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Guerra-Londono CE, Dexter F, Mitchell JD, Forrest PB, Penning DH. Effect of a non-reactive absorbent with or without environmentally oriented electronic feedback on anesthesia provider's fresh gas flow rates: A greening initiative. J Clin Anesth 2024; 95:111441. [PMID: 38452428 DOI: 10.1016/j.jclinane.2024.111441] [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: 11/28/2023] [Revised: 12/29/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVE To examine the effects of a non-reactive carbon dioxide absorbent (AMSORB® Plus) versus a traditional carbon dioxide absorbent (Medisorb™) on the FGF used by anesthesia providers and an electronic educational feedback intervention using Carestation™ Insights (GE HealthCare) on provider-specific change in FGF. DESIGN Prospective, single-center cohort study set in a greening initiative. SETTING Operating room. PARTICIPANTS 157 anesthesia providers (i.e., anesthesiology trainees, certified registered nurse anesthetists, and solo anesthesiologists). INTERVENTIONS Intervention #1 was the introduction of AMSORB® Plus into 8 Aisys CS2, Carestation™ Insights-enabled anesthesia machines (GE HealthCare) at the study site. At the end of week 6, anesthesia providers were educated and given an environmentally oriented electronic feedback strategy for the next 12 weeks of the study (Intervention #2) using Carestation™ Insights data. MEASUREMENTS The dual primary outcomes were the difference in average daily FGF during maintenance anesthesia between machines assigned to AMSORB® Plus versus Medisorb™ and the provider-specific change in average fresh gas flows after 12 weeks of feedback and education compared to the historical data. MAIN RESULTS Over the 18-week period, there were 1577 inhaled anesthetics performed in the 8 operating rooms (528 for intervention 1, 1049 for intervention 2). There were 1001 provider days using Aisys CS2 machines and 7452 provider days of historical data from the preceding year. Overall, AMSORB® Plus was not associated with significantly less FGF (mean - 80 ml/min, 97.5% confidence interval - 206 to 46, P = .15). The environmentally oriented electronic feedback intervention was not associated with a significant decrease in provider-specific mean FGF (-112 ml/min, 97.5% confidence interval - 244 to 21, P = .059). CONCLUSIONS This study showed that introducing a non-reactive absorbent did not significantly alter FGF. Using environmentally oriented electronic feedback relying on data analytics did not result in significantly reduced provider-specific FGF.
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Affiliation(s)
- Carlos E Guerra-Londono
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA.
| | - Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - John D Mitchell
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Patrick B Forrest
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Donald H Penning
- Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health, Detroit, MI, USA
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Trieu E, Ramirez-Caban LC, Shockley ME. Review of sustainable practices for the gynecology operating room. Curr Opin Obstet Gynecol 2024:00001703-990000000-00137. [PMID: 38837721 DOI: 10.1097/gco.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement. RECENT FINDINGS From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals. SUMMARY This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.
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Affiliation(s)
- Elissa Trieu
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
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Ogeron P, Boukebous B, Desender A, Massard-Combe P, Vorimore C, Guillon P. Average total weight of surgical waste and CO 2 carbon footprint of orthopedic surgery in France, estimated on the basis of a representative panel. Orthop Traumatol Surg Res 2024:103910. [PMID: 38782115 DOI: 10.1016/j.otsr.2024.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO2 footprint generated by these wastes and extrapolate the figure at the national scale. HYPOTHESIS Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO2 emission. MATERIALS AND METHODS It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, arthroscopic procedures (shoulder, knee), nerve release, forefoot osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO2 equivalent (KgEqCO2). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the VisuChir tool. RESULTS A total of 937kg of waste were produced for the 140 procedures, amongst which 514kg of ICW (54.8%) and 423kg of HW (45.2%). The overall median waste weight was 5.9kg (Q1: 4.4, Q3: 8.1), ranging from 1.8kg to 18.3kg. The overall median waste weight for HW was 2.8kg (Q1: 2.5, Q3: 3.4), ranging from 1.8kg to 17.8kg. The overall median waste weight for ICW was 3.8kg (Q1: 2.7, Q3: 4.8), ranging from 0.8kg to 7.2kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r=-0.47, p<10-4. The total median estimated carbon footprint was 4.3KgCO2Eq (Q1: 3.1, Q3: 5.8), ranging from 1.59KgCO2Eq (Q1: 1.5, Q3: 1.8) and 7.07KgCO2Eq (Q1: 6.7, Q3: 8.17). The total median estimated carbon footprint was 3.5KgCO2Eq for ICW (Q1: 2.5, Q3: 4.5) and 0.76KgCO2Eq (Q1: 0.54, Q3: 1.3) for HW. The national median estimated carbon footprint was 10.1 million KgEqCO2 in 2021 for orthopedic surgery. CONCLUSION Our study revealed that in most cases more than half of the wastes were ICW. The total estimated national carbon footprint for orthopedic procedures was 10 million kilograms. The reduction of the ICW constitutes a cornerstone, as they are responsible for more carbon emissions. LEVEL OF EVIDENCE III; prospective comparative observational in vivo study.
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Affiliation(s)
- Pierre Ogeron
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Baptiste Boukebous
- Inserm, UMR 1153, équipe ECAMO, CRESS (Centre of Research in Epidemiology and StatisticS), université Paris-Cité, Paris, France; Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, université Paris-Cité, AP-HP, Paris, France
| | - Anthony Desender
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Philippe Massard-Combe
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Camille Vorimore
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
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Mohr-Sasson A, Aycock M, Higgason N, Hui M, Bhalwal A, Jalloul R, Leon MG, Dziadek O, Montealegre A. Excess use of surgical supplies in minimally invasive benign gynecology surgery: an observational study. Am J Obstet Gynecol 2024:S0002-9378(24)00590-8. [PMID: 38761838 DOI: 10.1016/j.ajog.2024.05.008] [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: 01/08/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Single-use materials and equipment are regularly opened by the surgical team during procedures but left unused, potentially resulting in superfluous costs and excess environmental waste. OBJECTIVE This study aimed to estimate the excess use of surgical supplies in minimally invasive benign gynecologic surgeries. STUDY DESIGN This is a prospective observational study conducted at a university-affiliated single tertiary medical center. Designated study personnel were assigned to observe surgical procedures performed during July to September 2022. Surgical teams were observed while performing surgeries for benign indications. The teams were not informed of the purpose of the observation to avoid potential bias. Disposable materials and equipment opened during the procedure were documented. Excess supplies were defined as those opened but left unused before being discarded. Costs per item of the excess supplies were estimated on the basis of material and equipment costs provided by the hospital. RESULTS A total of 99 surgeries were observed, including laparoscopic (32%), robotic (39%), hysteroscopic (14%), vaginal (11%), and laparotomy procedures (3%). Excess use of surgical supplies was documented in all but one procedure. The total cost across all surgeries reached $6357. The contained tissue extraction bag was the most expensive item not used (Applied Medical, Rancho Santa Margarita, CA; $390 per unit) in 4 procedures, contributing 25.54% to the total cost. Raytec was the most common surgical waste, with a total of n=583 opened but unused (average n=5.95 per surgery). A significant difference was found in the rate of excess supplies across the surgical approaches, with robotic surgery contributing 52.19% of the total cost (P=.01). CONCLUSION Excess use of disposable materials and equipment is common in minimally invasive benign gynecologic surgeries and contributes to superfluous costs and excess environmental waste. It is predominantly attributed to the opening of inexpensive materials that are left unused during the procedure. Increased awareness of costs and generated waste may reduce excess use of surgical supplies and should be further explored in future research.
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Affiliation(s)
- Aya Mohr-Sasson
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Madison Aycock
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Noel Higgason
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mason Hui
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Asha Bhalwal
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Randa Jalloul
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mateo G Leon
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Olivia Dziadek
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Alvaro Montealegre
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
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Or Z, Seppänen AV. The role of the health sector in tackling climate change: A narrative review. Health Policy 2024; 143:105053. [PMID: 38537397 DOI: 10.1016/j.healthpol.2024.105053] [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: 12/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Climate change is one of the largest threats to population health and has already affected the ecosystem, food production, and health and wellbeing of populations all over the world. The healthcare sector is responsible for around 5 % of greenhouse gas emissions worldwide and can play a key role in reducing global warming. This narrative review summarized the information on the role of healthcare systems in addressing climate change and strategies for reducing its negative impact to illustrate different types of actions that can support the ecological transformation of healthcare systems to help reaching sustainable development goals. A wide range of green interventions are shown to be effective to reduce the carbon footprint of healthcare and can have a meaningful impact if implemented systematically. However, these would not suffice unless accompanied by systemic mitigation strategies altering how healthcare is provided and consumed. Sustainable healthcare strategies such as reducing waste and low-value care will have direct benefits for the environment while improving economic and health outcomes. The healthcare sector has a unique opportunity to leverage its position and resources to provide a comprehensive strategy for fighting climate change and improving population health and the environment on which it depends.
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Affiliation(s)
- Zeynep Or
- Institut de recherche et documentation en économie de la santé (IRDES), France.
| | - Anna-Veera Seppänen
- Institut de recherche et documentation en économie de la santé (IRDES), France
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Loeb S. Engaging in Clinical Research and Practice Approaches that Reduce Environmental Impact. Eur Urol Oncol 2024:S2588-9311(24)00099-3. [PMID: 38688768 DOI: 10.1016/j.euo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.
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Affiliation(s)
- Stacy Loeb
- Department of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs, New York, NY, USA.
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Grüßer L, Bayram B, Ziemann S, Wallqvist J, Wienhold J, Rossaint R, Derwall M, Follmann A. Teleconsultation for Preoperative Anesthesia Evaluation: Identifying Environmental Potentials by Life Cycle Assessment. Telemed J E Health 2024. [PMID: 38656124 DOI: 10.1089/tmj.2023.0700] [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: 04/26/2024] Open
Abstract
Introduction: Teleconsultations for preoperative evaluation in anesthesiology proved to be feasible during the COVID-19 pandemic. However, widespread implementation of teleconsultations has not yet occurred. Besides time savings and economic benefits, teleconsultations in anesthesia may have the potential to reduce CO2 emissions. Methods: We conducted a life cycle assessment based on prospective surveys to assess the potential environmental benefits of preoperative anesthesia teleconsultations in comparison to the status-quo in-person consultations. Within 1 month, all patients presenting at the preoperative anesthesia clinic at RWTH Aachen University Hospital were asked about the distance traveled and mode of transportation to the hospital. The main outcome measure was the potential environmental benefit resulting from the implementation of teleconsultations. Results: In total, 821 out of 981 patients presenting at the anesthesia clinic participated in the survey. Most patients visited on an outpatient basis (62.9%) and traveled by car (81.7%). The median travel distance was 25 km [interquartile range 12-40]. If patients who came to the hospital solely for the anesthesia appointment had scheduled virtual appointments, the emissions of 3.03-ton CO2 equivalents (CO2-eq) could be avoided in the first month after implementation. The environmental impact associated with the production of teleconsultation equipment is outweighed by the reduction in patient travel. If all outpatient appointments were performed virtually, these savings would triple. Within 10 years, more than 1,300 tons CO2-eq could be avoided. Conclusion: Teleconsultations can mitigate the environmental impact of in-person anesthesia consultations. Further research is essential to leverage teleconsultations for preoperative evaluation also across other medical specialties.
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Affiliation(s)
- Linda Grüßer
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Berfin Bayram
- Department Anthropogenic Material Cycles, RWTH Aachen University, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Wienhold
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Andreas Follmann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
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Downes A, Healy DG. Expiry dates in surgical equipment: What are the options? Surgeon 2024:S1479-666X(24)00030-1. [PMID: 38584040 DOI: 10.1016/j.surge.2024.03.003] [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: 01/14/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Hospitals and the healthcare system contribute significantly to global warming, due to the energy use, water use and waste produce going directly to landfill. The operating theatre environment contributes to 70% of all hospital waste, and a proportion of this is due to unused surgical supplies, such as those stocked but never used as they go past their use-by date. AIM To evaluate how use-by dates are identified and assigned to surgical equipment, and if there are opportunities to re-use, or re-sterilise this equipment in order to reduce waste from the operating theatre environment. RESULTS Use-by dates are assigned to ensure sterility and longevity of the device, and are assigned based on risk analysis, retrospective and prospective assessment. Incineration is the mainstay of disposal of unused medical devices, but there are alternative options such as re-processing in specific circumstances. CONCLUSION A large volume of hospital waste is due to operating theatres, and there is movement towards developing more sustainable methods of dealing with expired surgical equipment. This is however in the early stages, with further research required to confirm if these methods will be safe for patients, and beneficial to the environment.
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Affiliation(s)
- Amber Downes
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - David G Healy
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Ireland
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Muret J. Environmental responsibility in the operating theater. J Visc Surg 2024; 161:1-2. [PMID: 38155040 DOI: 10.1016/j.jviscsurg.2023.11.009] [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] [Indexed: 12/30/2023]
Affiliation(s)
- Jane Muret
- Curie Institute, PSL University, Department of Anesthesia, Intensive Care and Pain, Pain Resuscitation, 26, rue d'Ulm, 75005 Paris, France.
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Leone N, Scozzari G, Olandese F, Horeman T, Passera R, Arezzo A, Morino M. "O.R. GOES GREEN": a first step toward reducing our carbon footprint in the operating room and hospital. Updates Surg 2024:10.1007/s13304-024-01793-8. [PMID: 38526697 DOI: 10.1007/s13304-024-01793-8] [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: 10/12/2023] [Accepted: 02/24/2024] [Indexed: 03/27/2024]
Abstract
Hospitals in Europe produce approximately 6 million tons of medical waste annually, about one-third of this originating in operating rooms. Most of it is solid waste, which can be recycled if bodily fluids do not contaminate it. Only 2-3% of hospital waste must be disposed of as infectious waste, and this is much lower than the 50-70% of garbage in the biohazard waste stream. In June 2021, at the main operating room of the Department of General Surgery of the University of Turin, we began a separate collection program for materials consisting of plastic, paper, TNT (material not contaminated by bodily fluids), and biohazardous waste. We calculated the number of boxes and the weight of special waste disposed produced every month in one operating room for 18 months. The monthly number of Sanibox and the monthly weight of biohazardous waste decreased during the observation period. The reduction trend was not constant but showed variations during the 18 months. Direct proportionality between number of low-complexity procedures and production of biohazardous waste was found (p = 0.050). We observed an optimization in the collection and filling of plastic, paper and TNT boxes separated and sent for recycling. One of the barriers to recycling hospital waste, and surgical waste in particular, is the failure to separate infectious waste from clean waste. A careful separate collection of waste in the operating room is the first step in reducing environmental pollution and management costs for the disposal of hospital waste.
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Affiliation(s)
- Nicola Leone
- Department of Surgical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy.
| | - Gitana Scozzari
- Department of Health Care Management, Città della Salute e Delle Scienze Molinette, Turin, Italy
| | - Francesco Olandese
- Department of Surgical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - Tim Horeman
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Roberto Passera
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, C.So Dogliotti 14, 10126, Turin, Italy
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Dölker T, Schuler J, Wallqvist J, Rossaint R, Kowark A, Ziemann S, Schneider F, Baumann AA, Conway N, Grüßer L. Easy-to-implement educational interventions to bring climate-smart actions to daily anesthesiologic practice: a cross-sectional before and after study. Minerva Anestesiol 2024; 90:126-134. [PMID: 38535970 DOI: 10.23736/s0375-9393.23.17767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Anesthesia contributes significantly to a hospital's carbon footprint. Climate-smart actions have the potential to reduce greenhouse gas emissions. Prerequisites for sustainable behavior of providers are knowledge and awareness. We aimed to assess the change in anesthesiologists' climate-friendly behavior before and after educational interventions in three areas that every anesthesiologist can address in their daily clinical routine: 1) energy use; 2) recycling opportunities; 3) consumption of volatile anesthetics. METHODS We performed a cross-sectional before-and-after single center sub-study within the multicenter "Provider Education and Evaluation Project" at the Department of Anesthesiology, RWTH Aachen University hospital from May3 2021 to May 1 2022. Educational interventions consisted of stickers, posters and a presentation on climate-smart actions in anesthesiologists' work routine between the first and the second assessment. For each cross-sectional assessment, all central 28 ORs were observed for one week. During the before-and-after comparison we analyzed: 1) energy wasted in unoccupied ORs because of running computers and turned-on lights at 9 p.m.; 2) feasibility of recycling preoperative anesthesia plastic packaging by determining the difference between calculated weight of unseparated preoperative plastic waste in the first assessment and the weight of actual separated waste in the second assessment; 3) fresh gas flow in balanced anesthesia cases in steady state at 9 a.m., and purchased hypnotics converted to bottles/1000 general anesthesia cases in 2018-2022. RESULTS We observed a reduction of wasted energy by 44% in unoccupied ORs. Usage of low fresh gas flow settings increased from 55% to 75%. The average of purchased desflurane in 2018-2020 decreased by 72% in 2022. We calculated 10.33 kg of preoperative plastic waste per week but were unable to implement waste separation for infrastructural and logistical reasons. CONCLUSIONS We found that environment-friendly working behaviors increased after the implementation of educational interventions. The causality between the interventions and the observed improvements remains to be proven.
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Affiliation(s)
- Theresa Dölker
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Julia Schuler
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Ana Kowark
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Frederick Schneider
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Adrian A Baumann
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Neal Conway
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Linda Grüßer
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany -
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12
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Baboudjian M, de La Taille A, Lechevallier E, Pradere B, Mallet R. Urologists and Sustainability: The First Survey from the French Sustainability Working Group. Eur Urol Focus 2024:S2405-4569(24)00020-8. [PMID: 38395728 DOI: 10.1016/j.euf.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Michael Baboudjian
- Department of Urology, North Academic Hospital, AP-HM, Marseille, France.
| | - Alexandre de La Taille
- Department of Urology, University Hospital Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, AP-HM, La Conception Academic Hospital, Marseille, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Department of Urology UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Richard Mallet
- Department of Urology, Hôpital Privé Francheville, Périgueux, France
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13
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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: 0] [Impact Index Per Article: 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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14
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Roscioli R, Wyllie T, Neophytou K, Dent L, Lowen D, Tan D, Dunne B, Hodgson R. How we can reduce the environmental impact of our operating theatres: a narrative review. ANZ J Surg 2023. [PMID: 37985608 DOI: 10.1111/ans.18770] [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: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re-use and re-processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service.
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Affiliation(s)
- Robert Roscioli
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Tracey Wyllie
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | | | - Lana Dent
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | - Darren Lowen
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - David Tan
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
| | - Ben Dunne
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Peter Macallum Cancer Centre, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Russell Hodgson
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
- Division of Surgery, Northern Health, Epping, Victoria, Australia
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15
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Leapman MS. Confronting the Climate Emergency in Urology. Eur Urol Focus 2023; 9:855-856. [PMID: 38042650 DOI: 10.1016/j.euf.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
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16
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Rodler S, Ramacciotti LS, Maas M, Mokhtar D, Hershenhouse J, De Castro Abreu AL, Fuchs G, Stief CG, Gill IS, Cacciamani GE. The Impact of Telemedicine in Reducing the Carbon Footprint in Health Care: A Systematic Review and Cumulative Analysis of 68 Million Clinical Consultations. Eur Urol Focus 2023; 9:873-887. [PMID: 38036339 DOI: 10.1016/j.euf.2023.11.013] [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: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT Carbon footprint (CF) has emerged as an important factor when assessing health care interventions. OBJECTIVE To investigate the reduction in CF for patients utilizing telemedicine. EVIDENCE ACQUISITION The PubMed, Scopus, and Web of Science databases were queried for studies describing telemedicine consultation and reporting on carbon emissions saved and the carbon emissions of telemedicine devices as primary outcomes, and travel distance and time and cost savings and safety as secondary outcomes. Outcomes were tabulated and calculated per consultation. Carbon emissions and travel distances were also calculated for each total study cohort. Risk of bias was assessed using the Newcastle-Ottawa scale, and the Oxford level of evidence was determined. EVIDENCE SYNTHESIS A total of 48 studies met the inclusion criteria, covering 68 465 481 telemedicine consultations and savings of 691 825 tons of CO2 emissions and 3 318 464 047 km of travel distance. Carbon assessment was mostly reported as the estimated distance saved using a conversion factor. Medical specialties used telemedicine to connect specialists with patients at home (n = 25) or at a local center (n = 6). Surgical specialties used telemedicine for virtual preoperative assessment (n = 9), follow-up (n = 4), and general consultation (n = 4). The savings per consultation were 21.9-632.17 min and $1.85-$325. More studies focused on the COVID-19 time frame (n = 33) than before the pandemic (n = 15). The studies are limited by calculations, mostly for the travel distance for carbon savings, and appropriate follow-up to analyze the real impact on travel and appointments. CONCLUSIONS Telemedicine reduces the CF of the health care sector. Expanding the use of telemedicine and educating providers and patients could further decrease CO2 emissions and save both money and time. PATIENT SUMMARY We reviewed 48 studies on the use of telemedicine. We found that people used their cars less and saved time and money, as well as CO2 emissions, if they used teleconsultations. Some studies only looked at how much CO2 from driving was saved, so there might be more to learn about the benefits of teleconsultations. The use of online doctor appointments is not only good for our planet but also helps patients in saving time and money. This review is registered on the PROSPERO database for systematic reviews (CRD42023456839).
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Affiliation(s)
- Severin Rodler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA; Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Maas
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Mokhtar
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jacob Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Gerhard Fuchs
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Christian G Stief
- Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
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Pradere B, Misraï V, Baboudjian M. How Best to Implement Climate-smart Actions in Clinical Urologic Care. Eur Urol Focus 2023; 9:863-865. [PMID: 37940391 DOI: 10.1016/j.euf.2023.10.017] [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: 09/10/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023]
Abstract
We highlight the need for multidisciplinary teamwork, education, practical sustainability actions, informed choices for devices, and research in urologic care to reduce its environmental impact while maintaining quality health care for patients.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France.
| | - Vincent Misraï
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France
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18
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Ho KA, Naseem Z. Greener theatre, greener surgery - environmental sustainability in a rural surgical setup. ANZ J Surg 2023; 93:1134-1140. [PMID: 37226662 DOI: 10.1111/ans.18369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Kah Ann Ho
- Department of Surgery, Griffith Base Hospital, Griffith, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | - Zainab Naseem
- Department of Surgery, Griffith Base Hospital, Griffith, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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19
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Lim BLS, Narayanan V, Nah SA. Knowledge, attitude, and practices of operating theatre staff towards environmentally sustainable practices in the operating theatres. Pediatr Surg Int 2023; 39:152. [PMID: 36930355 DOI: 10.1007/s00383-023-05400-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Successful implementation of environmentally sustainable practices in the operating theatre (OT) requires stakeholder engagement. We evaluate the knowledge, attitudes, and practices of OT users in our institution towards sustainable practices in the OT. METHODS A survey was conducted among OT users in August 2022. Respondents completed a 44-question anonymised online survey covering sustainability in (1) knowledge, (2) attitude, (3) practice, and (4) proposed changes to current practices. Points were assigned to knowledge (15 points) and attitude (40 points) sections. Practice was evaluated based on proportion of measures practiced. Appropriate statistical tests were used, with significance p < 0.05. Data are presented as mean ± standard deviation (SD) or proportion (%). RESULTS Among 149 respondents were doctors (n = 76), non-doctors (n = 45), and medical students (n = 28). Doctors scored highest in knowledge of sustainability (8.58 ± 1.83) compared to non-doctors and medical students (7.62 ± 1.75, 8.39 ± 1.87). Positive attitudes towards sustainability correlated with years of experience (p < 0.01). Non-doctors were more likely to practice sustainable measures, versus doctors (61 vs 52%, p < 0.01). Most (69%) respondents were unwilling to adopt any practice changes. The least popular measure was replacement of standard hand scrubbing with alcohol-based hand rub, considered unsafe by 74% of respondents. CONCLUSION Despite positive attitudes towards sustainable measures, there remains wariness of practice changes, which should be addressed by educational campaigns.
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Affiliation(s)
- Bonnie L S Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Vairavan Narayanan
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Shireen Anne Nah
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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20
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Sherry B, Lee S, Ramos Cadena MDLA, Laynor G, Patel SR, Simon MD, Romanowski EG, Hochman SE, Schuman JS, Prescott C, Thiel CL. How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take. Ophthalmology 2023:S0161-6420(23)00137-9. [PMID: 36889466 DOI: 10.1016/j.ophtha.2023.02.028] [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: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
TOPIC Understanding approaches to sustainability in cataract surgery and their risks and benefits CLINICAL RELEVANCE: In the United States, healthcare is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single use supplies to reusables or implementing a hub-and-spoke style theatre setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery.
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Affiliation(s)
| | - Samuel Lee
- NYU Langone Health, NYU Langone Hospitals
| | | | | | | | | | - Eric G Romanowski
- Research Director of The Charles T. Campbell Ophthalmic Microbiology Laboratory; Research Instructor of Ophthalmology, Department of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh, PA
| | - Sarah E Hochman
- Assistant Professor, Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine
| | | | - Christina Prescott
- Residency Program Director; Vice Chair for Education; Director of the Cornea Service; Department of Ophthalmology, NYU Langone Health, New York University, New York, New York, 10017, USA
| | - Cassandra L Thiel
- Assistant Professor Department of Population Health, NYU Grossman School of Medicine.
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21
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Hathi K, Fowler J, Zahabi S, Dzioba A, Madou E, Gunz AC, Sowerby LJ, Nichols AC, Strychowsky JE. Attitudes and Perceptions of Canadian Otolaryngology‐Head and Neck Surgeons and Residents on Environmental Sustainability. OTO Open 2023; 7:e40. [PMID: 36998559 PMCID: PMC10046710 DOI: 10.1002/oto2.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design Cross-sectional virtual survey. Setting Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.
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Affiliation(s)
- Kalpesh Hathi
- Faculty of Medicine Dalhousie Medicine New Brunswick Saint John New Brunswick Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Sarah Zahabi
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anna C. Gunz
- Department of Paediatrics Western University Ontario London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
- Department of Paediatrics Western University Ontario London Canada
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22
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Baboudjian M, Pradere B, Martin N, Gondran-Tellier B, Angerri O, Boucheron T, Bastide C, Emiliani E, Misrai V, Breda A, Lechevallier E. Life Cycle Assessment of Reusable and Disposable Cystoscopes: A Path to Greener Urological Procedures. Eur Urol Focus 2022:S2405-4569(22)00291-7. [PMID: 36543725 DOI: 10.1016/j.euf.2022.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The environmental impact of reusable and disposable devices is unclear; reuse is expected to reduce the carbon footprint, but the environmental impact of reprocessing of reusable devices is increasingly being questioned. OBJECTIVE The aim was to provide the first rigorous life cycle assessment of reusable and disposable flexible cystoscopes. DESIGN, SETTING, AND PARTICIPANTS We performed a life cycle assessment of reusable flexible cystoscopes and the aS4C single-use cystoscope (aScope; Ambu, Ballerup, Denmark). For the aScope, the complete lifespan of the scope was evaluated, including raw material extraction, material formulation, component production, product assembly, distribution, transportation after use, and final disposal. For reusable cystoscopes, we limited our analysis to their reprocessing, using a model consisting of standard high-level disinfection with peracetic acid. The environmental impact was evaluated by an independent third-party consulting company APESA (Technopole Hélioparc, Pau, France) dedicated to such risk assessments. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The environmental footprint of both cystoscopes was assessed using five environmental impact categories, namely, climate change, mineral resource depletion, ecotoxicity, acidification, and eutrophication. To perform the life cycle assessment, Simapro v9.3.3 software was used and the Ecoinvent v3.5 database was employed as the primary life cycle inventory database. A Monte Carlo analysis was used to account for the inherent uncertainty in life cycle inventory data and the variability in material and energy consumption for each type of flexible cystoscope. RESULTS AND LIMITATIONS By only comparing the disinfection reprocessing of reusable cystoscopes with the complete lifespan of the single-use cystoscope, the use of the aScope would allow a reduction of at least 33% in the climate change category, 50% in the mineral resources' depletion category, 51% in the ecotoxicity category, 71% in the acidification category, and 49% in the eutrophication category. Our results cannot be generalized to all health care facilities as we studied only one type of reprocessing method and one disposable flexible cystoscope. CONCLUSIONS Disinfection reprocessing of reusable cystoscopes was found to have a significantly larger environmental footprint and impact than the whole lifespan of the single-use cystoscope aScope. PATIENT SUMMARY Using a cradle-to-grave life cycle analysis, we showed that the environmental footprint of a flexible cystoscopy procedure can be reduced by using a disposable cystoscope instead of a reusable cystoscope.
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23
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Shum PL, Kok HK, Maingard J, Zhou K, Van Damme V, Barras CD, Slater LA, Chong W, Chandra RV, Jhamb A, Brooks M, Asadi H. Sustainability in interventional radiology: are we doing enough to save the environment? CVIR Endovasc 2022; 5:60. [PMCID: PMC9703417 DOI: 10.1186/s42155-022-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Healthcare waste contributes substantially to the world’s carbon footprint. Our aims are to review the current knowledge of Interventional Radiology (IR) waste generation and ways of reducing waste in practice, to quantify the environmental and financial impact of waste generated and address green initiatives to improve IR waste management.
Methods
A systematic literature search was conducted in July 2022 using the Medline and Embase literature databases. The scope of the search included the field of IR as well as operating theatre literature, where relevant to IR practice.
Results
One-hundred articles were reviewed and 68 studies met the inclusion criteria. Greening initiatives include reducing, reusing and recycling waste, as well as strict waste segregation. Interventional radiologists can engage with suppliers to reformulate procedure packs to minimize unnecessary items and packaging. Opened but unused equipment can be prevented if there is better communication within the team and increased staff awareness of wasted equipment cost. Incentives to use soon-to-expire equipment can be offered. Power consumption can be reduced by powering down operating room lights and workstations when not in use, changing to Light Emitting Diode (LED) and motion sensor lightings. Surgical hand wash can be replaced with alcohol-based hand rubs to reduce water usage. Common barriers to improving waste management include the lack of leadership, misconceptions regarding infectious risk, lack of data, concerns about increased workload, negative staff attitudes and resistance to change. Education remains a top priority to engage all staff in sustainable healthcare practices.
Conclusion
Interventional radiologists have a crucial role to play in improving healthcare sustainability. By implementing small, iterative changes to our practice, financial savings, greater efficiency and improved environmental sustainability can be achieved.
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Boucheron T, Lechevallier E, Gondran-Tellier B, Michel F, Bastide C, Martin N, Baboudjian M. Cost and Environmental Impact of Disposable Flexible Cystoscopes Compared to Reusable Devices. J Endourol 2022; 36:1317-1321. [PMID: 35703325 DOI: 10.1089/end.2022.0201] [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: 11/13/2022] Open
Abstract
Objectives: To quantify the environmental impact and costs associated with flexible cystoscopy procedures from an institutional perspective, with particular attention for the comparison between disposable and reusable cystoscopes. Materials and Methods: This is a single-center retrospective study, including all flexible cystoscopies performed between 2020 and 2021 using reusable or single-use devices. The Ambu aS4C single-use cystoscope (Ballerup, Denmark) gradually replaced the reusable device in our center, with exclusive use from October 2021. Reprocessing costs for reusable cystoscopes were evaluated using a micro-costing approach. The environmental impact of reusable and disposable cystoscopes was assessed by the amount of waste and water consumed for each procedure. Results: A total of 1578 flexible cystoscopies using reusable cystoscopes were performed in 2020, and 550 cystoscopies were performed using the Ambu aS4C cystoscope from October 2021 to February 2022. The cost of flexible cystoscopy with a reusable and a disposable endoscope was €196 and €192, respectively. The amount of waste generated by reprocessing reusable and disposable cystoscopes was 800 and 200 g per procedure, respectively. Water consumption for sterilization of the reusable cystoscope was 60 L per procedure, whereas no water consumption was required with the Ambu aS4C cystoscope. A 100% Ambu aS4C cystoscope use would reduce waste generation and water consumption by 946.8 kg and 94.68 m3 per year. Conclusion: In this study, implementing a strategy of using 100% disposable cystoscopes was associated with similar costs and reduced waste generation and water consumption compared to reusable devices. Future studies are needed to compare the carbon footprint of these devices, through a comprehensive and rigorous life cycle assessment from manufacturing to recycling.
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Affiliation(s)
- Tiphaine Boucheron
- Pharmacy Department, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Eric Lechevallier
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Floriane Michel
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Cyrille Bastide
- Department of Urology, North Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nathalie Martin
- Pharmacy Department, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Michael Baboudjian
- Department of Urology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Department of Urology, North Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.,Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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25
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Baboudjian M, Diana P, Breda A. Re: Benjamin Pradere, Richard Mallet, Alexandre de La Taille, et al. Climate-smart Actions in the Operating Theatre for Improving Sustainability Practices: A Systematic Review. Eur Urol. In press. https://doi.org/ 10.1016/j.eururo.2022.01.027. Eur Urol 2022; 82:e84-e85. [PMID: 35738981 DOI: 10.1016/j.eururo.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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Atif QAA. “The wheel is come full circle” – Sustainability in surgery. Ann Med Surg (Lond) 2022; 76:103473. [PMID: 35495389 PMCID: PMC9052127 DOI: 10.1016/j.amsu.2022.103473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
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