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Gumera A, Mil M, Hains L, Fanshaw SR, Dunne B. Reusable surgical headwear has a reduced carbon footprint and matches disposables regarding surgical site infection: a systematic review and meta-analysis. J Hosp Infect 2024; 152:164-172. [PMID: 39197751 DOI: 10.1016/j.jhin.2024.07.017] [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: 01/19/2024] [Revised: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 09/01/2024]
Abstract
Surgical headwear is designed to maintain sterility and prevent microbial contamination. However, the environmental impact of the healthcare industry carries an obligation to develop sustainable alternatives. We aim to explore the environmental impact and safety of reusable surgical headwear. A systematic review and meta-analysis were performed using MEDLINE, Embase, Scopus, Google Scholar, PubMed, and the Cochrane Library until December 10, 2023. Studies were reviewed for suitability and risk of bias using the ROBINS-I tool, with the results aggregated using Review Manager Version 5.4 for odds ratios (ORs) and 95% confidence intervals (CIs), and the I2 was used to assess heterogeneity. This systematic review included nine studies, and the meta-analysis included six studies involving 45,708 procedural cases. There was no significant difference in surgical site infection (SSI) rates between the reusable and disposable groups (OR: 0.79; 95% CI: 0.59-1.07; P=0.13). Policy implementation did not affect SSI rates (OR: 1.21; 95% CI: 0.85-1.73; P=0.30). Reusable surgical head covers demonstrated a significantly lower carbon footprint (P<0.001), ozone depletion (P<0.005), fossil fuel depletion (P<0.005), terrestrial acidification (P<0.005), and fine particulate matter formation (P<0.005) than disposable alternatives. Reusable surgical headwear matches disposable options for SSI incidence and offers environmental advantages. These findings support a shift towards reusable alternatives in healthcare, aligning patient safety with ecological responsibility. By adopting reusable alternatives, healthcare systems can actively contribute to planetary health, thereby highlighting the significant role of sustainable practices in modern medical settings.
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Affiliation(s)
- A Gumera
- Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - M Mil
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - L Hains
- Department of Surgery, The University of Adelaide, Adelaide, Australia
| | - S-R Fanshaw
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - B Dunne
- Department of Surgery, The University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
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Beesoon S, Sydora BC, Klassen T, Baron T, Robert J, Khadaroo R, White J, Brindle M, Barker L, Spruce L. Does the Type of Surgical Headwear Worn in the OR Matter? A Review of Evidence and Opinions. AORN J 2023; 118:157-168. [PMID: 37624059 DOI: 10.1002/aorn.13983] [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: 08/08/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 08/26/2023]
Abstract
Proper surgical attire is essential in decreasing surgical site infections; however, the effectiveness of the different types of headwear is a controversial topic. We conducted a narrative review based on studies identified through a focused literature search to summarize and critically assess evidence and opinions on the most appropriate type of headwear for OR personnel. We included 48 articles: 17 original research studies and 31 non-peer-reviewed articles of various types. Research published before 2014 mostly supports the complete coverage of all hair, which aligns with the 2015 AORN guidelines. However, more recent literature rebuts these guidelines and emphasizes the importance of clean headwear. Although earlier studies (published before 2017) lacked scientific rigor, later studies (published after 2017) have other various limitations, including missing data on compliance, surgery-related techniques, and surgical attire other than headwear. The findings from this review highlight the importance of solid evidence-based guidelines and expert collaboration.
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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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Peedikayil F, Kottayi S, Ismail S. Attitude and response of indian dentists about corona (Covid-19) infection. DENTISTRY AND MEDICAL RESEARCH 2020. [DOI: 10.4103/dmr.dmr_8_20] [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] Open
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Jones RM, Bleasdale SC, Maita D, Brosseau LM. A systematic risk-based strategy to select personal protective equipment for infectious diseases. Am J Infect Control 2020; 48:46-51. [PMID: 31358421 PMCID: PMC7132808 DOI: 10.1016/j.ajic.2019.06.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 01/20/2023]
Abstract
Selection of personal protective equipment (PPE) can be systematic and risk-based. Potential exposures are compared with sites susceptible to infection. Facilitates transparent decision-making about personal protective equipment. PPE evaluation includes: donning/doffing/changing, usability, and fit for purpose.
Background Personal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases. Methods The approach used in this study included the following 4 steps: (1) job hazard analysis, (2) infectious disease hazard analysis, (3) selection of PPE, and (4) evaluation of selected PPE. Selected PPE should protect HCP from exposure, be usable by HCP, and fit for purpose. Results The approach was demonstrated for the activity of intubation of a patient with methicillin-resistant Staphylococcus aureus or Severe Acute Respiratory Syndrome coronavirus. As expected, the approach led to the selection of different ensembles of PPE for these 2 pathogens. Discussion A systematic risk-based approach to the selection of PPE will help health care facilities and HCP select PPE when transmission-based precautions are not appropriate. Owing to the complexity of PPE ensemble selection and evaluation, a team with expertise in infectious diseases, occupational health, the health care activity, and related disciplines, such as human factors, should be engaged. Conclusions Participation, documentation, and transparency are necessary to ensure the decisions can be communicated, critiqued, and understood by HCP.
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Affiliation(s)
- Rachael M Jones
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, IL; School of Medicine, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT.
| | - Susan C Bleasdale
- College of Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Dayana Maita
- College of Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Lisa M Brosseau
- School of Public Health, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, IL
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Evidence-based Sterility: The Evolving Role of Field Sterility in Skin and Minor Hand Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2481. [PMID: 31942288 PMCID: PMC6908338 DOI: 10.1097/gox.0000000000002481] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 01/20/2023]
Abstract
Field sterility is commonly used for skin and minor hand surgery performed in the ambulatory setting. Surgical site infection (SSI) rates are similar for these same procedures when performed in the main operating room (OR). In this paper, we aim to look at both current evidence and common sense logic supporting the use of some of the techniques and apparel designed to prevent SSI. This is a literature review of the evidence behind the ability of gloves, masks, gowns, drapes, head covers, footwear, and ventilation systems to prevent SSIs. We used MEDLINE, EMBASE, and PubMed and included literature from the inception of each database up to March 2019. We could not find substantial evidence to support the use of main OR sterility practices such as head covers, gowns, full patient draping, laminar airflow, and footwear to reduce SSIs in skin and minor hand surgery. Field sterility in ambulatory minor procedure rooms outside the main OR is appropriate for most skin and minor hand surgery procedures. SSIs in these procedures are easily treatable with minimal patient morbidity and do not justify the cost and waste associated with the use of main OR sterility.
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The Bouffant Hat Debate and the Illusion of Quality Improvement. Ann Surg 2019; 271:635-636. [PMID: 31592893 DOI: 10.1097/sla.0000000000003623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Lisa Spruce
- Association of periOperative Registered Nurses (AORN), Denver, Colorado
| | - Amber Wood
- Association of periOperative Registered Nurses (AORN), Denver, Colorado
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Operating Room Attire Policy and Healthcare Cost: Favoring Evidence over Action for Prevention of Surgical Site Infections. J Am Coll Surg 2019; 228:98-106. [DOI: 10.1016/j.jamcollsurg.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022]
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Smith CR. Appendacide! Alas, poor auricle…. J Thorac Cardiovasc Surg 2018; 157:1000-1003. [PMID: 30391007 DOI: 10.1016/j.jtcvs.2018.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Craig R Smith
- Department of Surgery, Vagelos College of Physicians & Surgeons of Columbia University, Columbia University Irving Medical Center of New York Presbyterian Hospital, New York, NY.
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The art and science of surgery: Do the data support the banning of surgical skull caps? Surgery 2018; 164:921-925. [DOI: 10.1016/j.surg.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022]
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Verdial F, Bartek M, Dellinger EP. Reply to Williams et al. Clin Infect Dis 2018; 67:1471-1472. [PMID: 29846547 DOI: 10.1093/cid/ciy367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francis Verdial
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Matthew Bartek
- Department of Surgery, University of Washington School of Medicine, Seattle
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Farach SM, Kelly KN, Farkas RL, Ruan DT, Matroniano A, Linehan DC, Moalem J. Have Recent Modifications of Operating Room Attire Policies Decreased Surgical Site Infections? An American College of Surgeons NSQIP Review of 6,517 Patients. J Am Coll Surg 2018; 226:804-813. [DOI: 10.1016/j.jamcollsurg.2018.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 01/23/2023]
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Markel TA, Gormley T, Greeley D, Ostojic J, Wagner J. Out of Sight, but Not Out of Mind: Covering Hair in the Operating Room Is Not Effective If the Hat Is Suboptimal: In Reply to Fabre and Colleagues. J Am Coll Surg 2018; 226:329-330. [PMID: 29478467 DOI: 10.1016/j.jamcollsurg.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load. Infect Control Hosp Epidemiol 2018; 39:391-397. [DOI: 10.1017/ice.2017.323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVETo determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR.DESIGNObservation and sampling study.SETTINGAcademic health center, public hospital.METHODSWe first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression.RESULTSThe microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR.CONCLUSIONSMovement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk.Infect Control Hosp Epidemiol 2018;39:391–397
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