgery, Helsinki, Finland
| | - Debra L Malone
- University of Maryland, Department of Surgery, Baltimore, MD
| | - Christopher Newton
- University of California San Francisco Benioff Children's Hospital Oakland, Department of Surgery, Oakland, CA
| | | | - Evan G Wong
- McGill University, Department of Surgery, Montreal, Quebec, Canada
| | - Adam L Kushner
- Surgeons OverSeas, New York City, NY
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD
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97
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Smith SL, Orsborn GN, Sulley A, Chatterjee NB, Morgan PB. An investigation into disposal and recycling options for daily disposable and monthly replacement soft contact lens modalities. Cont Lens Anterior Eye 2021; 45:101435. [PMID: 33715968 DOI: 10.1016/j.clae.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the annualised waste and end-of-life disposal options with two representative soft contact lens (CL) modalities. METHODS The component parts of two representative soft CL modalities were catalogued, separated, weighed and inspected for material identification: somofilcon A soft CLs (clariti elite, CooperVision Inc.) used with multi-purpose solution (MPS) (All in one Light, CooperVision Inc.) and somofilcon A CLs (clariti 1 day, CooperVision Inc). Using a model that assumed compliant wear and care of CLs, the mass of material solid waste generated by CL use over a year was calculated. Disposal options were explored using household and specialist recycling streams in order to develop recommendations for responsible disposal of CL waste. RESULTS Full-time daily disposable (DD) CL wear generates 1.06 kg of waste annually compared to 0.83 kg generated by reusable-monthly replacement daily wear ('reusable') CLs. Plastic was the dominant material in both modalities. With full-time use of DD CLs, 64% of waste by mass was plastic blister trays. For full-time use of reusable CLs, where figures from lens and MPS packaging are combined, plastics accounted for 67% of waste by mass. MPS bottles alone made up almost half the waste (45%) associated with full-time reusable CL wear. CONCLUSION Full-time DD wear generates 27% more waste annually than full-time reusable lens wear. Reusable CL wearers can recycle 78% of waste at home. DD lens wearers have access to recycling options that allow them to recycle 100% of CL related waste. Full-time CL lens wear represents just 0.20-0.26% of the 412 kg of household waste generated per person, per year in the United Kingdom. Worn CLs should never be disposed of down the sink or lavatory. CL wearers should be aware of responsible end-of-life recycling and disposal options for all CL waste.
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Affiliation(s)
- Sarah L Smith
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, UK.
| | | | | | - Neil B Chatterjee
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, UK
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, UK
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98
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Rammelkamp Z, Dirnberger J, Johnson G, Waisbren S. An Audit of All Waste Leaving the Operating Room: Can the Surgical Suite Be More Environmentally Sustainable? WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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99
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Zorrilla-Vaca A, Marmolejo-Posso D, Caballero-Lozada AF, Miño-Bernal JF. Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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100
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MacNeill AJ, Hopf H, Khanuja A, Alizamir S, Bilec M, Eckelman MJ, Hernandez L, McGain F, Simonsen K, Thiel C, Young S, Lagasse R, Sherman JD. Transforming The Medical Device Industry: Road Map To A Circular Economy. Health Aff (Millwood) 2020; 39:2088-2097. [PMID: 33284689 DOI: 10.1377/hlthaff.2020.01118] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy- and market-driven solutions are needed to encourage systemic transformation.
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Affiliation(s)
- Andrea J MacNeill
- Andrea J. MacNeill is a clinical associate professor in the Department of Surgery at the University of British Columbia, in Vancouver, British Columbia, Canada
| | - Harriet Hopf
- Harriet Hopf is a professor of anesthesiology in the Department of Anesthesiology at the University of Utah, in Salt Lake City, Utah
| | - Aman Khanuja
- Aman Khanuja is an MPH/MBA candidate in the Yale School of Management and the Yale School of Public Health at Yale University, in New Haven, Connecticut
| | - Saed Alizamir
- Saed Alizamir is an associate professor of operations management in the School of Management at Yale University
| | - Melissa Bilec
- Melissa Bilec is an associate professor in the Department of Civil and Environmental Engineering at the University of Pittsburgh, in Pittsburgh, Pennsylvania
| | - Matthew J Eckelman
- Matthew J. Eckelman is an associate professor in the Department of Civil and Environmental Engineering at Northeastern University, in Boston, Massachusetts
| | - Lyndon Hernandez
- Lyndon Hernandez is an adjunct clinical faculty member at the Medical College of Wisconsin, in Milwaukee, Wisconsin
| | - Forbes McGain
- Forbes McGain is an associate professor in the Centre for Integrated Critical Care at the University of Melbourne, in Melbourne, Victoria, Australia
| | - Kari Simonsen
- Kari Simonsen is a professor in the Division of Pediatric Infectious Diseases at the University of Nebraska Medical Center, in Omaha, Nebraska
| | - Cassandra Thiel
- Cassandra Thiel is an assistant professor at the NYU Langone Health School of Medicine, the Robert F. Wagner Graduate School of Public Service, and the NYU Tandon School of Engineering at New York University, in New York, New York
| | - Steven Young
- Steven Young is an associate professor in the School of Environment, Enterprise, and Development at the University of Waterloo, in Waterloo, Ontario, Canada
| | - Robert Lagasse
- Robert Lagasse is a professor and vice chair for quality and regulatory affairs, Department of Anesthesiology, Yale School of Medicine, Yale University
| | - Jodi D Sherman
- Jodi D. Sherman is an associate professor of anesthesiology in the Yale School of Medicine and the Yale School of Public Health, Yale University
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