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de'Angelis N, Conso C, Bianchi G, Rodríguez AGB, Marchegiani F, Carra MC, Lafont C, Canouï-Poitrine F, Slim K, Pessaux P. Systematic review of carbon footprint of surgical procedures. J Visc Surg 2024; 161:7-14. [PMID: 38087700 DOI: 10.1016/j.jviscsurg.2023.03.002] [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: 05/01/2024]
Abstract
The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4-814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.
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Affiliation(s)
- Nicola de'Angelis
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Christel Conso
- Service de chirurgie orthopedique, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Giorgio Bianchi
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Ana Gabriela Barría Rodríguez
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Francesco Marchegiani
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Maria Clotilde Carra
- Service of odontology, department of periodontology, Rothschild hospital, U.F.R. of odontology-Garancière, université de Paris, AP-HP, 75006 Paris, France
| | - Charlotte Lafont
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Florence Canouï-Poitrine
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Karem Slim
- Department of digestive surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), university hospital, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Patrick Pessaux
- Digestive surgery department, HPB unit, Nouvel Hôpital Civil, university of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [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: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Lam K, Gadi N, Acharya A, Winter Beatty J, Darzi A, Purkayastha S. Interventions for sustainable surgery: a systematic review. Int J Surg 2023; 109:1447-1458. [PMID: 37042311 PMCID: PMC10389594 DOI: 10.1097/js9.0000000000000359] [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: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To systematically evaluate interventions designed to improve the sustainability of surgical practice with respect to their environmental and financial impact. BACKGROUND Surgery contributes significantly to emissions attributed to healthcare due to its high resource and energy use. Several interventions across the operative pathway have, therefore, been trialed to minimize this impact. Few comparisons of the environmental and financial effects of these interventions exist. MATERIALS AND METHODS A search of studies published up to 2nd February 2022 describing interventions to increase surgical sustainability was undertaken. Articles regarding the environmental impact of only anesthetic agents were excluded. Data regarding environmental and financial outcomes were extracted with a quality assessment completed dependent upon the study design. RESULTS In all, 1162 articles were retrieved, of which 21 studies met inclusion criteria. Twenty-five interventions were described, which were categorized into five domains: 'reduce and rationalize', 'reusable equipment and textiles', 'recycling and waste segregation', 'anesthetic alternatives', and 'other'. Eleven of the 21 studies examined reusable devices; those demonstrating a benefit reported 40-66% lower emissions than with single-use alternatives. In studies not showing a lower carbon footprint, the reduction in manufacturing emissions was offset by the high environmental impact of local fossil fuel-based energy required for sterilization. The per use monetary cost of reusable equipment was 47-83% of the single-use equivalent. CONCLUSIONS A narrow repertoire of interventions to improve the environmental sustainability of surgery has been trialed. The majority focuses on reusable equipment. Emissions and cost data are limited, with longitudinal impacts rarely investigated. Real-world appraisals will facilitate implementation, as will an understanding of how sustainability impacts surgical decision-making.
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Affiliation(s)
- Kyle Lam
- Department of Surgery and Cancer, St Mary’s Hospital, London, UK
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Smith L, Ali M, Agrissais M, Mulligan S, Koh L, Martin N. A comparative life cycle assessment of dental restorative materials. Dent Mater 2023; 39:13-24. [PMID: 36428112 DOI: 10.1016/j.dental.2022.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging. METHODS Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials. RESULTS Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging. SIGNIFICANCE Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.
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Affiliation(s)
- Lucy Smith
- Materials Processing Institute, Eston Road, Middlesbrough TS6 6US, United Kingdom; Advanced Resource Efficiency Centre, The University of Sheffield, Sheffield, United Kingdom; The Energy Institute, The University of Sheffield, Sheffield, United Kingdom
| | - Mustafa Ali
- Advanced Resource Efficiency Centre, The University of Sheffield, Sheffield, United Kingdom; The Energy Institute, The University of Sheffield, Sheffield, United Kingdom; School of Management, The University of Sheffield, Sheffield, United Kingdom.
| | | | - Steven Mulligan
- School of Clinical Dentistry, The University of Sheffield, United Kingdom; Grantham Centre for Sustainable Futures, The University of Sheffield, United Kingdom
| | - Lenny Koh
- Advanced Resource Efficiency Centre, The University of Sheffield, Sheffield, United Kingdom; The Energy Institute, The University of Sheffield, Sheffield, United Kingdom; School of Management, The University of Sheffield, Sheffield, United Kingdom; Grantham Centre for Sustainable Futures, The University of Sheffield, United Kingdom
| | - Nicolas Martin
- The Energy Institute, The University of Sheffield, Sheffield, United Kingdom; School of Clinical Dentistry, The University of Sheffield, United Kingdom; Grantham Centre for Sustainable Futures, The University of Sheffield, United Kingdom
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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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Papadopoulou A, Kumar NS, Vanhoestenberghe A, Francis NK. Environmental sustainability in robotic and laparoscopic surgery: systematic review. Br J Surg 2022; 109:921-932. [PMID: 35726503 DOI: 10.1093/bjs/znac191] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Minimally invasive surgical (MIS) techniques are considered the gold standard of surgical interventions, but they have a high environmental cost. With global temperatures rising and unmet surgical needs persisting, this review investigates the carbon and material footprint of MIS and summarizes strategies to make MIS greener. METHODS The MEDLINE, Embase, and Web of Science databases were interrogated between 1974 and July 2021. The search strategy encompassed surgical setting, waste, carbon footprint, environmental sustainability, and MIS. Two investigators independently performed abstract/full-text reviews. An analysis of disability-adjusted life years (DALYs) averted per ton of carbon dioxide equivalents (CO2e) or waste produced was generated. RESULTS From the 2456 abstracts identified, 16 studies were selected reporting on 5203 MIS procedures. Greenhouse gas (GHG) emissions ranged from 6 kg to 814 kg CO2e per case. Carbon footprint hotspots included production of disposables and anaesthetics. The material footprint of MIS ranged from 0.25 kg to 14.3 kg per case. Waste-reduction strategies included repackaging disposables, limiting open and unused instruments, and educational interventions. Robotic procedures result in 43.5 per cent higher GHG emissions, 24 per cent higher waste production, fewer DALYs averted per ton of CO2, and less waste than laparoscopic alternatives. CONCLUSION The increased environmental impact of robotic surgery may not sufficiently offset the clinical benefit. Utilizing alternative surgical approaches, reusable equipment, repackaging, surgeon preference cards, and increasing staff awareness on open and unused equipment and desflurane avoidance can reduce GHG emissions and waste.
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Affiliation(s)
| | - Niraj S Kumar
- University College London Medical School, University College London, London, UK
| | - Anne Vanhoestenberghe
- UCL Institute of Orthopaedics and Musculoskeletal Sciences Royal National Orthopaedic Hospital (RNOH), Brockley Hill, UK
| | - Nader K Francis
- Division of Surgery and Interventional Science, University College London, London, UK.,The Griffin Institute, Northwick Park and St Mark's Hospital, Harrow, UK
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Shoham MA, Baker NM, Peterson ME, Fox P. The environmental impact of surgery: A systematic review. Surgery 2022; 172:897-905. [PMID: 35788282 DOI: 10.1016/j.surg.2022.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Climate change is a significant public health threat. Health care comprises 10% of greenhouse gas emissions in the United States, where surgery is especially resource intensive. We did a systematic review to assess and summarize the published evidence of the environmental impact of surgery. METHODS We searched Medline, Embase, Web of Science, and GreenFILE databases for publications that report any environmental impact measure by all surgical subspecialties, including anesthesia. Inclusion criteria were published in English, original research, and passed peer review. Because data were heterogeneous and the aim was broad, we conducted a qualitative summary of data. Where possible, we compare impact measures. RESULTS In the study, 167 articles were identified by our search strategy and reviewed, of which 55 studies met criteria. Eight were about anesthesia, 27 about operating room waste, and 6 were life cycle assessments. Other topics include carbon footprint and greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the operating room is a significant source of emissions and waste. Using anesthetic gases with low global warming potential reduces operating room emissions without compromising patient safety. Operating room waste is often disposed of improperly, often due to convenience or knowledge gaps. There are environmental benefits to replacing disposable materials with reusable equivalents, and to proper recycling. Surgeons can help implement these changes at their institution. CONCLUSION Although there is a clear need to lower the carbon footprint of surgery, the quality of research with which to inform protocol changes is deficient overall. Our attempt to quantify surgery's carbon footprint yielded heterogeneous data and few standardized, actionable recommendations. However, this data serves as a starting point for important future initiatives to decrease the environmental impact of surgery.
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Affiliation(s)
- Maia A Shoham
- Stanford University School of Medicine, Stanford, CA
| | | | | | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA.
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Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations. SUSTAINABILITY 2022. [DOI: 10.3390/su14095286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mobile health (mHealth) innovations are considered by governments as game changers toward more sustainable health systems. The existing literature focuses on the clinical aspects of mHealth but lacks an integrated framework on its sustainability. The foundational idea for this paper is to include disciplinary complementarities into a multi-dimensional vision to evaluate the non-clinical aspects of mHealth innovations. We performed a targeted literature review to find how the sustainability of mHealth innovations was appraised in each discipline. We found that each discipline considers a different outcome of interest and adopts different time horizons and perspectives for the evaluation. This article reflects on how the sustainability of mHealth innovation can be assessed at both the level of the device itself as well as the level of the health system. We identify some of the challenges ahead of researchers working on mobile health innovations in contributing to shaping a more sustainable health system.
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Ferrero A, Thouvenin R, Hoogewoud F, Marcireau I, Offret O, Louison P, Monnet D, Brézin AP. The carbon footprint of cataract surgery in a French University Hospital. J Fr Ophtalmol 2021; 45:57-64. [PMID: 34823888 DOI: 10.1016/j.jfo.2021.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the carbon footprint of cataract surgery in a French university hospital. SETTING Operating room of Cochin University Hospital, Paris, France. DESIGN Single-center component analysis. METHODS One day of surgery was used as a reference. Greenhouse gases (GHG) related to patient and staff transportation were calculated based on the distance travelled and the means of transportation used. The annual consumption of energy (heating and electricity) of our building was converted in kg equivalent of carbon dioxide (CO2eq), and the principle of proportionality was used to calculate what was used for a single cataract procedure. GHG emissions related to the life cycle assessment (LCA) of the equipment used and the sterilization process were calculated. RESULTS The LCA of disposable items accounted for 59.49kg (73.32%) of CO2eq for each procedure. A single procedure generated 2.83±0.10kg of waste. The average CO2eq produced by the transportation of the patients to and from our center, adjusted for one procedure, was 7.26±6.90kg (8.95%) of CO2eq. The CO2eq produced by the sterilization of the phacoemulsifier handpiece was 2.12kg (2.61%). The energy consumption of the building and staff transportation accounted for the remaining CO2eq emissions, 0.76kg (0.93%) and 0.08kg (0.10%) respectively. Altogether, the carbon footprint of one cataract procedure in our center was 81.13kg CO2eq - the equivalent of an average car driving 800km. CONCLUSION Our data provide a basis to quantify cataract surgery as a source of GHG and suggests that reductions in emissions can be achieved.
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Affiliation(s)
- A Ferrero
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - R Thouvenin
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - F Hoogewoud
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - I Marcireau
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - O Offret
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - P Louison
- Hôpital Cochin, service d'ingénierie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Monnet
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France
| | - A P Brézin
- Université de Paris, Hôpital Cochin, Service d'ophtalmologie, Paris, France.
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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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O'Sullivan KJ, Power V, Linnane B, McGrath D, Fogarty H, Ryan M, White R, Noonan C, Mulloy E, O'Sullivan LW, Dunne CP. An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a sort-term pilot study. BMC Pulm Med 2021; 21:326. [PMID: 34666748 PMCID: PMC8524222 DOI: 10.1186/s12890-021-01689-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device—the ‘UL-OPEP’ (University of Limerick—Oscillating Positive Expiratory Pressure device)—was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. Methods A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. Results 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53–85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. Conclusions The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients’ lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).
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Affiliation(s)
- Kevin J O'Sullivan
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Valerie Power
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Barry Linnane
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Dooradoyle, Limerick, Ireland.,National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Paediatric Cystic Fibrosis Department, University Hospital Limerick (UHL), Limerick, Ireland
| | - Deirdre McGrath
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Hilda Fogarty
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Rebecca White
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | | | | | - Leonard W O'Sullivan
- Rapid Innovation Unit - Confirm Centre for Smart Manufacturing, School of Design and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland.
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Alrashoudi AA, Albalawi HI, Aldoukhi AH, Moretti M, Bilalis P, Abedalthagafi M, Hauser CAE. Fabrication of a Lateral Flow Assay for Rapid In-Field Detection of COVID-19 Antibodies Using Additive Manufacturing Printing Technologies. Int J Bioprint 2021; 7:399. [PMID: 34805593 PMCID: PMC8600310 DOI: 10.18063/ijb.v7i4.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/29/2021] [Indexed: 01/07/2023] Open
Abstract
The development of lateral flow immunoassay (LFIA) using three-dimensional (3D) printing and bioprinting technologies can enhance and accelerate the optimization process of the fabrication. Therefore, the main goal of this study is to investigate methods to speed up the developing process of a LFIA as a tool for community screening. To achieve this goal, an in-house developed robotic arm and microfluidic pumps were used to print the proteins during the development of the test. 3D printing technologies were used to design and print the housing unit for the testing strip. The proposed design was made by taking into consideration the environmental impact of this disposable medical device.
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Affiliation(s)
- Abdulelah A. Alrashoudi
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Hamed I. Albalawi
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Ali H. Aldoukhi
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Manola Moretti
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Panayiotis Bilalis
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Malak Abedalthagafi
- King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
- Department of Genomics Research, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Charlotte A. E. Hauser
- Laboratory for Nanomedicine, Division of Biological and Environmental Science and Engineering, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
- Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
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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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