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Roscioli R, Wyllie T, Neophytou K, Dent L, Lowen D, Tan D, Dunne B, Hodgson R. How we can reduce the environmental impact of our operating theatres: a narrative review. ANZ J Surg 2024; 94:1000-1010. [PMID: 37985608 DOI: 10.1111/ans.18770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re-use and re-processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service.
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Affiliation(s)
- Robert Roscioli
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Tracey Wyllie
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | | | - Lana Dent
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | - Darren Lowen
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - David Tan
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
| | - Ben Dunne
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Peter Macallum Cancer Centre, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Russell Hodgson
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
- Division of Surgery, Northern Health, Epping, Victoria, Australia
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Spinos D, Doshi J, Garas G. Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand? J Laryngol Otol 2024; 138:373-380. [PMID: 37795753 DOI: 10.1017/s0022215123001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. METHOD Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. RESULTS The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. CONCLUSION Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.
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Affiliation(s)
- Dimitrios Spinos
- Department of Otorhinolaryngology - Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Department of Otolaryngology, Gloucester, UK
| | - Jayesh Doshi
- Department of Otorhinolaryngology - Head and Neck Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - George Garas
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Surgical Innovation Centre, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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Aboueid S, Beyene M, Nur T. Barriers and enablers to implementing environmentally sustainable practices in healthcare: A scoping review and proposed roadmap. Healthc Manage Forum 2023; 36:405-413. [PMID: 37357691 PMCID: PMC10604425 DOI: 10.1177/08404704231183601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
This scoping review sought to identify the barriers and enablers to implementing environmentally sustainable practices in healthcare, as well as propose a multi-phased approach to enable such implementation. The three concepts guiding the search were (1) environmental sustainability; (2) healthcare; and (3) barriers or enablers. The PRISMA checklist for scoping reviews was used to guide this search. A total of 16 articles were included and reviewed for data extraction. While most articles focused on healthcare in general, dentistry and surgery were the most recurring clinical areas of focus. Barriers and enablers were related to the individual (e.g. knowledge, skills, and attitude), institutional (e.g. budget, strategy, and readiness), geographical/infrastructural (e.g. infrastructure and public awareness), political (e.g. regulations and incentives), and other (e.g. patient awareness and knowledge). A key enabler identified was having transformational leadership with a clear vision and collaborative approach.
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Affiliation(s)
| | | | - Teeyaa Nur
- University of Waterloo, Waterloo, Ontario, Canada
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Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2022; 20:399-410. [PMID: 36481812 PMCID: PMC9735025 DOI: 10.1038/s41575-022-00716-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Miguel F. Cunha
- grid.7157.40000 0000 9693 350XColorectal Surgery group - General Surgery Department, Algarve University Centre, Portimão, Portugal ,Algarve Biomedical Centre, Portimão, Portugal
| | - Gianluca Pellino
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy ,grid.411083.f0000 0001 0675 8654Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
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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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Novosel S, Prangenberg C, Wirtz DC, Burger C, Welle K, Kabir K. [Climate change: how surgery contributes to global warming]. Chirurg 2022; 93:579-585. [PMID: 35138418 PMCID: PMC9133313 DOI: 10.1007/s00104-021-01551-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgery as an important part of the healthcare sector contributes to environmental pollution and therefore to the climate crisis. The aim of this review is to create an overview of the current data situation and possibilities for improvement. METHODS A literature search was performed in PubMed/MEDLINE using the following five terms: "carbon footprint and surgery", "climate change and surgery", "waste and surgery" and "greening the operating room" focusing on energy, waste, water and anesthesia. RESULTS The greatest part of emissions in surgery is generated by the use of energy. The operating rooms (OR) need 3-6 times more energy than the other hospital rooms. Of the total hospital waste 20-30% is produced during operations, which is particularly due to the increasing use of disposable articles and 50-90% of waste classified as hazardous is incorrectly sorted. The disposal of this waste is not only more environmentally harmful but also much more expensive. The processing of surgical items by autoclaving consumes large amounts of water. Modern sterilization methods, for example using plasma could be future alternatives. Up to 20% of volatile nonmetabolized anesthetic agents are vented into the stratosphere and destroy the ozone layer. Intravenous anesthetic drugs should be used whenever possible instead. The choice of operating method can also contribute to the environmental impact of an operation. CONCLUSION The surgical disciplines are a relevant producer of environmental pollutants. Through diverse interdisciplinary approaches surgery can also contribute to protecting the environment.
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Affiliation(s)
- Suncana Novosel
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Dieter C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirugie, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Teutsch S, McCullough JM, Magnan S. Teutsch et al. Respond. Am J Public Health 2021; 111:e16. [PMID: 33689406 DOI: 10.2105/ajph.2020.306140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Steven Teutsch
- Steven Teutsch is with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. J. Mac McCullough is with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis
| | - J Mac McCullough
- Steven Teutsch is with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. J. Mac McCullough is with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis
| | - Sanne Magnan
- Steven Teutsch is with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. J. Mac McCullough is with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis
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