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Abeles SR, Kline A, Lee P. Climate change and resilience for antimicrobial stewardship and infection prevention. Curr Opin Infect Dis 2024; 37:270-276. [PMID: 38843434 DOI: 10.1097/qco.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This review covers recent research regarding the challenges posed by climate change within the areas of antimicrobial stewardship and infection prevention, and ways to build resiliency in these fields. RECENT FINDINGS Infectious disease patterns are changing as microbes adapt to climate change and changing environmental factors. Capacity for testing and treating infectious diseases is challenged by newly emerging diseases, which exacerbate challenges to antimicrobial stewardship and infection prevention.Antimicrobial resistance is accelerated due to environmental factors including air pollution, plastic pollution, and chemicals used in food systems, which are all impacted by climate change.Climate change places infection prevention practices at risk in many ways including from major weather events, increased risk of epidemics, and societal disruptions causing conditions that can overwhelm health systems. Researchers are building resilience by advancing rapid diagnostics and disease modeling, and identifying highly reliable versus low efficiency interventions. SUMMARY Climate change and associated major weather and socioeconomic events will place significant strain on healthcare facilities. Work being done to advance rapid diagnostics, build supply chain resilience, improve predictive disease modeling and surveillance, and identify high reliability versus low yield interventions will help build resiliency in antimicrobial stewardship and infection prevention for escalating challenges due to climate change.
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Affiliation(s)
- Shira R Abeles
- Division of Infectious Diseases and Global Public Health, Department of Medicine
| | - Ahnika Kline
- Associate Director, Clinical Microbiology Laboratory, Department of Pathology, University of California, San Diego
| | - Pamela Lee
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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2
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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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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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Chia JS, Chang C, Yang CH, Yang CH, Chiang YT, Wu CE. An operational maintenance approach for improving physiological monitor by HFMEA process: an empirical case study. Ann Med Surg (Lond) 2023; 85:3916-3924. [PMID: 37554888 PMCID: PMC10405987 DOI: 10.1097/ms9.0000000000001064] [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] [Received: 03/15/2023] [Accepted: 07/02/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED This study explored the application of healthcare failure mode and effect analysis (HFMEA) to identify and evaluate risk-associated factors in the intensive care unit (ICU) through a clinical-based expert knowledge (decision) for the physiological monitor operational maintenance process. METHODS AND INTERVENTION A mixed qualitative and quantitative proactive approach to explore the HFMEA process by analyzing 20 units of physiological monitors in the ICU. An HFMEA expert team of six people was formed to perform a risk-based analysis and evaluate the potential hazard index, mitigating the hazard scores and risks. RESULTS From the main processes and possible failure reasons, one high-risk hazard index greater than or equal to 8 of the standard score was found. This standard score indicates the signed manufacturer's contract for maintenance was the hazard index failure mode on the parts not regularly replaced according to the contract. This systematic hazard index failure mode shows the highest hazard scores in the possible failure reason category, established as a standard maintenance procedure. In addition, the HFMEA expert analysis of the 20 units of physiological monitors within 6 months of the original and remanufactured part maintenance results in operational availability from 90.9% for self-repair to 99.2% for contract manufacturer repair. CONCLUSIONS This study concludes a systematic reference in malpractices caused by maintenance negligence. The HFMEA expert team agrees that hazard failure scores greater than or equal to 8 are vital assessments and evaluations for decision-making, especially in maintaining healthcare intensive unit care physiological monitors.
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Affiliation(s)
| | - Ching Chang
- Department of Business Administration, College of Management
| | - Chen-Hsuan Yang
- Industry-University Education Center, Chung Hua University, Hsinchu
| | - Ching-Hui Yang
- General Education Center, Hungkuang University, Taichung
| | - Yung-Tai Chiang
- Kinesiology, Health and Leisure, Chienkuo Technology University, Changhua, Taiwan, ROC
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Affiliation(s)
- Heather Baid
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Eleanor Damm
- Intensive Care Medicine and Anaesthesia, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Louise Trent
- Hawke's Bay Hospital, Te Matau a Māui, Te Whatu Ora, New Zealand
| | - Forbes McGain
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Australia
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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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Slutzman JE, Bockius H, Gordon IO, Greene HC, Hsu S, Huang Y, Lam MH, Roberts T, Thiel CL. Waste audits in healthcare: A systematic review and description of best practices. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:3-17. [PMID: 35652693 PMCID: PMC9925917 DOI: 10.1177/0734242x221101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.
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Affiliation(s)
- Jonathan E Slutzman
- Center for the Environment and
Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Hannah Bockius
- Department of Biomedical
Engineering, University of Delaware, Newark, DE, USA
| | - Ilyssa O Gordon
- Robert J. Tomsich Pathology &
Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
| | - Hannah C Greene
- Department of Biology, New York
University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Hsu
- Warren Alpert Medical School,
Brown University, Providence, RI, USA
| | | | - Michelle H Lam
- Department of Chemical and
Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY,
USA
| | - Timothy Roberts
- Health Sciences Library, NYU
Langone Health, Grossman School of Medicine, New York University, New York,
NY, USA
| | - Cassandra L Thiel
- Grossman School of Medicine,
Wagner Graduate School of Public Service, Tandon School of Engineering, New
York University, New York, NY, USA
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8
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Raymakers AJN, Sue-Chue-Lam C, Haldane V, Cooper-Reed A, Toccalino D. Climate change, sustainability, and health services research. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Shoham MA, Baker NM, Peterson ME, Fox P. The environmental impact of surgery: A systematic review. Surgery 2022; 172:897-905. [PMID: 35788282 DOI: 10.1016/j.surg.2022.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Climate change is a significant public health threat. Health care comprises 10% of greenhouse gas emissions in the United States, where surgery is especially resource intensive. We did a systematic review to assess and summarize the published evidence of the environmental impact of surgery. METHODS We searched Medline, Embase, Web of Science, and GreenFILE databases for publications that report any environmental impact measure by all surgical subspecialties, including anesthesia. Inclusion criteria were published in English, original research, and passed peer review. Because data were heterogeneous and the aim was broad, we conducted a qualitative summary of data. Where possible, we compare impact measures. RESULTS In the study, 167 articles were identified by our search strategy and reviewed, of which 55 studies met criteria. Eight were about anesthesia, 27 about operating room waste, and 6 were life cycle assessments. Other topics include carbon footprint and greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the operating room is a significant source of emissions and waste. Using anesthetic gases with low global warming potential reduces operating room emissions without compromising patient safety. Operating room waste is often disposed of improperly, often due to convenience or knowledge gaps. There are environmental benefits to replacing disposable materials with reusable equivalents, and to proper recycling. Surgeons can help implement these changes at their institution. CONCLUSION Although there is a clear need to lower the carbon footprint of surgery, the quality of research with which to inform protocol changes is deficient overall. Our attempt to quantify surgery's carbon footprint yielded heterogeneous data and few standardized, actionable recommendations. However, this data serves as a starting point for important future initiatives to decrease the environmental impact of surgery.
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Affiliation(s)
- Maia A Shoham
- Stanford University School of Medicine, Stanford, CA
| | | | | | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA.
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10
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McGain F, Wickramarachchi K, Sheridan N, McAlister S. Carbon Footprint of Anesthesia: Reply. Anesthesiology 2022; 137:123-125. [PMID: 35507727 DOI: 10.1097/aln.0000000000004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Forbes McGain
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; School of Public Health, University of Sydney, Sydney, Australia (F.M.).
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11
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Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologe 2022; 119:567-576. [PMID: 35451609 PMCID: PMC9024069 DOI: 10.1007/s00347-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Großbritannien.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Großbritannien.
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Schulz
- Deutsche Allianz Klimawandel und Gesundheit, Berlin, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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White SM, Shelton CL, Gelb AW, Lawson C, McGain F, Muret J, Sherman JD. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia 2022; 77:201-212. [PMID: 34724710 PMCID: PMC9298028 DOI: 10.1111/anae.15598] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.
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Affiliation(s)
- S. M. White
- Department of AnaesthesiaUniversity Hospitals Sussex NHS Foundation TrustBrightonUK
| | - C. L. Shelton
- Department of AnaesthesiaWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK,Lancaster Medical SchoolFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - A. W. Gelb
- Department of Anesthesia and Peri‐operative CareUniversity of California San FranciscoSan FranciscoCAUSA
| | - C. Lawson
- Royal Victoria InfirmaryNewcastle upon TyneUK
| | - F. McGain
- Departments of Anaesthesia and Intensive CareWestern HealthMelbourneVic.Australia,Department of Critical CareUniversity of MelbourneMelbourneVic.Australia
| | - J. Muret
- Departments of Anaesthesia and Intensive CareInstitut CuriePSL Research UniversityParisFrance
| | - J. D. Sherman
- Yale School of Medicine and Associate Professor of Epidemiology in Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
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Reducing the Environmental Impact of Sterilization Packaging for Surgical Instruments in the Operating Room: A Comparative Life Cycle Assessment of Disposable versus Reusable Systems. SUSTAINABILITY 2021. [DOI: 10.3390/su14010430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The widespread use of single-use polypropylene packaging for sterilization of surgical instruments (blue wrap) results in enormous environmental pollution and plastic waste, estimated at 115 million kilograms on a yearly basis in the United States alone. Rigid sterilization containers (RSCs) are a well-known alternative in terms of quality and price. This paper deals with two research questions investigating the following aspects: (A) the environmental advantage of RCS for high volumes (5000 use cycles) in big hospitals, and (B) the environmental break-even point of use-cycles for small hospitals. An in-depth life cycle assessment was used to benchmark the two systems. As such a benchmark is influenced by the indicator system, three indicator systems were applied: (a) carbon footprint, (b) ReCiPe, and (c) eco-costs. The results are as follows: (1) the analyzed RSC has 85% less environmental impact in carbon footprint, 52% in ReCiPe, and 84.5% in eco-costs; and (2) an ecological advantage already occurs after 98, 228, and 67 out of 5000 use cycles, respectively. Given these two alternative packaging systems with comparable costs and quality, our results show that there are potentially large environmental gains to be made when RSC is preferred to blue wrap as a packaging system for sterile surgical instruments on a global scale.
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Senay E, Bernstein A, Shephard P, Salas R, Rizzo A, Sherman J, Richardson L, Butts G, Marwah H, Solomon C, Galvez M, Thanik E, Pezeshki G, Zajac L, Lee A, Sheffield P, Wright R. Improving Patient Outcomes in the Dual Crises of Climate Change and COVID-19: Proceedings of the Third Annual Clinical Climate Change Meeting, January 8, 2021. J Occup Environ Med 2021; 63:e813-e818. [PMID: 34354022 PMCID: PMC8842883 DOI: 10.1097/jom.0000000000002345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The tremendous global toll of the COVID-19 pandemic does not fall equally on all populations. Indeed, this crisis has exerted more severe impacts on the most vulnerable communities, spotlighting the continued consequences of longstanding structural, social, and healthcare inequities. This disparity in COVID-19 parallels the unequal health consequences of climate change, whereby underlying inequities perpetuate adverse health outcomes disproportionately among vulnerable populations. As these two crises continue to unfold, there is an urgent need for healthcare practitioners to identify and implement solutions to mitigate adverse health outcomes, especially in the face of global crises. To support this need, the 2021 Clinical Climate Change Conference held a virtual meeting to discuss the implications of the convergence of the climate crisis and COVID-19, particularly for vulnerable patient populations and the clinicians who care for them. Presenters and panelists provided evidence-based solutions to help health professionals improve and adapt their practice to these evolving scenarios. Together, participants explored the community health system and national solutions to reduce the impacts of COVID-19 and the climate crisis, to promote community advocacy, and foster new partnerships between community and healthcare leaders to combat systemic racism and achieve a more just and equitable society.
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Affiliation(s)
- Emily Senay
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aaron Bernstein
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA
- Boston Children’s Hospital, Boston, MA
| | | | - Renee Salas
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | | | - Jodi Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
- Department of Epidemiology in Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Population Health Science & Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Butts
- Diversity Programs, Policy, and Community Affairs, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Maida Galvez
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grant Pezeshki
- New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Lauren Zajac
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Lee
- Departments of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Mount Sinai Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Mitigating Health Care's Contribution to the Climate Crisis: Mitigating Health Care's Contribution to the Climate Crisis. Jt Comm J Qual Patient Saf 2021; 47:609-611. [PMID: 34456150 DOI: 10.1016/j.jcjq.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Comparison of the strength of various disposable videolaryngoscope blades. Can J Anaesth 2021; 68:1651-1658. [PMID: 34405354 DOI: 10.1007/s12630-021-02069-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Breaking of disposable blades during emergency endotracheal intubation has been reported. Breakage can cause serious injury and foreign body ingestion. We aimed to measure and analyze the strength characteristics of different disposable videolaryngoscope blades with the application of an upward-lifting force. METHODS We measured the strength of four disposable videolaryngoscope blades (C-Mac® S Video laryngoscope MAC #3, Glidescope GVL® 3 stat, Pentax AWS® PBlade TL type, and King Vision® aBlade #3) using the fracture test. The strength of 12 samples of each type of disposable videolaryngoscope blade was measured using an Instron 5,966 tensile tester by applying an upward-lifting force. RESULTS After the fracture test using C-Mac, Glidescope GVL, Pentax AWS, and King Vision, the number of deformed blades were 0, 12, 3, and 7, respectively, and the number of broken blades were 12, 0, 9, and 5, respectively. The mean (standard deviation) maximum force strengths of Pentax AWS, C-Mac, King Vision, and Glidescope GVL blades were 408.4 (27.4) N, 325.8 (26.5) N, 291.8 (39.3) N, and 262.7 (3.8) N, respectively (P < 0.001). CONCLUSION Clinicians should be aware of the varied strength characteristics of the four types of disposable videolaryngoscope blades when they are used in endotracheal intubation.
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17
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Abstract
BACKGROUND The climate crisis is the most serious threat to global health in the twenty-first century. In western countries 5-10% of all greenhouse gas emissions originate from the healthcare sector and the main contributing factors are energy-intense departments (intensive care units, operating suits and prehospital emergency services). OBJECTIVE The aim of this review is to provide background knowledge and practical ideas to achieve climate-neutral hospitals. MATERIAL AND METHODS Narrative review with information on the topics of (I) volatile anesthetics as greenhouse gases, (II) energy supply in hospitals and (III) solid waste management. RESULTS AND CONCLUSION (I) Volatile anesthetics are highly potent greenhouse gases, especially desflurane has a major global warming potential. Total intravenous anesthesia (TIVA) with propofol or regional anesthetic techniques have a much lower impact on the climate. (II) Using sustainable energy sources as well as initiating energy sparing techniques, such as light-emitting diodes (LED) and motion sensors, can reduce CO2 emissions. (III) Waste can be managed by the reduce, reuse, recycle, rethink and research concept. Doctors should actively contribute to reach the climate goals.
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Affiliation(s)
- S Koch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - S Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland
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18
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Senay E, Gore K, Sherman J, Patel S, Ziska L, Lucchini R, DeFelice N, Just A, Nabeel I, Thanik E, Sheffield P, Rizzo A, Wright R. Coming Together for Climate and Health: Proceedings of the Second Annual Clinical Climate Change Meeting, January 24, 2020. J Occup Environ Med 2021; 63:e308-e313. [PMID: 33710106 PMCID: PMC8842823 DOI: 10.1097/jom.0000000000002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Climate change is imposing increasingly severe impacts on public health. Addressing these impacts requires heightened awareness of climate-driven health conditions and appropriate clinical practices to manage these conditions. Within this context, the 2nd Annual Clinical Climate Change Conference, held January 24, 2020 at the New York Academy of Medicine, brought together more than 150 allied health practitioners from across the United States for a one-day conference showcasing the state of the science on the climate and health. Eight platform presentations—including a keynote address from Karenna Gore of the Center for Earth Ethics at Union Theological Seminary—covered a range of environmentally induced, climate-related disease areas as well as topics related to environmental justice. Additionally, key workshops engaged participants in the clinical management of climate-related health conditions. Communicating the existing evidence base for climate change-driven impacts on human health is crucial for preparing practitioners to identify and address these impacts. Further partnership between researchers and practitioners to extend and disseminate this evidence base will yield important advancements toward protecting patients and improving health outcomes in an era of climate crisis.
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Affiliation(s)
- Emily Senay
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karenna Gore
- Center for Earth Ethics, Union Theological Seminary, New York, NY
| | - Jodi Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
- Department of Epidemiology in Environmental Health Sciences, Yale School of Public Health, New Haven, CT
| | - Surili Patel
- The Center for Public Health Policy, Washington, D.C
| | - Lewis Ziska
- Department of Environmental Health Sciences, Columbia University Irving Medical Center, New York, NY
| | - Roberto Lucchini
- Department of Occupational and Environmental Medicine, School of Public Health, Florida International University, Miami, FL
| | - Nicholas DeFelice
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ismail Nabeel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Perry Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Robert Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
- Mount Sinai Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
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19
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Hicks A, Temizel-Sekeryan S, Kontar W, Ghamkhar R, Rodríguez Morris M. Personal respiratory protection and resiliency in a pandemic, the evolving disposable versus reusable debate and its effect on waste generation. RESOURCES, CONSERVATION, AND RECYCLING 2021; 168:105262. [PMID: 34785861 PMCID: PMC8588576 DOI: 10.1016/j.resconrec.2020.105262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic sweeping much of the globe is not anticipated to be short in duration, with contingency plans suggesting that it may last at least eighteen months. In the United States, one of the critical issues in coping with the pandemic has been a lack of essential personal protective equipment (PPE), at the local, state, and national level. As COVID-19 is primarily transferred through respiratory routes, adequate respiratory protection is a dire necessity. The shift from durable and reusable medical supplies in recent years to their single use counterparts has reduced the resiliency of the medical system with respect to PPE and other critical supplies in the current pandemic. This work explores the role of reusable compared to single use respiratory protection in the current pandemic, including reprocessing of single use options, from the perspective of number of equivalent protection devices needed. The current state of literature is also reviewed to provide context to this work, with respect to resource procurement. The economic cost of PPE throughout a pandemic is explored, and it is found that utilizing reusable PPE options depending on filter cycling may be less costly. Increased waste production is another issue with the current pandemic, and this is explored utilizing a mass basis, finding that reusable respiratory PPE would generate less waste than using single use PPE in a business as usual scenario. As future outbreaks of COVID-19 are likely along with other future pandemics, this work provides insights at how to prepare from the standpoint of PPE, and in particular respiratory protection.
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Affiliation(s)
- Andrea Hicks
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, United States
| | - Sila Temizel-Sekeryan
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, United States
| | - Wissam Kontar
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, United States
| | - Ramin Ghamkhar
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, United States
| | - Mónica Rodríguez Morris
- University of Wisconsin-Madison, Department of Civil and Environmental Engineering, United States
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20
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Zorrilla-Vaca A, Marmolejo-Posso D, Caballero-Lozada AF, Miño-Bernal JF. Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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McGain F, Muret J, Lawson C, Sherman JD. Effects of the COVID-19 pandemic on environmental sustainability in anaesthesia. Response to Br J Anaesth 2021;126:e118-e119. Br J Anaesth 2020; 126:e119-e122. [PMID: 33388139 PMCID: PMC8885114 DOI: 10.1016/j.bja.2020.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Forbes McGain
- Departments of Anaesthesia and Intensive Care, Western Health, Footscray, Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Jane Muret
- Institut Curie PSL Research University, Paris, France; Sustainability Committee, French Society of Anesthesia and Intensive Care Medicine, Paris, France
| | - Cathy Lawson
- Newcastle Upon Tyne Hospitals, Newcastle upon Tyne, England, UK
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology (Environmental Health Sciences), Yale School of Public Health, New Haven, CT, USA
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22
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MacNeill AJ, Hopf H, Khanuja A, Alizamir S, Bilec M, Eckelman MJ, Hernandez L, McGain F, Simonsen K, Thiel C, Young S, Lagasse R, Sherman JD. Transforming The Medical Device Industry: Road Map To A Circular Economy. Health Aff (Millwood) 2020; 39:2088-2097. [PMID: 33284689 DOI: 10.1377/hlthaff.2020.01118] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy- and market-driven solutions are needed to encourage systemic transformation.
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Affiliation(s)
- Andrea J MacNeill
- Andrea J. MacNeill is a clinical associate professor in the Department of Surgery at the University of British Columbia, in Vancouver, British Columbia, Canada
| | - Harriet Hopf
- Harriet Hopf is a professor of anesthesiology in the Department of Anesthesiology at the University of Utah, in Salt Lake City, Utah
| | - Aman Khanuja
- Aman Khanuja is an MPH/MBA candidate in the Yale School of Management and the Yale School of Public Health at Yale University, in New Haven, Connecticut
| | - Saed Alizamir
- Saed Alizamir is an associate professor of operations management in the School of Management at Yale University
| | - Melissa Bilec
- Melissa Bilec is an associate professor in the Department of Civil and Environmental Engineering at the University of Pittsburgh, in Pittsburgh, Pennsylvania
| | - Matthew J Eckelman
- Matthew J. Eckelman is an associate professor in the Department of Civil and Environmental Engineering at Northeastern University, in Boston, Massachusetts
| | - Lyndon Hernandez
- Lyndon Hernandez is an adjunct clinical faculty member at the Medical College of Wisconsin, in Milwaukee, Wisconsin
| | - Forbes McGain
- Forbes McGain is an associate professor in the Centre for Integrated Critical Care at the University of Melbourne, in Melbourne, Victoria, Australia
| | - Kari Simonsen
- Kari Simonsen is a professor in the Division of Pediatric Infectious Diseases at the University of Nebraska Medical Center, in Omaha, Nebraska
| | - Cassandra Thiel
- Cassandra Thiel is an assistant professor at the NYU Langone Health School of Medicine, the Robert F. Wagner Graduate School of Public Service, and the NYU Tandon School of Engineering at New York University, in New York, New York
| | - Steven Young
- Steven Young is an associate professor in the School of Environment, Enterprise, and Development at the University of Waterloo, in Waterloo, Ontario, Canada
| | - Robert Lagasse
- Robert Lagasse is a professor and vice chair for quality and regulatory affairs, Department of Anesthesiology, Yale School of Medicine, Yale University
| | - Jodi D Sherman
- Jodi D. Sherman is an associate professor of anesthesiology in the Yale School of Medicine and the Yale School of Public Health, Yale University
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23
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McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125:680-692. [PMID: 32798068 PMCID: PMC7421303 DOI: 10.1016/j.bja.2020.06.055] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 01/17/2023] Open
Abstract
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
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Affiliation(s)
| | - Jane Muret
- French Society of Anaesthesia and Intensive Care (SFAR), Institut Curie PSL Research University, Paris, France
| | - Cathy Lawson
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England, UK
| | - Jodi D. Sherman
- Department of Anesthesiology, Yale School of Medicine, Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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24
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Ryan EC, Dubrow R, Sherman JD. Medical, nursing, and physician assistant student knowledge and attitudes toward climate change, pollution, and resource conservation in health care. BMC MEDICAL EDUCATION 2020; 20:200. [PMID: 32576175 PMCID: PMC7310528 DOI: 10.1186/s12909-020-02099-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/29/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Climate change and pollution generated by the health care sector impose significant public health burdens. This study aimed to assess medical, nursing and physician assistant student knowledge and attitudes regarding climate change, pollution from the health care sector, and responsibility for resource conservation within professional practice. METHODS In February-March, 2018, medical, nursing, and physician assistant students at Yale University (1011 potential respondents) were sent a 17-question online Qualtrics survey. Data analysis included descriptive statistics, as well as Fisher's exact test and logistic regression to assess associations between variables of interest and the personal characteristics of gender, age, geographic place of origin, school, and year in school (among medical students). RESULTS The response rate was 28% (280 respondents). 90% felt that physicians, nurses, and physician assistants have a responsibility to conserve resources and prevent pollution within their professional practice. 63% agreed or strongly agreed that the relationship between pollution, climate change, and health should be covered in the classroom and should be reinforced in the clinical setting. 57% preferred or strongly preferred reusable devices. 91% felt lack of time and production pressure, and 85% believed that lack of education on disease burden stemming from health care pollution, were barriers to taking responsibility for resource conservation and pollution prevention. Women and physician assistant students exhibited a greater commitment than men and medical students, respectively, to address pollution, climate change, and resource conservation in patient care and professional practice. CONCLUSION We found that health professional students are engaged with the concept of environmental stewardship in clinical practice and would like to see pollution, climate change, and health covered in their curriculum. In order for this education to be most impactful, more research and industry transparency regarding the environmental footprint of health care materials and specific clinician resource consumption patterns will be required.
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Affiliation(s)
- Emma C Ryan
- Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Robert Dubrow
- Environmental Health Sciences, Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Jodi D Sherman
- Anesthesiology, Environmental Health Sciences, Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
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25
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Petre MA, Malherbe S. Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice. Can J Anaesth 2020; 67:1044-1063. [DOI: 10.1007/s12630-020-01726-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/03/2019] [Accepted: 01/30/2020] [Indexed: 12/14/2022] Open
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26
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Tom J. Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices. Anesth Prog 2020; 67:109-120. [PMID: 32633770 PMCID: PMC7342805 DOI: 10.2344/anpr-67-02-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/03/2020] [Indexed: 07/25/2023] Open
Abstract
Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.
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Affiliation(s)
- James Tom
- Associate Clinical Professor, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California
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27
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Thiel CL, Sherman JD, Hopf HW. Use of Disposable Perioperative Jackets and Surgical Site Infections. JAMA Surg 2020; 155:453-454. [PMID: 32129807 DOI: 10.1001/jamasurg.2019.6374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Cassandra L Thiel
- New York University Wagner School of Public Service, New York University Langone Health, New York University, New York
| | - Jodi D Sherman
- Anesthesiology, Yale University, New Haven, Connecticut.,Epidemiology in Environmental Health Sciences, Yale University, New Haven, Connecticut
| | - Harriet W Hopf
- Anesthesiology, University of Utah, Salt Lake City.,Bioengineering, University of Utah, Salt Lake City
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28
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McGain F, Ma SC, Burrell RH, Percival VG, Roessler P, Weatherall AD, Weber IA, Kayak EA. Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper. Anaesth Intensive Care 2019; 47:413-422. [PMID: 31684744 DOI: 10.1177/0310057x19884075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare’s environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the statement is to affirm ANZCA’s commitment to environmental sustainability and support anaesthetists in promoting environmentally sustainable work practices. This article presents the main features of PS64 and its background paper, and the associated supporting evidence. The healthcare sector is highly interconnected with activities that emit pollution to air, water and soils, considerably adding to humanity’s collective ecological footprint. As anaesthetists, we are uniquely high-carbon doctors due to our work anaesthetising with greenhouse gases (particularly desflurane and nitrous oxide) and our exposure and contribution to large amounts of resource and energy use and waste generation in operating theatres. Discussion is made of the improving research base of anaesthetic life-cycle assessments—that is, cradle-to-grave studies of how much energy, water and so on a product or process requires throughout its entire life. Thereafter, reducing, reusing and recycling as well as water use are examined. Ongoing research efforts within environmentally sustainable anaesthesia are highlighted. Environmentally sustainable anaesthesia requires scholarship, health advocacy, leadership, communication and collaboration. The focus is placed on practical initiatives within PS64 and the background paper that can be achieved by all anaesthetists striving towards more sustainable healthcare practices that reduce waste, reap financial benefits and improve health.
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Affiliation(s)
- Forbes McGain
- Department of Anaesthesia and Intensive Care, Western Health, Footscray Hospital, Melbourne, Australia
| | - Scott Cy Ma
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia
| | - Rob H Burrell
- Department of Anaesthesia and Intensive Care, Middlemore Hospital, Auckland, New Zealand
| | | | - Peter Roessler
- Australian and New Zealand College of Anaesthetists, Melbourne, Australia
| | | | - Ingo A Weber
- Department of Anaesthesia and Pain Medicine, Flinders University of South Australia, Adelaide, Australia
| | - Eugenie A Kayak
- Department of Anaesthesia, Alfred Health, Melbourne, Australia
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29
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Glick DB. The Costs and Costing of Regulatory Compliance. Anesth Analg 2019; 127:331-332. [PMID: 30028383 DOI: 10.1213/ane.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David B Glick
- From the Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois
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30
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Surface contamination in the operating room: use of adenosine triphosphate monitoring. J Anesth 2018; 33:85-89. [PMID: 30539274 DOI: 10.1007/s00540-018-2590-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. METHODS ORs with high case volumes were selected for the study. Ten sites in each OR were swabbed using the AccuPoint® HC ATP Sanitation Monitoring device, which provided a numerical measure of contamination (relative light units, RLUs). According to the manufacturer, surfaces are considered clean at ≤ 400 RLUs. AM measurements were taken before the start of surgical cases and PM measurements were taken after cases were completed. RESULTS Eighty morning and 70 afternoon samples were obtained from 8 ORs. Apart from the OR floor, laryngoscope handles had the highest level of morning contamination (1204 RLUs, interquartile range 345, 2603), with 75% of AM samples and 100% of PM samples exceeding 400 RLUs. This contamination was comparable to hospital toilet seats (87% of samples exceeding 400 RLUs). No sites showed statistically significant increases in contamination from AM to PM. CONCLUSION Apart from the OR floors, laryngoscope handles emerged as a key OR site where improved cleaning practices may reduce cross-contamination risk. While some sites showed increased contamination over the course of the day, none of these met statistical significance thereby offering tentative evidence that current cleaning practices during case turnover are effective for most sites.
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Reprocessed single-use devices in laparoscopy: assessment of cost, environmental impact, and patient safety. Surg Endosc 2018; 32:4310-4313. [DOI: 10.1007/s00464-018-6275-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
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Sherman JD, Raibley LA, Eckelman MJ. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes. Anesth Analg 2018; 127:434-443. [PMID: 29324492 DOI: 10.1213/ane.0000000000002683] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Traditional medical device procurement criteria include efficacy and safety, ease of use and handling, and procurement costs. However, little information is available about life cycle environmental impacts of the production, use, and disposal of medical devices, or about costs incurred after purchase. Reusable and disposable laryngoscopes are of current interest to anesthesiologists. Facing mounting pressure to quickly meet or exceed conflicting infection prevention guidelines and oversight body recommendations, many institutions may be electively switching to single-use disposable (SUD) rigid laryngoscopes or overcleaning reusables, potentially increasing both costs and waste generation. This study provides quantitative comparisons of environmental impacts and total cost of ownership among laryngoscope options, which can aid procurement decision making to benefit facilities and public health. METHODS We describe cradle-to-grave life cycle assessment (LCA) and life cycle costing (LCC) methods and apply these to reusable and SUD metal and plastic laryngoscope handles and tongue blade alternatives at Yale-New Haven Hospital (YNHH). The US Environmental Protection Agency's Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) life cycle impact assessment method was used to model environmental impacts of greenhouse gases and other pollutant emissions. RESULTS The SUD plastic handle generates an estimated 16-18 times more life cycle carbon dioxide equivalents (CO2-eq) than traditional low-level disinfection of the reusable steel handle. The SUD plastic tongue blade generates an estimated 5-6 times more CO2-eq than the reusable steel blade treated with high-level disinfection. SUD metal components generated much higher emissions than all alternatives. Both the SUD handle and SUD blade increased life cycle costs compared to the various reusable cleaning scenarios at YNHH. When extrapolated over 1 year (60,000 intubations), estimated costs increased between $495,000 and $604,000 for SUD handles and between $180,000 and $265,000 for SUD blades, compared to reusables, depending on cleaning scenario and assuming 4000 (rated) uses. Considering device attrition, reusable handles would be more economical than SUDs if they last through 4-5 uses, and reusable blades 5-7 uses, before loss. CONCLUSIONS LCA and LCC are feasible methods to ease interpretation of environmental impacts and facility costs when weighing device procurement options. While management practices vary between institutions, all standard methods of cleaning were evaluated and sensitivity analyses performed so that results are widely applicable. For YNHH, the reusable options presented a considerable cost advantage, in addition to offering a better option environmentally. Avoiding overcleaning reusable laryngoscope handles and blades is desirable from an environmental perspective. Costs may vary between facilities, and LCC methodology demonstrates the importance of time-motion labor analysis when comparing reusable and disposable device options.
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Affiliation(s)
- Jodi D Sherman
- From the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Matthew J Eckelman
- Department of Civil & Environmental Engineering, Northeastern University, Boston, Massachusetts
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