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Lawaczeck L, Rudolph J, Norz V, Tsaur I, Rausch S. The role of planetary health in urologic oncology. Expert Rev Anticancer Ther 2024; 24:513-523. [PMID: 38709157 DOI: 10.1080/14737140.2024.2350631] [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: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Climate change and global warming are an omnipresent topic in our daily lives. Planetary health and oncology represent two critical domains within the broader spectrum of healthcare, each addressing distinct yet interconnected aspects of human well-being. We are encouraged to do our part in saving our planet. This should include the decisions we make in our professional life, especially in uro-oncology, as the healthcare sector significantly contributes to environmental pollution. AREAS COVERED There are many aspects that can be addressed in the healthcare sector in general, as there are structural problems in terms of energy consumption, water waste, therapeutic techniques, transportation and drug manufacturing, as well as in uro-oncology specific areas. For example, the use of different surgical techniques, forms of anesthesia and the use of disposable or reusable instruments, each has a different impact on our environment. The literature search was carried out using PubMed, a medical database. EXPERT OPINION We are used to making decisions based on the best outcome for patients without considering the impact that each decision can have on the environment. In the present article, we outline options and choices for a more climate-friendly approach in urologic oncology.
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Affiliation(s)
- Laura Lawaczeck
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Julia Rudolph
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Valentina Norz
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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Stockert EW, Carvalho B, Sun EC. A Cost and Waste-Savings Comparison Between Single-Use and Reusable Pulse Oximetry Sensors Across US Operating Rooms. Anesth Analg 2024; 139:220-225. [PMID: 38195082 PMCID: PMC11182726 DOI: 10.1213/ane.0000000000006778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Operating room (OR) expenditures and waste generation are a priority, with several professional societies recommending the use of reprocessed or reusable equipment where feasible. The aim of this analysis was to compare single-use pulse oximetry sensor stickers ("single-use stickers") versus reusable pulse oximetry sensor clips ("reusable clips") in terms of annual cost savings and waste generation across all ORs nationally. METHODS This study did not involve patient data or research on human subjects. As such, it did not meet the requirements for institutional review board approval. An economic model was used to compare the relative costs and waste generation from using single-use stickers versus reusable clips. This model took into account: (1) the relative prices of single-use stickers and reusable clips, (2) the number of surgeries and ORs nationwide, (3) the workload burden of cleaning the reusable clips, and (4) the costs of capital for single-use stickers and reusable clips. In addition, we also estimated differences in waste production based on the raw weight plus unit packaging of single-use stickers and reusable clips that would be disposed of over the course of the year, without any recycling interventions. Estimated savings were rounded to the nearest $0.1 million. RESULTS The national net annual savings of transitioning from single-use stickers to reusable clips in all ORs ranged from $510.5 million (conservative state) to $519.3 million (favorable state). Variability in savings estimates is driven by scenario planning for replacement rate of reusable clips, workload burden of cleaning (ranging from an additional expense of $618k versus a cost savings of $309k), and cost of capital-interest gained on investment of capital that is freed up by the monetary savings of a transition to reusable clips contributes between $541k (low-interest rates of 2.85%) and $1.3 million (high-interest rates of 7.08%). The annual waste that could be diverted from landfill by transitioning to reusable clips was found to be between 587 tons (conservative state) up to 589 tons (favorable state). If institutions need to purchase new vendor monitors or cables to make the transition, that may increase the 1-time capital disbursement. CONCLUSIONS Using reusable clips versus single-use stickers across all ORs nationally would result in appreciable annual cost savings and waste generation reduction impact. As both single-use stickers and reusable clips are equally accurate and reliable, this cost and waste savings could be instituted without a compromise in clinical care.
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Affiliation(s)
| | - Brendan Carvalho
- From the Departments of Anesthesiology, Perioperative and Pain Medicine and
| | - Eric C Sun
- From the Departments of Anesthesiology, Perioperative and Pain Medicine and
- Health Policy, Stanford University School of Medicine, Stanford, California
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Filley GI, Kayastha D, Hayes W, Mehra S, Sherman JD, Eckelman MJ. Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation. Laryngoscope 2024; 134:3206-3214. [PMID: 38379176 DOI: 10.1002/lary.31341] [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: 09/25/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. STUDY DESIGN This is a life cycle assessment (LCA) modeling study. SETTING Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. METHODS We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. RESULTS Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. CONCLUSIONS Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. LEVEL OF EVIDENCE NA Laryngoscope, 134:3206-3214, 2024.
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Affiliation(s)
- Grace I Filley
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
| | - Darpan Kayastha
- Department of Surgery (Division of Otolaryngology), Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Wesley Hayes
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
| | - Saral Mehra
- Department of Surgery (Division of Otolaryngology), Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, U.S.A
| | - Matthew J Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, U.S.A
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Grunert M, Hunt MF, Decker M. The environmental impacts of anesthesia. Curr Opin Urol 2024:00042307-990000000-00168. [PMID: 38898779 DOI: 10.1097/mou.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. RECENT FINDINGS The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. SUMMARY Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.
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Affiliation(s)
- Matthew Grunert
- Department of Anesthesiology, Critical Care, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Soong JL, Ho PL, Neo VSH, Lie SA. Evaluating the carbon footprint of sedation practices in intensive care. Nurs Crit Care 2024. [PMID: 38866584 DOI: 10.1111/nicc.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/24/2023] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs. AIM To evaluate carbon footprint arising from sedation practices in the ICUs. STUDY DESIGN A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24 h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data. RESULTS A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7 weeks in both ICUs were 2.206 kg CO2-e and 0.286 g CO2-e, respectively. In total, this equates to driving 15.8 km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage. CONCLUSION Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital. RELEVANCE TO CLINICAL PRACTICE Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint.
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Affiliation(s)
- Jie Lin Soong
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy and Pharmaceutical Sciences, National University of Singapore, Singapore, Singapore
| | - Pei Lin Ho
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Sui An Lie
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore
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Fuschi A, Pastore AL, Al Salhi Y, Martoccia A, De Nunzio C, Tema G, Rera OA, Carbone F, Asimakopoulos AD, Sequi MB, Valenzi FM, Suraci PP, Scalzo S, Del Giudice F, Nardecchia S, Bozzini G, Corsini A, Sciarra A, Carbone A. The impact of radical prostatectomy on global climate: a prospective multicentre study comparing laparoscopic versus robotic surgery. Prostate Cancer Prostatic Dis 2024; 27:272-278. [PMID: 37085603 DOI: 10.1038/s41391-023-00672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). METHODS In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien-Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO2 produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO2 consumption for disposal and decontamination was also evaluated. RESULTS Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO2. The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO2. The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. CONCLUSIONS RALP generates substantially less CO2 than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy.
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Onofrio Antonio Rera
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Flavia Carbone
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | | | - Manfredi Bruno Sequi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Fabio Maria Valenzi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Silvio Scalzo
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Stefano Nardecchia
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant'Anna Hospital, Como, Italy
| | - Alessandro Corsini
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
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Yang L, Hubert J, Gitundu S, Brovman E, Cobey F. Carbon Footprint of Total Intravenous and Inhalation Anesthesia in the Transcatheter Aortic Valve Replacement Procedure. J Cardiothorac Vasc Anesth 2024; 38:1314-1321. [PMID: 38490897 DOI: 10.1053/j.jvca.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To quantify and compare the emissions for deep sedation with total intravenous anesthesia (TIVA) and general anesthesia with inhaled agents during the transcatheter aortic valve replacement procedure. DESIGN A retrospective study. SETTING A tertiary hospital in Boston, Massachusetts. PARTICIPANTS The anesthesia records of 604 consecutive patients who underwent the transcatheter aortic valve replacement procedure between January 1, 2018, and March 31, 2022, were reviewed and analyzed. INTERVENTIONS Data were examined and compared in the following 2 groups: general anesthesia with inhaled agents and deep sedation with TIVA. MEASUREMENTS AND MAIN RESULTS The gases, drugs, airway management devices, and anesthesia machine electricity were collected and converted into carbon dioxide emissions (CO2e). The carbon emissions of intravenous medications were converted with the CO2e data for anesthetic pharmaceuticals from the Parvatker et al. study. For inhaled agents, inhaled anesthetics and oxygen/air flow rate were collected at 15-minute intervals and calculated using the anesthetic gases calculator provided by the Association of Anesthetists. The airway management devices were converted based on life-cycle assessments. The electricity consumed by the anesthesia machine during general anesthesia was estimated from the manufacturer's data (Dräger, GE) and local Energy Information Administration data. The data were analyzed in the chi-squared test or Wilcoxon rank-sum test. There were no significant differences in the patients' demographic characteristics, such as age, sex, weight, height, and body mass index. The patients who received general anesthesia with inhaled agents had statistically higher total CO2e per case than deep sedation with TIVA (16.188 v 1.518 kg CO2e; p < 0.001), primarily due to the inhaled agents and secondarily to airway management devices. For deep sedation with TIVA, the major contributors were intravenous medications (71.02%) and airway management devices (16.58%). A subgroup study of patients who received sevoflurane only showed the same trend with less variation. CONCLUSIONS The patients who received volatile anesthesia were found to have a higher CO2e per case. This difference remained after a subgroup analysis evaluating those patients only receiving sevoflurane and after accounting for the differences in the duration of anesthesia. Data from this study and others should be collectively considered as the healthcare profession aims to provide the best care possible for their patients while limiting the harm caused to the environment.
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Affiliation(s)
- Lei Yang
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
| | - Joshua Hubert
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Samwel Gitundu
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Ethan Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Frederick Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
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Vanderwee K, Demarré L, Malfait S, Kieckens E, De Waegemaeker P, Duprez V, Fraeyman N. How to choose between single-use and reusable medical materials for sustainable nursing: Methodological lessons learned from a national study. J Adv Nurs 2024. [PMID: 38812214 DOI: 10.1111/jan.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
AIM To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single-use healthcare materials. DESIGN A cross-sectional multi-centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials. METHODS A hospital survey was conducted to collect the procurement data for single-use medical materials. Based on consumption and cost, five single-use medical materials with sustainable alternatives were selected using different reuse strategies. Single-use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency. RESULTS A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single-use options. First, an inventory of single-use medical materials consumed was collected. Next, single-use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single-use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material. CONCLUSION This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide. IMPACT Patient care involves a large consumption of single-use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single-use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single-use medical materials, thereby yielding positive outcomes for the entire population. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Liesbet Demarré
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Simon Malfait
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Evelien Kieckens
- Environmental Department, Ghent University Hospital, Ghent, Belgium
| | | | - Veerle Duprez
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Norbert Fraeyman
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Gonzalez-Pizarro P, Brazzi L, Koch S, Trinks A, Muret J, Sperna Weiland N, Jovanovic G, Cortegiani A, Fernandes TD, Kranke P, Malisiova A, McConnell P, Misquita L, Romero CS, Bilotta F, De Robertis E, Buhre W. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol 2024; 41:260-277. [PMID: 38235604 DOI: 10.1097/eja.0000000000001942] [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: 01/19/2024]
Abstract
Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.
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Affiliation(s)
- Patricio Gonzalez-Pizarro
- From the Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), the Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital, Department of Surgical Science, University of Turin, Turin, Italy (LB), the University of Southern Denmark (SDU) Odense, Department of Anesthesia, Hospital of Nykobing Falster, Denmark (SK), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (SK), the Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT), the Department of Anaesthesia and Intensive Care. Institute Curie & PSL Research University, Paris, France (JM), the Department of Anaesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands (NSW), the Department of Anaesthesia and Perioperatve Medicine. Medical Faculty, University of Novi Sad, Novi Sad, Serbia (GJ), the Department of Surgical, Oncological and Oral Science, University of Palermo, Italy. Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy (AC), the Department of Anaesthesiology, Hospital Pedro Hispano, Matosinhos, Portugal (TDF), the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Germany (PK), the Department of Anaesthesiology and Pain. P&A Kyriakou Children's Hospital Athens Greece (AM), Royal Alexandra Hospital. Paisley, Scotland, United Kingdom (PM), Department of Neuro-anaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, England, United Kingdom (LM), the Department of Anesthesia, Critical care and Pain Unit, Hospital General Universitario de Valencia. Research Methods Department, European University of Valencia, Spain (CR), the "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy (FB), the Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery - University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB)
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Rouvière N, Pitard M, Boutry E, Prudhomme M, Bertrand M, Leguelinel-Blache G, Chasseigne V. How a hospital pharmacist can contribute to a more sustainable operating theater. J Visc Surg 2024; 161:37-45. [PMID: 38092591 DOI: 10.1016/j.jviscsurg.2023.11.004] [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
Healthcare sectors, particularly operating theaters, are major consumers of resources. Given today's climate-related issues, its seems vital that the different healthcare professionals in operating areas become aware of their roles. This is pronouncedly the case for hospital pharmacists, who fulfill cross-sectional functions in the proper use and management of healthcare products and sterile medical devices. The objective of this review of the literature is to identify the actions a hospital pharmacist can take to impel evolution toward ecologically responsible care in the operating theater. Seven areas in which a pharmacist can assume a leading, supporting or composite role in rendering an operating theater ecologically responsible have been highlighted: purchasing, procurement and storage, harmonization of practices, modification of practices, professional attire, waste elimination and research/teaching. The active participation of all healthcare professionals, including the hospital pharmacist, is essential to the development of a sustainable approach to healthcare.
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Affiliation(s)
- Ninon Rouvière
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Maria Pitard
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Etienne Boutry
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Michel Prudhomme
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Martin Bertrand
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Géraldine Leguelinel-Blache
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France
| | - Virginie Chasseigne
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France.
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11
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Shelton C, Lentzos S. Sustainability is a core outcome: filling research gaps in sustainable peri-operative care. Anaesthesia 2024; 79:226-231. [PMID: 38205566 DOI: 10.1111/anae.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Affiliation(s)
- C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S Lentzos
- National Institute for Health and Care Research Co-ordinating Centre, Southampton, UK
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12
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Tsay EL, Sabharwal S. Reuse of Orthopaedic Equipment: Barriers and Opportunities. JBJS Rev 2024; 12:01874474-202403000-00005. [PMID: 38466800 DOI: 10.2106/jbjs.rvw.23.00117] [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: 03/13/2024]
Abstract
» Reuse of orthopaedic equipment is one of many potential ways to minimize the negative impact of used equipment on the environment, rising healthcare costs and disparities in access to surgical care.» Barriers to widespread adoption of reuse include concerns for patient safety, exposure to unknown liability risks, negative public perceptions, and logistical barriers such as limited availability of infrastructure and quality control metrics.» Some low- and middle-income countries have existing models of equipment reuse that can be adapted through reverse innovation to high-income countries such as the United States.» Further research should be conducted to examine the safety and efficacy of reusing various orthopaedic equipment, so that standardized guidelines for reuse can be established.
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Affiliation(s)
- Ellen L Tsay
- University of California, San Francisco, San Francisco, California
| | - Sanjeev Sabharwal
- University of California, San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital Oakland, Oakland, California
- Institute of Global Orthopaedics and Traumatology, San Francisco, California
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13
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Thakrar J, Patel A, Joseph J. UK national survey on surgical gowning for tonsillectomy. J Laryngol Otol 2024:1-4. [PMID: 38563203 DOI: 10.1017/s0022215124000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
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.
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Affiliation(s)
- Jai Thakrar
- School of Medicine, University College London, London, UK
| | - Ankit Patel
- ENT Department, University College London Hospital, London, UK
| | - Jonathan Joseph
- ENT Department, University College London Hospital, London, UK
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14
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Davies JF, McAlister S, Eckelman MJ, McGain F, Seglenieks R, Gutman EN, Groome J, Palipane N, Latoff K, Nielsen D, Sherman JD. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis. Br J Anaesth 2024:S0007-0912(23)00725-0. [PMID: 38296752 DOI: 10.1016/j.bja.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. METHODS Life-cycle assessment of GHG emissions (expressed as carbon dioxide equivalents CO2e) of i.v. and oral paracetamol preparations was performed. Perioperative paracetamol prescribing practices and costs for 26 hospitals in USA, UK, and Australia were retrospectively audited. For those surgical patients for whom oral formulations were indicated, CO2e and costs of actual prescribing practices for i.v. or oral doses were compared with optimal oral prescribing. RESULTS The carbon footprint for a 1 g dose was 38 g CO2e (oral tablet), 151 g CO2e (oral liquid), and 310-628 g CO2e (i.v. dependent on type of packaging and administration supplies). Of the eligible USA patients, 37% received paracetamol (67% was i.v.). Of the eligible UK patients, 85% received paracetamol (80% was i.v.). Of the eligible Australian patients, 66% received paracetamol (70% was i.v.). If the emissions mitigation opportunity from substituting oral tablets for i.v. paracetamol is extrapolated to USA, UK, and Australia elective surgical encounters in 2019, ∼5.7 kt CO2e could have been avoided and would save 98.3% of financial costs. CONCLUSIONS Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Scott McAlister
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sydney School of Public Health, University of Sydney, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia
| | - Richard Seglenieks
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia; Department of Anaesthesia, Grampians Health, Ballarat, VIC, Australia
| | - Elena N Gutman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Groome
- Barts Health NHS Trust, London, UK; Nuffield Health, London, UK
| | - Natasha Palipane
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Katherine Latoff
- Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Dominic Nielsen
- Greener Anaesthesia & Sustainability Project (GASP), London, UK
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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15
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Parker EB, Bluman EM, Chiodo CP, Martin EA, Smith JT. Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241238231. [PMID: 38510517 PMCID: PMC10952996 DOI: 10.1177/24730114241238231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
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.
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Affiliation(s)
- Emily B. Parker
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Eric M. Bluman
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher P. Chiodo
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Martin
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeremy T. Smith
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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16
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Lam L, Bradbrook D, Gale J. Tracing the barriers to decarbonising ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:78-90. [PMID: 38213078 DOI: 10.1111/ceo.14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.
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Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Darren Bradbrook
- Surgery and Perioperative Medicine Division, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Southern Adelaide Local Health Network (SALHN), Bedford Park, South Australia, Australia
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
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17
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Cachefo-Pereira A, Souza Neto EPD. Greening the operating room. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744464. [PMID: 37717924 PMCID: PMC10877345 DOI: 10.1016/j.bjane.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Affiliation(s)
| | - Edmundo Pereira de Souza Neto
- Intensive care anesthetist at Montauban Hospital, Montauban, France; Intensive care anesthetist at Army Hospital Robert Picqué, Bordeaux, France; Intensive care anesthetist at fire and rescue service, Montauban, France; Committee of Protection of Persons Sud-Ouest et Outre-Mer II, Toulouse, France; Tarn-et-Garonne Medical Council, Montauban, France.
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18
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Lichtnegger S, Meissner M, Paolini F, Veloz A, Saunders R. Comparative Life Cycle Assessment Between Single-Use and Reprocessed IPC Sleeves. Risk Manag Healthc Policy 2023; 16:2715-2726. [PMID: 38107437 PMCID: PMC10725682 DOI: 10.2147/rmhp.s439982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Healthcare has a large environmental footprint, not least due to the wide use of single-use supplies. Reprocessing of medical devices is a well-established, regulated process, and can reduce its environmental impact. This life cycle assessment (LCA) compares the environmental footprint of a single-use and a reprocessed version of otherwise identical intermittent pneumatic compression (IPC) sleeves. Materials and Methods The LCA was performed in accordance with the international standard ISO 14044 using the Environmental Footprint 3.0 (EF) method for the assessment. Data were obtained in cooperation with IPC sleeve manufacturers. Where no primary data were available, ecoinvent database records were used. The functional unit is five hospital treatments applying IPC. The robustness of the results was interrogated in sensitivity analyses of the energy mix, the ethylene oxide emissions during reprocessing, and the transport distances. The impact of waste reduction on hospital disposal costs was calculated. Results The environmental footprint of reprocessed IPC sleeves was found to be reduced in all categories compared to single-use devices, leading to a weighted normalized reduction of 43% across all categories. In a breakdown of the LCA results, reprocessed IPC sleeves were found to reduce the carbon footprint by 40%, with the treatment of five patients with single-use IPC sleeves creating 7 kg CO2eq, compared to 4.2 kg CO2eq from reprocessed sleeves. Waste disposal costs were also reduced by 90%. Conclusion Reprocessing of IPC sleeves provides an environmental and economic benefit in comparison to single-use devices.
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Affiliation(s)
| | - Markus Meissner
- Austrian Institute of Ecology and Pulswerk GmbH, Vienna, VIE, Austria
| | | | | | - Rhodri Saunders
- Coreva Scientific GmbH & Co. KG, Koenigswinter, NRW, Germany
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19
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Andrieu B, Roche M, Simeone P, Leone M, De Sainte Marie B, Andre B, Boyer L, Zieleskiewicz L, Fond G. Navigating Healthcare's Dual Fronts — Balancing Quality and the Environment. Rev Epidemiol Sante Publique 2023; 71:102182. [PMID: 37918045 DOI: 10.1016/j.respe.2023.102182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Affiliation(s)
- Baptiste Andrieu
- Institut de Sciences de la Terre (ISTerre), CNRS-Université de Grenoble, France
| | - Manon Roche
- Service Central des Opérations Pharmaceutiques, AP-HM, Marseille, France; UMR CNRS 7273, Aix Marseille Univ, Marseille, France
| | - Pierre Simeone
- Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, Marseille, France; Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289 Marseille, France
| | - Marc Leone
- Hôpitaux Universitaires de Marseille, Département d'anesthésie réanimation hôpital nord 13015 Marseille APHM, C2VN, Aix-Marseille University, France
| | | | - Baptiste Andre
- Hôpitaux Universitaires de Marseille, Département de médecine interne, CHU Timone, France
| | - Laurent Boyer
- Hôpitaux Universitaires de Marseille, Département d'information médicale, CEReSS, Aix-Marseille university, France; Fondation FondaMental, France
| | - Laurent Zieleskiewicz
- Hôpitaux Universitaires de Marseille, Département d'anesthésie réanimation hôpital nord 13015 Marseille APHM, C2VN, Aix-Marseille University, France
| | - Guillaume Fond
- Hôpitaux Universitaires de Marseille, Centre expert dépression, service universitaire de psychiatrie et d'addictologie, CEReSS, Aix-Marseille university, France; Hôpitaux Universitaires de Marseille, Département d'information médicale, CEReSS, Aix-Marseille university, France; Fondation FondaMental, France.
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20
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Mehtsun WT, Hyland CJ, Offodile AC. Adopting a Circular Economy for Surgical Care to Address Supply Chain Shocks and Climate Change. JAMA HEALTH FORUM 2023; 4:e233497. [PMID: 37921743 DOI: 10.1001/jamahealthforum.2023.3497] [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: 11/04/2023] Open
Abstract
This Viewpoint describes a circular economy for operating room supply chain networks as a climate-oriented approach that maintains organizational viability and patient health and welfare.
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Affiliation(s)
| | | | - Anaeze C Offodile
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
- Baker Institute for Public Policy, Rice University, Houston, Texas
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21
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Rouvière N, Chkair S, Auger F, Cuvillon P, Leguelinel-Blache G, Chasseigne V. Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative. Anaesth Crit Care Pain Med 2023; 42:101276. [PMID: 37437711 DOI: 10.1016/j.accpm.2023.101276] [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: 02/02/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch. METHODS The ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management. RESULTS In 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of CO2eq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m2 per year and water savings of 221.6 m3 per year. The average cost per intubation varies from 3.16 [3.15-3.16] for SUB to 2.81 [2.77-2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00-6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively. CONCLUSION In a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of CO2eq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.
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Affiliation(s)
- N Rouvière
- Department of Pharmacy, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - S Chkair
- Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - F Auger
- Primum non nocere agency, Beziers, France
| | - P Cuvillon
- UR-UM103 IMAGINE, University Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Montpellier, France
| | - G Leguelinel-Blache
- Department of Pharmacy, Nîmes University Hospital, University of Montpellier, Nîmes, France; Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - V Chasseigne
- Department of Pharmacy, Nîmes University Hospital, University of Montpellier, Nîmes, France; Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France.
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22
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McGain F, Shelton C, McAlister S. French professional society guidelines on improving patient and planetary health: Liberté, égalité, fraternité… et durabilité! Anaesth Crit Care Pain Med 2023; 42:101292. [PMID: 37562691 DOI: 10.1016/j.accpm.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Forbes McGain
- University of Melbourne, Melbourne, Australia; Departments of Anaesthesia and Intensive Care Medicine, Western Health, Melbourne, Australia; University of Sydney, Sydney, Australia.
| | - Clifford Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Scott McAlister
- University of Melbourne, Melbourne, Australia; University of Sydney, Sydney, Australia.
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23
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Richter H, Schulz-Stübner S, Pecher S. [What is new… in single-use or reusable laryngoscope blades : Sustainability in anesthesiology]. DIE ANAESTHESIOLOGIE 2023; 72:746-747. [PMID: 37679504 DOI: 10.1007/s00101-023-01335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Hannah Richter
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Akademisches Lehrkrankenhaus der Universität Heidelberg, Gutleutstr. 1-14, 76646, Bruchsal, Deutschland.
- Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland.
| | | | - Sabine Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum, Stuttgart, Deutschland
- Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland
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24
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Sowa PM, Fooken J, McGowan K, Birch S. Disposable and reusable instruments in dental health practice: A comparison of cost factors in a public provider organization in Queensland, Australia. Community Dent Oral Epidemiol 2023; 51:794-803. [PMID: 35661220 DOI: 10.1111/cdoe.12764] [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: 11/25/2021] [Revised: 03/12/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations. METHODS A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI-only and DI-only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering. RESULTS At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI-only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI-only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI-only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI-only alternative and generated 36% waste of the DI-only alternative. CONCLUSIONS Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors.
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Affiliation(s)
- P Marcin Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Kelly McGowan
- Oral Health Service, West Moreton Health, Ipswich, Queensland, Australia
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Health Economics, The University of Manchester, Manchester, UK
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Chang DR, Burnett GW, Chiu S, Ouyang Y, Lin HM, Hyman JB. Single-use versus reusable metallic laryngoscopes for non-emergent intubation: A retrospective review of 72,672 intubations. J Clin Anesth 2023; 89:111187. [PMID: 37339555 DOI: 10.1016/j.jclinane.2023.111187] [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: 04/08/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
STUDY OBJECTIVE Increased regulatory requirements for sterilization in recent years have prompted a widespread transition from reusable to single-use laryngoscopes. The purpose of this study was to determine if the transition from metallic reusable to metallic single-use laryngoscopes impacted the performance of direct laryngoscopy at an academic medical center. DESIGN Single-site retrospective cohort study. SETTING General anesthetic cases requiring tracheal intubation. PATIENTS Adult patients undergoing non-emergent procedures. INTERVENTIONS Data were collected two years before and two years after a transition from metallic reusable to metallic single-use laryngoscopes. MEASUREMENTS The primary outcome was need for intubation rescue with an alternate device. Secondary outcomes were difficult laryngeal view (modified Cormack-Lehane grade ≥ 2b) and hypoxemia (SpO2 < 90% for >30 s) during direct laryngoscopy intubations. Subgroup analyses for rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors (Obstructive Sleep Apnea, Mallampati ≥3, Body Mass Index >30 kg/m2) were performed. MAIN RESULTS In total, 72,672 patients were included: 35,549 (48.9%) in the reusable laryngoscope cohort and 37,123 (51.1%) in the single-use laryngoscope cohort. Compared with reusable laryngoscopes, single-use laryngoscopes were associated with fewer rescue intubations with an alternate device (covariates-adjusted odds ratio [OR] 0.81 95% CI 0.66-0.99). Single-use laryngoscopes were also associated with lower odds of difficult laryngeal view (OR 0.86; 95% CI 0.80-0.93). Single use laryngoscopes were not associated with hypoxemia during the intubation attempt (OR 1.03; 95% CI 0.88-1.20). Similar results were observed for subgroup analyses including rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors. CONCLUSIONS Metallic single-use laryngoscopes were associated with less need for rescue intubation with alternate devices and lower incidence of poor laryngeal view compared to reusable metallic laryngoscopes.
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Affiliation(s)
- Daniel R Chang
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Sophia Chiu
- Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, Suite 680 Dulles, Philadelphia, PA 19104, United States.
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States.
| | - Hung-Mo Lin
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, United States.
| | - Jaime B Hyman
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06510, United States.
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Delaie C, Cerlier A, Argenson JN, Escudier JC, Khakha R, Flecher X, Jacquet C, Ollivier M. Ecological Burden of Modern Surgery: An Analysis of Total Knee Replacement's Life Cycle. Arthroplast Today 2023; 23:101187. [PMID: 37745969 PMCID: PMC10514426 DOI: 10.1016/j.artd.2023.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background It is estimated that surgical procedures account for 20%-30% of the greenhouse gases emissions from health-care systems. Total knee replacements (TKR) are one of the most frequently performed procedures in orthopaedics. The aim of this study was to identify and quantify the environmental impacts generated by TKRs, the factors that generate the most emissions, and those that can be easily modified. Methods To calculate the life cycle carbon footprint of a posterior stabilized cemented TKR performed in a single orthopaedic surgery department, 17 TKRs performed between October 12 and 20, 2020 by 4 senior surgeons were analysed. The analysis of the life cycle included the manufacture of the implant, from raw materials to distribution; the journey made by patients and staff; and the surgery including all consumables required to facilitate the procedure. Results The overall life cycle carbon footprint of a single TKR was 190.5 kg of CO2. This consisted of 53.7 kg CO2 (28%) for the manufacture of the prosthesis, 50.9 kg CO2 (27%) for travel, 57.1 kg CO2 (30%) for surgery, and 28.8 kg CO2 (15%) for waste management. This is comparable to a New York-Detroit direct flight. Conclusions The production of a total knee prosthesis, throughout its life cycle, generates emissions with important consequences on the environment and therefore on our health. Although much data are currently missing to make precise estimates, and especially regarding benefits in terms of patient function and its impact on carbon emissions, these data serve as a starting point for other more detailed or comparative studies.
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Affiliation(s)
- Camille Delaie
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Alexandre Cerlier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Noel Argenson
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Charles Escudier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Raghbir Khakha
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Xavier Flecher
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
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Pauchard JC, Hafiani EM, Bonnet L, Cabelguenne D, Carenco P, Cassier P, Garnier J, Lallemant F, Pons S, Sautou V, De Jong A, Caillard A. Guidelines for reducing the environmental impact of general anaesthesia. Anaesth Crit Care Pain Med 2023; 42:101291. [PMID: 37562688 DOI: 10.1016/j.accpm.2023.101291] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To provide guidelines for reducing the environmental impact of general anaesthesia. DESIGN A committee of ten experts from SFAR and SF2H and SFPC learned societies was set up. A policy of declaration of competing interests was applied and observed throughout the guideline-writing process. Likewise, it did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for three different fields: anaesthesia vapours and gases; intravenous drugs; medical devices and the working environment. Each question was formulated according to the PICO format (Population, Intervention, Comparator, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' work on the synthesis and application of the GRADE® method led to the formulation of 17 recommendations. Since the GRADE® method could not be entirely applied to all of the questions, some of the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we produced 17 recommendations designed to guide reducing the environmental impact of general anaesthesia.
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Affiliation(s)
- Jean-Claude Pauchard
- Ramsay Santé, Member of Société Française d'Anesthésie Réanimation (SFAR) Substainable Development Committee, Clinique Aguiléra, Biarritz, France.
| | - El-Madhi Hafiani
- Department of Anaesthesia, Resuscitation and Perioperative Medicine, DMU DREAM - Tenon Hospital, AP-HP Sorbonne University, Paris, France.
| | - Laure Bonnet
- Department of Anesthesia and Intensive Care, Centre Hospitalier Princess Grace, Monaco
| | | | - Philipe Carenco
- Hygiene Department CHU de Nice, Nice, France; CPias PACA, Marseille, France; AFNOR, La Plaine Saint-Denis, France; Comité Européen de Normalisation, Brussels, Belgium; Bureau de Normalisation de l'Industrie Textile et de l'Habillement (BNITH), domaine des textiles en santé, Paris, France
| | - Pierre Cassier
- Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Jérémie Garnier
- Department of Anesthesia and Intensive Care Unit, CHU Amiens-Picardie, 1 Rond-Point du Pr Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Florence Lallemant
- Department of Anesthesia and Intensive Care Unit, CHU Lille, F-59000 Lille, France; CHU Lille, Pôle des Urgences, F-59000 Lille, France
| | - Stéphanie Pons
- DMU DREAM, Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière, Paris, France
| | - Valérie Sautou
- Clermont Auvergne University, Clermont Auvergne INP, CNRS, CHU Clermont Ferrand, ICCF, F-63000 Clermont-Ferrand, France
| | - Audrey De Jong
- PhyMedExp, Montpellier University, INSERM, CNRS, CHU Montpellier, France; Department of Anesthesia and Intensive Care Unit, St-Eloi Hospital, France
| | - Anaïs Caillard
- Department of Anesthesia and Intensive Care Unit, CHU Brest, Cavale Blanche Hospital, France; ORPHY, EA 4324, France
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Meissner M, Hafermann J, Silas U, Saunders R. Evaluating the Environmental Impact of Single-Use and Multi-Use Surgical Staplers with Staple Line Buttressing in Laparoscopic Bariatric Surgery. Risk Manag Healthc Policy 2023; 16:1423-1433. [PMID: 37560134 PMCID: PMC10408667 DOI: 10.2147/rmhp.s415989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Operation rooms have a large environmental impact. Single-use staplers (SUS) are widely used surgical instruments that contribute to resource consumption and waste generation, whereas multi-use staplers (MUS) can greatly reduce the environmental impact of surgery. The staple lines are often reinforced with buttressing material to prevent leaks and bleeding. We explore current clinical practice and environmental concerns regarding stapling and buttressing, as well as the environmental impact of staple line buttressing in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, we extend this analysis by taking packaging material and the lithium in power supplies into consideration. MATERIALS AND METHODS A survey of bariatric surgeons was conducted to assess stapler and buttressing use in clinical practice. We deconstructed and analyzed the product and packaging composition of a commonly used SUS with separate staple line reinforcement (Echelon Flex™ with Echelon Endopath™, Ethicon) and MUS (Signia™ with Tri-Staple™ reinforced reloads, Medtronic), where the buttressing material was delivered separately or already incorporated in the reload cartridge, respectively. Both systems were compared regarding total waste generation, resource use (determined as total material requirement), and greenhouse gas emission caused by their lithium content. RESULTS 60 mm cartridges were most frequently used in bariatric surgery, and 67% of surveyed surgeons applied staple line reinforcement. MUS with pre-attached buttressing resulted in a reduction of waste, material consumption, and greenhouse gas emissions compared to SUS with separate buttressing: they reduced product waste by 40% (SG and RYBG), packaging waste by 60% (SG) and 57% (RYGB), resource consumption by more than 90%, and greenhouse gas emissions related to the lithium in the batteries by 99.7%. Preloaded buttressing produced less waste than separate buttressing per stapler firing. CONCLUSION The environmental impact of surgery can be greatly reduced by using MUS with pre-attached buttressing rather than SUS with separate buttressing.
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Affiliation(s)
| | | | - Ubong Silas
- Coreva Scientific GmbH & Co. KG, Koenigswinter, Germany
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Byrne C, Pley C, Schorscher P, Brandon Z, Gatumbu P, Mallinson C, Vaghela M. A mixed-methods analysis of the climate impact, acceptability, feasibility and cost of switching from single-use pulp to reusable plastic trays in a large NHS trust. Future Healthc J 2023; 10:157-160. [PMID: 37786636 PMCID: PMC10540794 DOI: 10.7861/fhj.2022-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
A large, multi-site NHS trust piloted switching from single-use pulp to reusable plastic trays for use in clinical care. This mixed-methods analysis combines quantitative cost-effectiveness and greenhouse gas (GHG) emissions calculations with a stakeholder analysis and user survey to not only ascertain the cost and climate implications of this intervention, but to also better understand the use of trays across the trust to improve staff buy-in and, ultimately, the feasibility and success of the policy. We show that the plastic trays are both more cost-effective and climate friendly compared with the pulp trays, even using an annual replacement rate of 50% (higher than our anticipated rate of 5%), and that staff and key stakeholders would support the policy. Our analysis is one example of a larger trend in the return to reusable items, as awareness grows of the significant GHG emissions and waste produced from disposable, single-use items in healthcare.
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Affiliation(s)
- Calum Byrne
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- *Joint first authors
| | - Caitlin Pley
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- *Joint first authors
| | - Philipp Schorscher
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Zoe Brandon
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Gatumbu
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Mallinson
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Madhvi Vaghela
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lakatos K, Teherani A, Thottathil SE, Gandhi S, Weiser SD, Brindis CD. A race to net zero-early lessons from healthcare's decarbonization marathon. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad006. [PMID: 38770407 PMCID: PMC11103727 DOI: 10.1093/haschl/qxad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/22/2024]
Abstract
Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission-reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.
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Affiliation(s)
- Kyle Lakatos
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- Harvard Kennedy School of Government, Cambridge, MA 02138, United States
| | - Arianne Teherani
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Sapna E Thottathil
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Seema Gandhi
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
| | - Sheri D Weiser
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Claire D Brindis
- UC Center for Climate, Health, and Equity, University of California, CA, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94158, United States
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Galvão DM, Cezar-Vaz MR, Xavier DM, Penha JGM, Lourenção LG. Hospital sustainability indicators and reduction of socio-environmental impacts: a scoping review. Rev Esc Enferm USP 2023; 57:e20220364. [PMID: 37366602 DOI: 10.1590/1980-220x-reeusp-2022-0364en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact. METHOD Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included. RESULTS A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability. CONCLUSION The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved.
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Rowan NJ, Kremer T, McDonnell G. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 878:162976. [PMID: 36963674 DOI: 10.1016/j.scitotenv.2023.162976] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
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Affiliation(s)
- N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon Midwest Mideast, Athlone Campus, Ireland; SFI-funded CURAM Centre for Medical Device Research, University of Galway, Ireland.
| | - T Kremer
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
| | - G McDonnell
- Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
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Davies JF, Ikin B, Francis JJ, McGain F. Implementation approaches to improve environmental sustainability in operating theatres: a systematic review. Br J Anaesth 2023:S0007-0912(23)00253-2. [PMID: 37344341 DOI: 10.1016/j.bja.2023.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Operating theatres consume large amounts of energy and consumables and produce large amounts of waste. There is an increasing evidence base for reducing the climate impacts of healthcare that could be enacted into routine practice; yet, healthcare-associated emissions increase annually. Implementation science aims to improve the systematic uptake of evidence-based care into practice and could, therefore, assist in addressing the environmental impacts of healthcare. The aim of this systematic search with narrative synthesis was to explore what implementation approaches have been applied to reduce the environmental impact of operating theatre activities, described by implementation phases and methodologies. A search was conducted in EMBASE, PubMed, and CINAHL, limited to English and publication since 2010. In total, 3886 articles were retrieved and 11 were included. All were in the exploratory phase (seven of 11) or initial implementation phase (four of 11), but none were in the installation or full implementation phase. Three studies utilised a recognised implementation theory, model, or framework in the design. Four studies used interprofessional education to influence individuals' behaviour to reduce waste, improve waste segregation, or reduce anaesthetic gases. Of those that utilised behaviour change interventions, all were qualitatively successful in achieving environmental improvement. There was an absence of evidence for sustained effects in the intervention studies and little follow-up from studies that explored barriers to innovation. This review demonstrates a gap between evidence for reducing environmental impacts and uptake of proposed practice changes to deliver low-carbon healthcare. Future research into 'greening' healthcare should use implementation research methods to establish a solid implementation evidence base. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42022342786.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Brigit Ikin
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Jillian J Francis
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Centre for Implementation Research, Ottawa Hospital Research Institute-General Campus, Ottawa, ON, Canada
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Western Health, Footscray, Victoria, Australia; Department of Intensive Care, Western Health, Footscray, Victoria, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
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Rizan C, Lillywhite R, Reed M, Bhutta MF. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. J R Soc Med 2023; 116:199-213. [PMID: 37054734 PMCID: PMC10331364 DOI: 10.1177/01410768231166135] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/12/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots). DESIGN A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England. SETTING The carbon footprint inventory was based on direct observation of 6-10 operations/type, conducted across three sites within one NHS Foundation Trust in England. PARTICIPANTS Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 - January 2020). MAIN OUTCOME MEASURES We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes. RESULTS The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%. CONCLUSIONS Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%-42%.
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Affiliation(s)
- Chantelle Rizan
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
| | - Robert Lillywhite
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Malcom Reed
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
| | - Mahmood F Bhutta
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, BN2 5BE, UK
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Perry H, Reeves N, Ansell J, Cornish J, Torkington J, Morris DS, Brennan F, Horwood J. Innovations towards achieving environmentally sustainable operating theatres: A systematic review. Surgeon 2023; 21:141-151. [PMID: 35715311 DOI: 10.1016/j.surge.2022.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The NHS accounts for 5.4% of the UK's total carbon footprint, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focussing on the impact of implemented interventions. METHODS A systematic review was performed using Pubmed, OVID, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included. RESULTS 675 abstracts were screened with 34 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability. DISCUSSION This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery.
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Affiliation(s)
- Helen Perry
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK; NHS Wales Health Education and Improvement Wales, UK.
| | - Nicola Reeves
- NHS Wales Health Education and Improvement Wales, UK; Aneurin Bevan Health Board, UK
| | - James Ansell
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Julie Cornish
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Jared Torkington
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Daniel S Morris
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Fiona Brennan
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - James Horwood
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
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ter Avest E, Kratz M, Dill T, Palmer M. Green HEMS: how to make it happen. Scand J Trauma Resusc Emerg Med 2023; 31:23. [PMID: 37143112 PMCID: PMC10158689 DOI: 10.1186/s13049-023-01087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- E. ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield, Redhill, Surrey, RH1 5YP UK
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. Kratz
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, Tampere University, FinnHEMS 30 & 40, Tampere, Finland
| | - T. Dill
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - M. Palmer
- Emergency Medical Transfer Retrieval Service- Wales Air Ambulance, Ty Elusen, Ffordd Angel, Llanelli Gate, Dafen, Llanelli UK
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Pernod C, Bonnet L, Muret J, Jouot T, Moulin M, Lamblin A. Reusable laryngoscope blades: not a thing of the past but a choice for the future. Minerva Anestesiol 2023; 89:479-480. [PMID: 37140193 DOI: 10.23736/s0375-9393.22.16965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Cyril Pernod
- Department of Anesthesia and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon - HCL, Lyon, France -
- Department of Anesthesia, Desgenettes Military Teaching Hospital, Lyon, France -
| | - Laure Bonnet
- Department of Anesthesia and Critical Care Medicine, The Princesse Grace Hospital, Monaco, Principality of Monaco
| | - Jane Muret
- Department of Anesthesia and Critical Care Medicine, Institut Curie, Paris, France
| | - Thomas Jouot
- Department of Anesthesia and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon - HCL, Lyon, France
| | - Matthieu Moulin
- Department of Anesthesia and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon - HCL, Lyon, France
| | - Antoine Lamblin
- Department of Anesthesia and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon - HCL, Lyon, France
- Department of Anesthesia, Desgenettes Military Teaching Hospital, Lyon, France
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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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Batcup C, Breth-Petersen M, Dakin T, Barratt A, McGain F, Newell BR, Pickles K. Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review. BMC Health Serv Res 2023; 23:384. [PMID: 37081553 PMCID: PMC10116654 DOI: 10.1186/s12913-023-09370-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Clinical activity accounts for 70-80% of the carbon footprint of healthcare. A critical component of reducing emissions is shifting clinical behaviour towards reducing, avoiding, or replacing carbon-intensive healthcare. The objective of this systematic review was to find, map and assess behaviour change interventions that have been implemented in healthcare settings to encourage clinicians to reduce greenhouse gas emissions from their clinical activity. METHODS Studies eligible for inclusion were those reporting on a behaviour change intervention to reduce carbon emissions via changes in healthcare workplace behaviour. Six databases were searched in November 2021 (updated February 2022). A pre-determined template was used to extract data from the studies, and risk of bias was assessed. The behaviour change techniques (BCTs) used in the interventions were coded using the BCT Taxonomy. RESULTS Six full-text studies were included in this review, and 14 conference abstracts. All studies used a before-after intervention design. The majority were UK studies (n = 15), followed by US (n = 3) and Australia (n = 2). Of the full-text studies, four focused on reducing the emissions associated with anaesthesia, and two aimed at reducing unnecessary test ordering. Of the conference abstracts, 13 focused on anaesthetic gas usage, and one on respiratory inhalers. The most common BCTs used were social support, salience of consequences, restructuring the physical environment, prompts and cues, feedback on outcome of behaviour, and information about environmental consequences. All studies reported success of their interventions in reducing carbon emissions, prescribing, ordering, and financial costs; however, only two studies reported the magnitude and significance of their intervention's success. All studies scored at least one item as unclear or at risk of bias. CONCLUSION Most interventions to date have targeted anaesthesia or pathology test ordering in hospital settings. Due to the diverse study outcomes and consequent inability to pool the results, this review is descriptive only, limiting our ability to conclude the effectiveness of interventions. Multiple BCTs were used in each study but these were not compared, evaluated, or used systematically. All studies lacked rigour in study design and measurement of outcomes. REVIEW REGISTRATION The study was registered on Prospero (ID number CRD42021272526) (Breth-Petersen et al., Prospero 2021: CRD42021272526).
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Affiliation(s)
- Carys Batcup
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Matilde Breth-Petersen
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Thomas Dakin
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Forbes McGain
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
- Western Health, Department of Critical Care Medicine, University of Melbourne, Melbourne, Australia
| | - Ben R Newell
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia.
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Bringier R, Arrigoni A, Muret J, Dro A, Gayat E, Vallée F, Arrigoni Marocco S. An integrated environmental, economic, and clinician satisfaction comparison between single-use and reusable flexible bronchoscopes for tracheal intubation. Br J Anaesth 2023:S0007-0912(23)00119-8. [PMID: 37059624 DOI: 10.1016/j.bja.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/16/2023] Open
Affiliation(s)
- Romain Bringier
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alessandro Arrigoni
- Simbio Onlus, Sistemi Innovativi di Mantenimento della Biodiversità, Santa Maria Hoè, Italy; Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Jane Muret
- Institut Curie PSL Research University, Paris, France
| | - Antoine Dro
- Department of Biomedical Engineering, Lariboisière, Saint Louis Hospitals, Paris, France
| | - Etienne Gayat
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France; Université Paris Cité, Inserm, U942 MASCOT, Paris, France
| | - Fabrice Vallée
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France; Université Paris Cité, Inserm, U942 MASCOT, Paris, France; Inria, Paris, France; LMS, École Polytechnique, CNRS, Paris, France
| | - Stefano Arrigoni Marocco
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
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Kampman JM, Sperna Weiland NH. Anaesthesia and environment: impact of a green anaesthesia on economics. Curr Opin Anaesthesiol 2023; 36:188-195. [PMID: 36700462 PMCID: PMC9973446 DOI: 10.1097/aco.0000000000001243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The excessive growth of the health sector has created an industry that, while promoting health, is now itself responsible for a significant part of global environmental pollution. The health crisis caused by climate change urges us to transform healthcare into a sustainable industry. This review aims to raise awareness about this issue and to provide practical and evidence-based recommendations for anaesthesiologists.
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Affiliation(s)
| | - Nicolaas H. Sperna Weiland
- Amsterdam UMC location University of Amsterdam, Anaesthesiology
- Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam, The Netherlands
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Pradere B, Mallet R, de La Taille A, Bladou F, Prunet D, Beurrier S, Bardet F, Game X, Fournier G, Lechevallier E, Meria P, Matillon X, Polguer T, Abid N, De Graeve B, Kassab D, Mejean A, Misrai V, Pinar U. Climate-smart Actions in the Operating Theatre for Improving Sustainability Practices: A Systematic Review. Eur Urol 2023; 83:331-342. [PMID: 35151515 DOI: 10.1016/j.eururo.2022.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Surgical activity contributes to global warming though the production of greenhouse gases and consumption of resources. To date, no clinical practice guidelines have been made to promote and implement climate-smart actions. OBJECTIVE To perform a systematic review of the available actions that could limit CO2 emission in the operating room (OR) and their potential benefits upon the environment, whilst preserving quality of care. EVIDENCE ACQUISITION MEDLINE and Cochrane databases were searched from January 1, 1990 to April 2021. We included studies assessing carbon footprint (CF) in the OR and articles detailing actions that limit or reduce CF. EVIDENCE SYNTHESIS Thirty-eight studies met the inclusion criteria. We identified six core climate-smart actions: (1) waste reduction by segregation; (2) waste reduction by recycling, reuse, and reprocessing; (3) sterilisation; (4) anaesthesia gas management; and (5) improvement of energy use. Quantitative analysis regarding the CF was not possible due to the lack of homogeneous data. For climate-smart actions, the analysis was limited by discrepancies in study scope and in the methodology of CO2 emission calculation. Improvement of education and awareness was found to have an important impact on waste segregation and reduction. Waste management is the area where health care workers could have the strongest impact, whereas the main field to reduce CF in the OR was found to be energy consumption. CONCLUSIONS This review provides arguments for many climate-smart actions that could be implemented in our daily practice. Improving awareness and education are important to act collectively in a sustainable way. Further studies are mandatory to assess the impact of these climate-smart actions in the OR. PATIENT SUMMARY We performed a systematic review of the available scientific literature to reference all the climate-smart actions proposed to improve the sustainability of surgical activities. Waste segregation, waste reduction and recycling, reuse and reprocessing, sterilisation, anaesthesia gas changes, and improvement of energy use in the operating room were found to be the main areas of research. There is still a long way to go to homogenise and improve the quality of our climate-smart actions.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
| | - Richard Mallet
- Department of Urology, Hopital Privé Francheville, Périgueux, France
| | - Alexandre de La Taille
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, Créteil Cédex, France
| | - Franck Bladou
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
| | - Denis Prunet
- Department of Urology, Clinique Urologie Royan, Royan, France
| | - Sarah Beurrier
- Department of Urology, Hopital Cochin AP-HP, Paris, France
| | | | - Xavier Game
- Department of Urology, Centre Hospitalier Universitaire de Rangueil, Université Toulouse III, Toulouse, France
| | - Georges Fournier
- Department of Urology, Hôpital de la Cavale Blanche, Université de Brest, Brest, France
| | - Eric Lechevallier
- Department of Urology, Aix-Marseille Université, CHU La Conception, AP-HM, Marseille, France
| | - Paul Meria
- Department of Urology, Hopital Saint Louis, APH-HP, Paris, France
| | - Xavier Matillon
- Department of Urology, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Polguer
- Department of Urology, CH Romans-sur-Isère, Hopitaux Drome nord, Romans-sur-Isère, France
| | - Nadia Abid
- Department of Urology, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Ugo Pinar
- Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Paris, France
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Dilger AE, Bergmark RW. Environmental sustainability in otolaryngologic surgery. Curr Opin Otolaryngol Head Neck Surg 2023. [DOI: 10.1097/moo.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Richter H, Schulz-Stübner S, Pecher S, Orlowski S, Coburn M, Schuster M. [Prioritized utilisation and reprocessing of reusable equipment in anaesthesiology deparmtents : Recommendations on how to reduce CO 2 emissions from anaesthetic equipment]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01268-2. [PMID: 36930267 DOI: 10.1007/s00101-023-01268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Currently, few robust data are available to provide estimates of the environmental footprint and in particular the CO2 emissions of medical devices; however, existing life cycle assessments largely indicate that reusable materials have more favorable emissions and environmental footprints compared to disposable items. Thus, the challenge for every anesthesiology department is to identify items that can be used as reusable products for ecological and other reasons.A prerequisite for the use of reusable items is hygienically correct reprocessing and packaging. Here, a distinction must be made between noncritical, semicritical and critical medical devices, depending on the type of use. In addition, a distinction must be made between categories A-C, depending on the complexity of the reprocessing.In this narrative review article common reusable items used in anesthesiology are categorized and a standardized decision algorithm for reprocessing routes is proposed. Special attention is also given to the packaging of medical devices, which can contribute to the ecological footprint to a relevant extent.This article further explains the framework under which reprocessing can take place and analyzes the current state of knowledge on the life cycle assessment of reprocessing reusable devices.This requires the special commitment of clinically active anesthesiologists to include ecological aspects in the decision to use disposable or reusable items. In the medium term, comprehensible ecological key numbers should be provided on every medical device to make the ecological costs of the articles understandable in addition to the monetary costs.
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Affiliation(s)
- Hannah Richter
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Rechbergklinik Bretten, Akademische Lehrkrankenhäuser der Universität Heidelberg, Gutleutstr. 1-14, 76646, Bruchsal, Deutschland.,Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland
| | | | - Sabine Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum, Stuttgart, Deutschland.,Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland
| | | | - Mark Coburn
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Bonn, Bonn, Deutschland.,Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland
| | - Martin Schuster
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Rechbergklinik Bretten, Akademische Lehrkrankenhäuser der Universität Heidelberg, Gutleutstr. 1-14, 76646, Bruchsal, Deutschland. .,Nachhaltigkeit in der Anästhesiologie, Forum der DGAI und des BDA, Nürnberg, Deutschland.
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Sumner C, Ikuta I, Garg T, Martin JG, Mansoori B, Chalian M, Englander BS, Chertoff J, Woolen S, Caplin D, Sneider MB, Desouches SL, Chan TL, Kadom N. Approaches to Greening Radiology. Acad Radiol 2023; 30:528-535. [PMID: 36114076 DOI: 10.1016/j.acra.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Christina Sumner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ichiro Ikuta
- Department of Radiology & Biomedical Imaging, Yale Program for Innovation in Imaging Informatics, Department of Radiology, Yale University School of Medicine, New Haven, CT; Mayo Clinic Arizona, Phoenix, Arizona
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan G Martin
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina
| | - Bahar Mansoori
- Department of Radiology, University of Washington, Seattle, Washington
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington
| | - Brian S Englander
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jocelyn Chertoff
- Department of Radiology, Dartmouth Health and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sean Woolen
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California
| | - Drew Caplin
- Division of Interventional Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York
| | - Michael B Sneider
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, Virginia
| | | | - Tiffany L Chan
- Department of Radiology, University of California, Los Angeles, California
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta- Egleston Campus, Atlanta, Georgia.
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Keil M, Viere T, Helms K, Rogowski W. The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments. Eur J Public Health 2023; 33:56-63. [PMID: 36433787 PMCID: PMC9898010 DOI: 10.1093/eurpub/ckac174] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Replacing single-use products with reusable ones may reduce the environmental impact of healthcare. This study aimed to broadly assess the environmental effects of that substitution. METHODS A systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products was conducted. The main outcomes assessed were changes in the environmental impact that resulted after switching from single-use to reusable products. As no standardized transparency checklist was available, one was developed here using DIN ISO 14040/14044. The final checklist included 22 criteria used to appraise the included studies. RESULTS After screening, 27 studies were included in the analysis. The healthcare products were assigned to four categories: invasive medical devices, non-invasive medical devices, protection equipment and inhalers. The outcomes revealed a reduction in mean effect sizes for all environmental impacts except water use. Non-invasive medical devices have greater relative mitigation potential than invasive devices. On average, information on 64% of the transparency checklist items was reported. Gaps included the reporting of data quality requirements. CONCLUSIONS Switching to reusable healthcare products is likely to reduce most impacts on the environment except water use, but the effect size differs among product categories. Possible study limitations include location bias, no systematic search of the grey literature and small samples for some impacts. This study's strengths are its approach to product categories and developed transparency catalogue. This catalogue could be useful to inform and guide a future process towards creating a standardized transparency checklist for the systematic reviews of LCAs.
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Affiliation(s)
- Mattis Keil
- Health Sciences, Institute for Public Health and Nursing Sciences, University of Bremen, Bremen, Germany
| | - Tobias Viere
- Institute for Industrial Ecology, Pforzheim University, Pforzheim, Germany
| | - Kevin Helms
- Health Sciences, Institute for Public Health and Nursing Sciences, University of Bremen, Bremen, Germany
| | - Wolf Rogowski
- Health Sciences, Institute for Public Health and Nursing Sciences, University of Bremen, Bremen, Germany
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Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
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Simmons CG, Eckle T, Rogers D, Williams JD, Brainard JC. Disposable laryngoscope intubation to reduce equipment failure in an emergency out of OR setting - a quality control case study. BMC Anesthesiol 2023; 23:16. [PMID: 36627551 PMCID: PMC9830876 DOI: 10.1186/s12871-022-01956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reusable laryngoscopes have been reported to be superior to disposable laryngoscopes with plastic blades during emergent intubations. Surprisingly, at our institution a quality reporting system revealed a high number of equipment failures with reusable laryngoscopes in an emergency out-of-OR (operating room) setting. As recent studies indicated an improved quality of disposable laryngoscopes, we hypothesized that a thoroughly evaluated disposable laryngoscope would result in less equipment failure in an emergency out-of-OR setting. METHODS To perform a more standardized and time efficient analysis, four distinct disposable laryngoscope blade/handle configurations were trialed during standard intubations (n = 4 × 30) in the OR by experienced anesthesia providers who completed a 6-question, Likert-scale/open-ended survey for product evaluation. The 'best' disposable blade was implemented in an emergency out-of-OR setting and equipment failure rates were monitored over a 3-year period. RESULTS Different disposable laryngoscopes were equal regarding sturdiness, illumination and airway visualization. The laryngoscope with the highest overall score was significantly higher scored than the laryngoscope with the lowest overall score. All disposable laryngoscopes were more cost effective than the reusable ones, and the top scored laryngoscope demonstrated the highest 5-year cost-saving ($210 K). Implementation of the top scored disposable laryngoscope into an emergency out-of-OR setting reduced the equipment failure incidence from high 20s to 0. CONCLUSION Disposable laryngoscopes are cost effective and superior to reusable laryngoscopes in an emergency out-of-OR setting. We demonstrate that the implementation of a disposable laryngoscope in the emergency out-of-OR setting resulted in a near elimination of equipment related quality submissions which ultimately enhances patient safety.
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Affiliation(s)
- Colby G Simmons
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave Leprino Bldg #734Anschutz Medical Campus, Aurora, CO, USA.
| | - Tobias Eckle
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave Leprino Bldg #734Anschutz Medical Campus, Aurora, CO, USA
| | - Dustin Rogers
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Fitzsimons Building, 4th Floor 13001 E. 17th Place Mail Stop B119 Anschutz Medical Campus, Aurora, CO, USA
| | - Jason D Williams
- Saint Alphonsus Regional Medical Center, 1055 North Curtis Rd, Boise, ID, USA
| | - Jason C Brainard
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th Ave Leprino Bldg #734Anschutz Medical Campus, Aurora, CO, USA
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Leapman MS, Thiel CL, Gordon IO, Nolte AC, Perecman A, Loeb S, Overcash M, Sherman JD. Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy. Eur Urol 2023; 83:463-471. [PMID: 36635108 DOI: 10.1016/j.eururo.2022.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care. OBJECTIVE To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathology analysis. We compared environmental emissions across five clinical scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Greenhouse gas emissions (CO2 equivalents, CO2e), and equivalents of coal and gasoline burned were measured. RESULTS AND LIMITATIONS In the USA, a single transrectal prostate biopsy procedure including prostate MRI, and targeted and systematic biopsies emits an estimated 80.7 kg CO2e. An approach of MRI targeted cores alone without a systematic biopsy generated 76.2 kg CO2e, a systematic 12-core biopsy without mpMRI generated 36.2 kg CO2e, and bpMRI with targeted and systematic biopsies generated 70.5 kg CO2e; mpMRI alone contributed 42.7 kg CO2e (54.3% of baseline scenario). Energy was the largest contributor, with an estimated 38.1 kg CO2e, followed by staff travel (20.7 kg CO2e) and supply production (11.4 kg CO2e). Performing 100 000 fewer unnecessary biopsies would avoid 8.1 million kg CO2e, the equivalent of 4.1 million liters of gasoline consumed. Per 100 000 patients, the use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg of CO2 emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. CONCLUSIONS A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence-based approaches would decrease health care pollution from the procedure. PATIENT SUMMARY We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emissions and health care pollution.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Stacy Loeb
- Department of Urology, New York University Langone Health, New York, NY, USA; Departments of Urology and Population Health, New York University Langone Health, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | | | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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50
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Saleh JR, Mitchell A, Kha ST, Outterson R, Choi A, Allen L, Chang T, Ladd AL, Goodman SB, Fox P, Chou L. The Environmental Impact of Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:74-82. [PMID: 36574633 DOI: 10.2106/jbjs.22.00548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➤ There are a growing number of opportunities within the field of orthopaedic surgery to address climate change and investigate ways to promote sustainability. ➤ Orthopaedic surgeons can take a proactive role in addressing climate change and its impacts within the areas of operating-room waste, carbon emissions from transportation and implant manufacturing, anesthetic gases, and water usage. ➤ Future studies are needed to further these initiatives on quantifying and decreasing environmental impact and furthering sustainable use of our resources.
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Affiliation(s)
- Jason R Saleh
- VA Palo Alto Health Care System, Palo Alto, California
| | - Allison Mitchell
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stephanie T Kha
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Rachel Outterson
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Redwood City, California
| | - Aiden Choi
- Stanford University, Stanford, California
| | | | - Tony Chang
- Stanford University, Stanford, California
| | - Amy L Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery and Bioengineering, Stanford University, Redwood City, California
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Loretta Chou
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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