Disposable versus reusable medical gowns: A performance comparison

A narrative review of personal protective equipment gowns: lessons from COVID-19

This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current standards pertaining to isolation gowns might be irrelevant to the protection of healthcare workers from pathogen transmission, as they focus primarily on fluid barrier resistance values that are not reflective of all transmission conditions in hospitals. Although most available isolation gowns are disposable, reusable gowns could offer greater barrier protection and are more environmentally sustainable. Several techniques have been studied for their ability to impart antimicrobial properties to isolation gowns, extending their lifespan and reducing environmental impacts. However, evidence of the effectiveness of such techniques in clinical settings is scarce. We advocate for standardised guidelines inclusive of common pathogen survival tests, comfort, and durability, which reflect the actual infection risks encountered by healthcare workers, to improve the safety and efficacy of isolation gowns in hospital settings. Further research into the clinical effectiveness of antimicrobial gowns and their long-term implications on the environment is also warranted.

Arneja J. How Can Non-Hospital Surgical Centres Improve Their Environmental Footprint (and Reduce Costs)?

Introduction

Every industry has greenhouse gas emissions, with healthcare a significant contributor. In Canada, the healthcare sector is directly and indirectly responsible for 4.6% of the country's greenhouse gas emissions. Operating rooms (ORs) are major contributors to hospital waste, making the OR low hanging fruit for analyzing environmental practices. The OR can adopt a green mindset to reduce its carbon footprint, yet barriers to going green exist. Herein we study non-hospital surgical centres in British Columbia to assess current green practices, attitudes towards environmental sustainability, and barriers to implementation.

Methods

All accredited non-hospital surgical centres in BC were invited to complete a survey on current practices and plans to reduce their environmental impact.

Results

Of 56 non-hospital surgical centres contacted, 18 responded, with 89% willing to adapt their practice to promote environmental sustainability, yet lacked current knowledge (56%) and formal plans (0%). The wide use of anesthetic gases with high global warming potential (64%) and disposable drapes/ gowns (78%/ 67%) were noted. Barriers to adopting green practices included: cost (44%), infrastructure (44%), regulatory guidelines (39%), knowledge (39%), and safety (28%).

Conclusions

Transitioning to more environmentally sustainable practices in ORs can enhance healthcare value by reducing both costs and greenhouse gas emissions. The greatest effect can be achieved through prudent choice of anesthetic gas agent, followed by reusable linens and drapes. Education and regulatory leadership were identified as crucial for overcoming these barriers. This study underscores the need for education, guidelines, and economically viable options to transition from awareness to action.

A recycling quality improvement project to engage the multidisciplinary team with sustainability efforts

BACKGROUND

The provision of healthcare itself contributes to the global health crisis of the climate emergency. As critical care is a carbon hotspot within hospital medicine, healthcare professionals must take collaborative action to mitigate the environmental impact of the sector.

AIM

The purpose of the project was to engage the critical care multidisciplinary team with sustainability efforts, through involvement in a recycling Quality Improvement Project (QIP). The central QIP aimed to increase the recycling rates of single-use plastic enteral feed bottles in the intensive care unit (ICU) over a 31-day period.

STUDY DESIGN

A recycling 'challenge month' was launched, and staff opinion was surveyed before and after this intervention.

RESULTS

The QIP demonstrated an increase in feed bottle recycling by 53.2%, representing a carbon-saving effect of up to 6.02 kg CO2e for the intervention month. Following the central QIP, all survey respondents felt encouraged to consider their ICU's environmental impact.

CONCLUSIONS

Simple successful QIPs can act as a springboard to engage the staff body with sustainability initiatives and ignite wider conversation and consideration of the climate emergency in daily practice.

RELEVANCE FOR CLINICAL PRACTICE

Effective recycling constitutes only one element of responsible environmental stewardship, but authors discuss that it is an effective focus for QIPs. To maximize impact and success within critical care, nursing involvement in leading and participation is essential.

Reusable Personal Protective Equipment Viewed Through the Lens of Sustainability

From early 2020 the COVID-19 pandemic drove dramatic increases in the production and use of single use disposable masks, respirators and gowns, and highlighted the vulnerability of supply chains for these items. This paper explores the impacts of the rising demands for these single use items through the lens of sustainability, by collating data on the carbon footprint and other impacts, and then discussing challenges, solutions, and future perspectives. Polypropylene and other key synthetic fibre components of these items are not biodegradable, and persist in the environments for prolonged periods generating microplastics as they degrade slowly. Various methods have been shown to allow limited repeated use of surgical masks and respirators, and this has spurred the development of masks and respirators designed for many cycles of reuse. Parallel discussions around gowns reveal that reuseable gowns offer many advantages for performance as well as reduced environmental impact. At the local dental clinic level, those making purchasing decisions should consider impacts of their product choices on the environment. Such impacts occur from manufacture, transport, and disposal of PPE, and from degradation within the environment. Regulators need to encourage use of reuseable items and facilitate this through local guidelines, while at the international level, more work is needed to develop uniform standards for reuseable masks, respirators and gowns.

Environmental sustainability in gynecologic oncology

Climate change is a complex, global issue that is impacting human health in various ways, with healthcare being a significant contributor to carbon emissions in the United States. This review discusses the environmental impact of important aspects of gynecologic oncology care, including surgery, anesthesia care, radiology, chemotherapy, and radiation oncology. Operating room energy and material use is highlighted, with a focus on the environmental impact of robotic surgery. The contribution of certain anesthetic gases in increasing greenhouse gas emissions is addressed. Additionally, the environmental impacts of radiologic imaging, chemotherapy, and radiation oncology are also discussed. Despite the complexity of climate change, there are multiple strategies on the individual and institutional level that can help mitigate the environmental impact of gynecologic oncology care. Individual efforts include practicing red bag stewardship, limiting single use-supplies, decreasing the use of potentially deleterious anesthetics, and supporting research into alternative dosing for chemotherapy and radiation which requires less patient travel. Institutional strategies include investing in efficient HVAC systems, utilizing reusable and reprocessed materials and devices, and purchasing renewable energy sources. Both individuals and institutions can advocate with industry and government at all levels for practices and policies that support lower carbon emissions. By recognizing our role in reducing carbon emissions, we can work towards improving the well-being of our patients and the larger community.

Assessment of the carbon footprint of total hip arthroplasty and opportunities for emission reduction in a UK hospital setting

Aims

This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices.

Methods

Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from anaesthetic room to recovery. Scope 1 and scope 2 emissions were considered, focusing on direct emissions and energy consumption. Data included detailed assessments of consumables, waste generation, and energy use during surgeries.

Results

The carbon footprint of an uncemented THA was estimated at 100.02 kg CO2e, with a marginal increase to 104.89 kg CO2e for hybrid THA. Key contributors were consumables in the operating theatre (21%), waste generation (22%), and scope 2 emissions (38%). The study identified opportunities for reducing emissions, including instrument rationalization, transitioning to LED lighting, and improving waste-recycling practices.

Conclusion

This study sheds light on the substantial carbon footprint associated with THA. Actionable strategies for reducing emissions were identified, emphasizing the need for sustainable practices in orthopaedic surgery. The findings prompt a critical discussion on the environmental impact of single-use versus reusable items in the operating theatre, challenging traditional norms to make more environmentally responsible choices.

UK national survey on surgical gowning for tonsillectomy

OBJECTIVE

Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards.

METHOD

We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK.

RESULTS

The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure.

CONCLUSION

Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.

Sustainable orthopaedic surgery: Initiatives to improve our environmental, social and economic impact

In response to appeals from the WHO and The Lancet, a collaborative statement from over 200 medical journals was published in September 2021, advising international governments to combat the "catastrophic harm to health" from climate change. Healthcare, specifically surgery, constitutes a major contributor to environmental harm that remains unaddressed. This article provides practical guidance that can be instituted at a departmental, hospital and national level to institute transformative, sustainable efforts into practice. We also aim to provoke healthcare leaders to discuss policy-making with respect to this issue and highlight the necessity for sustainability to become a core domain of quality improvement. The average orthopaedic service produces 60% more waste than any other surgical specialty. Fortunately, simple measures such as a comprehensive education programme can decrease waste disposal costs by 20-fold. Other simple and effective "green" measures include integrating carbon literacy into surgical training, prioritising regional anaesthesia and conducting recycling audits. Furthermore, industry must take accountability and be incentivised to limit the use of single-item packaging and single-use items. National policymakers should consider the benefits of reusable implants, reusable surgical drapes and refurbishing crutches as these are proven cost and climate-effective interventions. It is crucial to establish a local sustainability committee to maintain these interventions and to bridge the gap between clinicians, industry and policymakers.

A Life Cycle Assessment of Reusable and Disposable Surgical Caps

INTRODUCTION

Surgical cap attire plays an important role in creating a safe and sterile environment in procedural suites, thus the choice of reusable versus disposable caps has become an issue of much debate. Given the lack of evidence for differences in surgical site infection (SSI) risk between the two, selecting the cap option with a lower carbon footprint may reduce the environmental impact of surgical procedures. However, many institutions continue to recommend the use of disposable bouffant caps.

METHODS

ISO-14044 guidelines were used to complete a process-based life cycle assessment to compare the environmental impact of disposable bouffant caps and reusable cotton caps, specifically focusing on CO2 equivalent (CO2e) emissions, water use and health impacts.

RESULTS

Reusable cotton caps reduced CO2e emissions by 79% when compared to disposable bouffant caps (10 kg versus 49 kg CO2e) under the base model scenario with a similar reduction seen in disability-adjusted life years. However, cotton caps were found to be more water intensive than bouffant caps (67.56 L versus 12.66 L) with the majority of water use secondary to production or manufacturing.

CONCLUSIONS

Reusable cotton caps have lower total lifetime CO2e emissions compared to disposable bouffant caps across multiple use scenarios. Given the lack of evidence suggesting a superior choice for surgical site infection prevention, guidelines should recommend reusable cotton caps to reduce the environmental impact of surgical procedures.

User experience of wearing comfort of reusable versus disposable surgical gowns and environmental perspectives: A cross-sectional survey

OBJECTIVE

To determine the user experience of wearing comfort of reusable sterile surgical gowns and compare these gowns with conventional disposable surgical gowns.

DESIGN

Cross-sectional survey.

SETTING

An academic hospital in the Netherlands.

POPULATION

Gynaecologists, surgeons, residents and operating room assistants (n=80).

METHODS

Quantitative and qualitative data were obtained via a written questionnaire. Participants provided subjective comments and scored the reusable gown on each individual topic with a score from 1 to 5 (1 = unsatisfactory, 2 = moderate, 3 = good, 4 = very good, 5 = excellent) and compared the reusable gown with the conventional disposable alternative (better, equal or worse).

MAIN OUTCOME MEASURES

Wearing comfort: ventilation and temperature regulation, fit and length, functionality, barrier function and ease of use.

RESULTS

The results of the overall scores of the reusable gown are scored as 'very good' (mean 4.3, SD ± 0.5) by its users. Regarding comparison of the gowns, more than 79% (lowest score 79%, highest score 95%) of the participants scored the reusable gown equal or higher on six of seven topics. The topic 'ease of use' was scored equal or higher by 59% of the participants. Subjective comments provided information on possible improvements.

CONCLUSIONS

The findings of this study demonstrate that there is professional acceptance regarding the utilisation of reusable surgical gowns. To facilitate broader adoption, it is imperative to foster collaboration among suppliers and healthcare institutions. The reusable surgical gown is an environmentally sustainable, safe and comfortable alternative in the operating room.

The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment

OBJECTIVE

To compare the carbon footprint of caesarean and vaginal birth.

DESIGN

Life cycle assessment (LCA).

SETTING

Tertiary maternity units and home births in the UK and the Netherlands.

POPULATION

Birthing women.

METHODS

A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands.

MAIN OUTCOME MEASURES

'Carbon footprint' (in kgCO2 equivalents [kgCO2 e]).

RESULTS

Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO2 e, compared with 12.47 kgCO2 e for vaginal birth in hospital and 7.63 kgCO2 e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO2 e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO2 e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08 kgCO2 e (with opioid analgesia) to 237.33 kgCO2 e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 versus 193.26 kgCO2 e).

CONCLUSION

The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial

Background

Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol.

Methods

Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated.

Results

On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group.

Conclusion

We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions.

Level of Evidence

Level I, randomized controlled trial.

Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study

OBJECTIVE

to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice.

METHOD

an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms.

RESULTS

after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples.

CONCLUSION

the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes. (1) Clinical use and processing exert an impact on the sterile fabric barrier system. (2) There was weight loss, reduction in size and increase in water absorption volume. (3) The longer the use, the more loose fibers. (4) Penetration by microorganisms did not increase over the 15 months of the study. (5) The physical changes of the fabric did not interfere with the fabric barrier efficiency.

An EAACI review: Go green in health care and research. Practical suggestions for sustainability in clinical practice, laboratories, and scientific meetings

Health care professionals (HCPs) and researchers in the health care sector dedicate their professional life to maintaining and optimizing the health of their patients. To achieve this, significant amounts of resources are used and currently it is estimated that the health care sector contributes to more than 4% of net greenhouse gas (GHG) emissions. GHG emissions adversely impact planetary health and consequently human health, as the two are intricately linked. There are many factors of health care that contribute to these emissions. Hospitals and research labs also use high amounts of consumables which require large amounts of raw materials and energy to produce. They are further responsible for polluting the environment via disposal of plastics, drug products, and other chemicals. To maintain and develop state-of-the-art best practices and treatments, medical experts exchange and update their knowledge on methods and technologies in the respective fields at highly specialized scientific meetings. These meetings necessitate thousands of attendants traveling around the globe. Therefore, while the goal of HCPs is to care for the individual, current practices have an enormous (indirect) impact on the health of the patients by their negative environmental impacts. There is an urgent need for HCPs and researchers to mitigate these detrimental effects. The installation of a sustainability-manager at health care facilities and research organizations to implement sustainable practices while still providing quality health care is desirable. Increased use of telemedicine, virtual/hybrid conferences and green chemistry have recently been observed. The benefits of these practices need to be evaluated and implemented as appropriate. With this manuscript, we aim to increase the awareness about the negative impacts of the health care system (including health care research) on planetary and human health. We suggest some easy and highly impactful steps and encourage health care professionals and research scientists of all hierarchical levels to immediately implement them in their professional as well as private life to counteract the health care sector's detrimental effects on the environment.

Rapid In Situ Thermal Decontamination of Wearable Composite Textile Materials

Pandemics stress supply lines and generate shortages of personal protective equipment (PPE), in part because most PPE is single-use and disposable, resulting in a need for constant replenishment to cope with high-volume usage. To better prepare for the next pandemic and to reduce waste associated with disposable PPE, we present a composite textile material capable of thermally decontaminating its surface via Joule heating. This material can achieve high surface temperatures (>100 °C) and inactivate viruses quickly (<5 s of heating), as evidenced experimentally with the surrogate virus HCoV-OC43 and in agreement with analytical modeling for both HCoV-OC43 and SARS-CoV-2. Furthermore, it does not require doffing because it remains relatively cool near the skin (<40 °C). The material can be easily integrated into clothing and provides a rapid, reusable, in situ decontamination method capable of reducing PPE waste and mitigating the risk of supply line disruptions in times of need.

Environmental effects of surgical procedures and strategies for sustainable surgery

There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.

Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable

Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada. This research supports the claim that adopting and supporting reusable PPE systems throughout the health sector can, if used appropriately on an ongoing basis, provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs, domestic jobs, and improved environmental performance such as reduced waste and greenhouse gas emissions.

Electrospinning in personal protective equipment for healthcare work

Protection in many service areas is mandatory for good performance in daily activities of workers, especially health areas. Personal protective equipment (PPE) is used to protect patients and health workers from contamination by harmful pathogens and body fluids during clinical attendance. The pandemic scenario caused by SARS-CoV-2 has shown that the world is not prepared to face global disease outbreaks, especially when it comes to the PPE of healthcare workers. In the last years, the world has faced a deficiency in the development of advanced technologies to produce high-quality PPE to attend to the exponential increasing demand. Electrospinning is a technology that can be used to produce high-quality PPE by improving the protective action of clothing. In the face of this concern, this manuscript presents as focus the potential of electrospinning to be applied in protective clothing. PPE mostly used by healthcare workers are also presented. The physico-chemical characteristics and production processes of medical textiles for PPE are addressed. Furthermore, an overview of the electrospinning technique is shown. It is important to highlight most research about electrospinning applied to PPE for health areas presents gaps and challenges; thus, future projections are also addressed in this manuscript.

[Sustainability in private surgical practice-A narrative review]

Background

Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs.

Method

Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews.

Results

Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5‑R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed.

Conclusion

Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.

Environmental footprints of disposable and reusable personal protective equipment ‒ a product life cycle approach for body coveralls

Body coveralls, often made of single-use plastics, are essential Personal Protective Equipment (PPE) and, along with masks, are widely used in healthcare facilities and public spaces in the wake of the recent COVID-19 pandemic. The widespread use of these body coveralls poses a significant threat to terrestrial and aquatic ecosystems, given their polluting nature and disposal frequency. Therefore, it is necessary to promote the adoption of alternatives that increase the safe reusability of PPE clothing and reduce environmental and health hazards. This study presents a comparative Cradle-to-Grave Life Cycle Assessment (LCA) of disposable and reusable PPE body coveralls from a product life cycle perspective. A comprehensive life cycle inventory and LCA framework specific to Indian conditions have been developed through this study. The LCA is performed as per standard protocols using SimaPro software under recipe 2016 (H) impact assessment method. Six midpoint impact categories viz. Global Warming Potential, Terrestrial Acidification, Freshwater Eutrophication, Terrestrial Ecotoxicity, Human Carcinogenic Toxicity, and Water Consumption are assessed, along with Cumulative Energy Demand. Results suggest that reusable PPE improves environmental and human health performance in all the impact categories except water consumption. Sensitivity analysis reveals that replacing conventional electricity with solar energy for PPE manufacturing and disposal will provide additional environmental benefits. The findings can help the medical textile industries, healthcare workers, and policymakers to make environmentally informed choices.

Approaches to Greening Radiology

The health care sector is a resource-intensive industry, consuming significant amounts of water and energy, and producing a multitude of waste. Health care providers are increasingly implementing strategies to reduce energy use and waste. Little is currently known about existing sustainability strategies and how they may be supported by radiology practices. Here, we review concepts and ideas that minimize energy use and waste, and that can be supported or implemented by radiologists.

The Environmental Impacts of Disposable Nonwoven Fabrics during the COVID-19 Pandemic: Case Study on the Francesc de Borja Hospital

Hospitals generate huge amounts of nonwoven residues daily. This paper focused on studying the evolution of nonwoven waste generated in the Francesc de Borja Hospital, Spain, over the last few years and its relation to the COVID-19 pandemic. The main objective was to identify the most impacting pieces of nonwoven equipment in the hospital and to analyze possible solutions. The carbon footprint of the nonwoven equipment was studied through a life-cycle assessment. The results showed an apparent increase in the carbon footprint in the hospital from 2020. Additionally, due to the higher annual volume, the simple nonwoven gown used primarily for patients had a higher carbon footprint over a year than the more sophisticated surgical gowns. It can be concluded that developing a local circular economy strategy for medical equipment could be the solution to avoid the enormous waste generation and the carbon footprint of nonwoven production.

Extending the Protection Ability and Life Cycle of Medical Masks through the Washing Process

The reuse of decontaminated disposable medical face masks can contribute to reducing the environmental burden of discarded masks. This research is focused on the effect of household and laboratory washing at 50 °C on the quality and functionality of the nonwoven structure of polypropylene medical masks by varying the washing procedure, bath composition, disinfectant agent, and number of washing cycles as a basis for reusability. The barrier properties of the medical mask were analyzed before and after the first and fifth washing cycle indirectly by measuring the contact angle of the liquid droplets with the front and back surface of the mask, further by measuring air permeability and determining antimicrobial resistance. Additional analysis included FTIR, pH of the material surface and aqueous extract, as well as the determination of residual substances-surfactants-in the aqueous extract of washed versus unwashed medical masks, while their aesthetic aspect was examined by measuring their spectral characteristics. The results showed that household washing had a stronger impact on the change of some functional properties, primarily air permeability, than laboratory washing. The addition of the disinfectant agent, didecyldimethylammonium chloride, contributes to the protective ability and supports the idea that washing of medical masks under controlled conditions can preserve barrier properties and enable reusability.

Perspectives of vets on plastics in veterinary medicine

INTRODUCTION

The use of disposable plastics and their subsequent environmental impacts are topics of increasing concern in modern society. Medical, including veterinary, sectors are major contributors to plastic waste production. While there is an existing body of literature on the use and reduction of disposable plastics in the human medical sector, few studies, if any, have specifically investigated the use of plastics within the veterinary field. The overall aim of this pilot study was to investigate Australian veterinarians regarding their attitudes toward the ways in which they use disposable plastic in their work and personal lives.

MATERIALS AND METHODS

Seven veterinarians were interviewed, representing a range of demographics and professional backgrounds from multiple states. Thematic qualitative analysis was employed to organise the data into several major themes encompassing many smaller nodes.

RESULTS

The dataset revealed that most, if not all, veterinarians interviewed agree that disposable plastic is used in excess in veterinary medicine, but that veterinarians will never be able to avoid using plastic entirely. Participants supplied differing opinions with respect to the best strategies for reducing plastic waste production within the veterinary field, including recycling, replacing disposable items or improving education.

DISCUSSION

Despite different participants suggesting conflicting ideas, most, if not all, of the ideas presented have support in the scientific literature. This supports a hybrid approach involving refining recycling systems, reducing plastic consumption and improving education on plastic waste production. A hybrid top-down-bottom-up approach must include encouraging cooperation among stakeholders, both within and outside the veterinary sector, as this will be a major contributor to progress. In a broader context, this hybrid approach to inciting change at all levels of the veterinary sector will require engagement from many interdependent entities; as such, this study should act as a starting point for an ongoing process of cooperative change. Recommendations for future research include life cycle analyses of reusable versus disposable veterinary materials; exploring ways to expand sustainability education within and beyond the veterinary sector, and examining methods of improving technology and infrastructure.

[Sustainability in private surgical practice-A narrative review]

BACKGROUND

Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs.

METHOD

Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews.

RESULTS

Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5‑R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed.

CONCLUSION

Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.

The Environmental Footprint Of Single versus Reusable Cloths For Clinical Surface Decontamination: A Life Cycle Approach

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.

The Surgical Suite-A Field Laboratory for Sustainability

This Viewpoint discusses the opportunities afforded by modern technological advances and infrastructure that enable health care facilities to develop and rethink approaches to recycling, reducing, and reusing personal protective equipment.

A review of HTM 01-05 through an environmentally sustainable lens

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.

The Triple Bottom Line and Stabilization Wedges: A Framework for Perioperative Sustainability

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.

Preliminary Research: Validation of the Method of Evaluating Resistance to Surface Wetting with Liquid of Protective Materials Intended for Polymer Protective Gloves

The article presents validation argumentation of the novel method of evaluating resistance to surface wetting with different liquids of protective materials intended for polymer protective gloves based on the three parameters: water permeability index, non-wettability index and absorption index. Using our own method of evaluating resistance to surface wetting, it was shown that the knurled structure of the palm part of polymer protective gloves may inhibit transport of harmful and hazardous liquids outside the area of the protective glove. Currently, there is lack of objectifying methods for evaluation of surface wettability focused on the mentioned aspects. In view of the above facts, an original method for evaluating the resistance of protective materials to surface wetting with mineral oils and water has been invented and validated. It was assumed that the non-wettability index will be subjected to metrological analysis. Consequently, the validation process refers to this index. A precise assessment of the uncertainty budget of the individual components was obtained. On the basis of the obtained results, the measurement errors that may affect the quality and reliability of the test result performed in the laboratory were identified.