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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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Comparison of new versus reused Harmonic scalpel performance in laparoscopic appendectomy in patients with acute appendicitis-a randomized clinical trial. Langenbecks Arch Surg 2020; 406:153-162. [PMID: 33241426 DOI: 10.1007/s00423-020-02039-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to compare lateral thermal damage of the appendix and clinical outcomes after laparoscopic appendectomy using new versus reused Harmonic scalpels. METHODS A total of 100 consecutive patients with acute appendicitis who underwent laparoscopic appendectomy were enrolled in the two-center, randomized clinical trial. Using a computer random number generator, patients were allocated to new or reused group. Histopathological measurement of lateral thermal damage of the appendiceal base and mesoappendix, speed of transection of the appendiceal base, duration of surgery, subjective rating of device functionality, length of hospital stay, and complications were compared within groups. RESULTS The median lateral thermal damage on the appendiceal base in the new group (N = 49) was 0.2 mm (IQR 0.1-0.2) and 0.1 mm (IQR 0.1-0.3) in the reused group (N = 51) (P = 0.644), while on the mesoappendix for both groups, thermal damage was 0.1 mm (IQR 0.1-0.2) (P = 0.418). The median time required for base transection in both groups was 8 s (IQR 7-9) (P = 0.776). The median duration of surgery was also comparable between the groups (22 min, IQR 20-30 vs 25 min, IQR 21-35; P = 0.233). Two postoperative complications in the new group and one in the reused group were recorded (4% vs 2%; P = 0.536). Surgeons' subjective assessment of the instrument did not reveal significant difference between the groups in all of the investigated categories. CONCLUSIONS The results of our study support the reuse of Harmonic scalpels especially in the settings where economic constraints might hamper access to minimally invasive surgery to a larger number of patients. The results obtained on laparoscopic appendectomy might not be reproducible to other more demanding surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov registry under identifier NCT04226482.
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Chivukula SR, Lammers S, Wagner J. Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices. Surg Endosc 2020; 35:4539-4549. [PMID: 32909208 PMCID: PMC8263541 DOI: 10.1007/s00464-020-07969-8] [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: 03/30/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
Background Reprocessed devices must be thoroughly cleaned prior to sterilization to ensure efficacy of sterilization agents. Many single-use devices are not designed to be thoroughly cleaned. Interlocking design features inherent to LigaSure™ vessel sealing devices may prevent thorough cleaning and promote accumulation of human tissue that cannot be removed. Thus, the aim of this study was to compare industry reprocessed and new LigaSure™ vessel sealing devices for organic material. Methods A total of 168, 84 new and 84 reprocessed, vessel sealing devices were disassembled and inspected for the presence of residual organic matter using visual, microscopic, and chemical analysis. Devices were randomized and test conductors blinded to group membership. Devices were aseptically disassembled and sent through visual inspection. Next, devices were either examined using light microscopy, scanning electron microscopy (SEM) or exposed to a solution that luminesces in the presence of hemoglobin. Additionally, 165 reprocessed devices were sent to a 3rd party lab for sterility testing via direct immersion culture for 14 days. Results Significant amounts of remnant organic material (C, N, O, S, Na, P) were observed with 81/84 reprocessed and 0/84 new devices failing inspection protocols. When tested for the presence of hemoglobin, only 1/12 reprocessed devices passed inspection. SEM of reprocessed devices revealed residues with liquid patterns and diffuse soiling with foreign material. Sterility testing of reprocessed devices revealed a sterility level < 6–3. Conclusions The abundance of material resembling human tissue observed on reprocessed VSDs suggests inadequate cleaning prior to sterilization. Atomic and morphological analyses of the remnant materials suggest that bacterial biofilms could also be present. Additionally, surface degradation and release of reinforcing glass fibers from the device were observed. Devices designed for single use can harbor significant amounts of remnant material that likely interfere with the sterilization process.
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Affiliation(s)
- Swathi Ramesh Chivukula
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA
| | - Steven Lammers
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA
| | - Jennifer Wagner
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA.
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Quitzan JG, Singh A, Beaufrere H, Valverde A, Lillie B, Salahshoor M, Bardelcik A, Saleh TM. Evaluation of the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device intended for single use after multiple use-and-resterilization cycles. Vet Surg 2020; 49 Suppl 1:O120-O130. [PMID: 32053219 DOI: 10.1111/vsu.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/22/2019] [Accepted: 01/18/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the performance of an endoscopic 3-mm electrothermal bipolar vessel sealing device (EBVS) intended for single use after multiple use-and-resterilization cycles. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Eight 3-mm EBVS handpieces. METHODS Handpieces were subjected to a maximum of 15 cycles of testing, including simulated surgery, sealing and burst pressure testing of porcine carotid arteries, reprocessing, and hydrogen peroxide plasma resterilization. Failure was defined as two sequential vascular seal leakage events occurring at <250 mm Hg. Histological evaluation, maximum external temperature of the jaws, sealing time, tissue adherence, jaw surface characterization, and mechanical deterioration were studied. Failure rate was analyzed by using a Kaplan-Meier curve. Linear and ordinal logistic mixed models were used to analyze sealing time, handpiece jaw temperature, and adherence score. RESULTS Mean ± SD diameter of arteries was 3.22 ± 0.35 mm. Failure was observed starting at cycle 10 and going up to cycle 13 in 37.5% (3/8) of the handpieces. Tissue adherence increased after each cycle (P < .001). Maximum external temperature (79.8°C ± 13.9°C) and sealing time (1.8 ± 0.5 seconds) were not significantly different throughout cycles up to failure. A flatter surface and large scratches were observed microscopically throughout the jaw surface after repeated use and resterilization. CONCLUSION The 3-mm EBVS handpiece evaluated in this study can be considered safe to use for up to nine reuse-and-resterilization cycles. CLINICAL SIGNIFICANCE These data provide the basis for establishing preliminary guidelines for the reuse and hydrogen peroxide plasma resterilization of an endoscopic 3-mm EBVS handpiece.
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Affiliation(s)
- Juliany Gomes Quitzan
- School of Veterinary Medicine and Animal Science, Sao Paulo State University, Botucatu, Sao Paulo, Brazil.,Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Brandon Lillie
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Masoomeh Salahshoor
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Alexander Bardelcik
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Ontario, Canada
| | - Tarek M Saleh
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Ontario, Canada
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