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Purpose In recent years, the rising costs and infection control lead to an increasing use of disposable surgical instruments in daily hospital practices. Environmental impacts have risen as a result across the life cycle of plastic or stainless steel disposables. Compared with the conventional reusable products, different qualities and quantities of disposable scissors have to be taken into account. An eco-efficiency analysis can shed some light for the potential contribution of those products towards a sustainable development. Methods Disposable scissors made of either stainless steel or fibre-reinforced plastic were compared with reusable stainless steel scissors for 4,500 use cycles of surgical scissors used in Germany. A screening life cycle assessment (LCA) and a life cycle costing were performed by following ISO 14040 procedure and total cost of ownership (TCO) from a customer perspective, respectively. Subsequently, their results were used to conduct an eco-efficiency analysis. Results and discussion The screening LCA showed a clear ranking regarding the environmental impacts of the three types of scissors. The impacts of the disposable steel product exceeds those of the two others by 80 % (disposable plastic scissors) and 99 % (reusable steel scissors), respectively. Differences in TCO were smaller, however, revealing significant economic advantages of the reusable stainless steel product under the constraints and assumptions of this case study. Accordingly, the reusable stainless steel product was revealed as the most eco-efficient choice. It was followed by the plastic scissors which turned out to be significantly more environmentally sound than the disposable stainless steel scissors but also more cost-intensive. Conclusions The overall results of the study prove to be robust against variations of critical parameters for the prescribed case study. The sensitivity analyses were also conducted for LCA and TCO results. LCA results are shown to be reliable throughout all assumptions and data uncertainties. TCO results are more dependent on the choice of case study parameters whereby the price of the disposable products can severely influence the comparison of the stainless steel and the plastic scissors. The costs related to the sterilisation of the reusable product are strongly case-specific and can reduce the economic benefit of the reusable scissors to zero. Differences in environmental and economic break-even analyses underline the comparatively high share of externalised environmental costs in the case of the disposable steel product.

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... However, nurses were the authors in only five studies (2 Brazilian studies) (14,15) , one from Canada (15) and two from the United States of America (16,17) . The other authors were from the areas of biology (2) , biostatistics (16) , biochemistry (17) , geology (18) , chemistry (19) , medicine (3,17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) , marketing (20,23) , engineering (19,20,(22)(23)(24)(25)(30)(31)(32)(33)(34)(35)(36)(37)(38) and administration (17,20,22,39) . ...
... Environmental sustainability indicators generally point to two attention groups; optimization of resources (energy and water) and monitoring and mitigation of the impact of its activities (effluents, waste and emissions) (11) , such as an integrated system of composting, incineration and recycling of materials (35) . From the selection of articles in this scoping review emerged two empirical categories for indicators, and another category was added for evidence of reduced socio-environmental impact. ...
... As for monitoring and mitigating the impact of its activities (effluents, waste and emissions) in hospitals, the selected studies (9,11,12,18,19,23,28,29,31,34,35) brought indicators related to the quantification of waste before and after interventions, recycling of hospital waste, effectiveness of infectious waste treatments, life cycle of solid waste, carbon footprint in surgeries and identification of pharmaceutical residues in effluents. ...
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Objective: To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact. Method: Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included. Results: A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability. Conclusion: The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved.
... No entanto, apenas cinco estudos tinham enfermeiros como autores (dois estudos brasileiros (14,15) , um do Canadá (15) e dois dos Estados Unidos da América (16,17) ). Os demais autores eram das áreas de biologia (2) , bioestatística (16) , bioquímica (17) , geologia (18) , química (19) , medicina (3,17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) , marketing (20,23) , engenharia (19,20,(22)(23)(24)(25)(30)(31)(32)(33)(34)(35)(36)(37)(38) e administração (17,20,22,39) . ...
... Os indicadores ambientais de sustentabilidade geralmente apontam para dois grupos de atenção; otimização de recursos (energia e água) e monitoramento e mitigação do impacto de suas atividades (efluentes, resíduos e emissões) (11) , a exemplo de um sistema integrado de compostagem, incineração e reciclagem de materiais (35) . Dessa forma, a partir da seleção dos artigos desta revisão de escopo, emergiram duas categorias empíricas para indicadores e foi acrescida mais uma categoria para evidências de redução do impacto socioambiental, que foram explanadas no Quadro 4. ...
... Quanto ao monitoramento e mitigação do impacto de suas atividades (efluentes, resíduos e emissões) nos hospitais; os estudos selecionados (9,11,12,18,19,23,28,29,31,34,35). trouxeram indicadores relacionados à quantificação de resíduos antes e depois de intervenções, reciclagem de resíduos hospitalares, eficácia de tratamentos de resíduos infecciosos, ciclo de vida de resíduos Quadro 3 -Caracterização das publicações recuperadas na busca nas bases de dados eletrônicas e busca pelas referências -Rio Grande, RS, Brasil, 2022 (n = 28). ...
Article
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Objective To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact. Method Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included. Results A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability. Conclusion The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved. Conservation of Natural Resource; Environment; Sustainable Development; Hospital; Sustainable Development Indicator
... Surgical procedures are one of the most resource intensive activities in healthcare [7] and an analysis of the environmental impacts of surgical procedures using life-cycle assessment (LCA) methodology is suggested as a valuable tool to increase sustainability of health care by allowing comparisons of the environmental impact of products or processes [8]. Previous studies have compared the environmental impact of reusable and single-use surgical and anesthetic items such as laparotomy pads [9], scissors [10], gowns and drapes [11], sets of instruments for spinal surgery and vascular access [7,12] airway management items [13,14] and anesthetic drug trays [15]. In the majority of these studies the reusable alternative has been suggested to have a lower environmental impact than their single-use alternatives [9][10][11][13][14][15], but in some cases the opposite is true [7,12]. ...
... Previous studies have compared the environmental impact of reusable and single-use surgical and anesthetic items such as laparotomy pads [9], scissors [10], gowns and drapes [11], sets of instruments for spinal surgery and vascular access [7,12] airway management items [13,14] and anesthetic drug trays [15]. In the majority of these studies the reusable alternative has been suggested to have a lower environmental impact than their single-use alternatives [9][10][11][13][14][15], but in some cases the opposite is true [7,12]. Thus, reusability of medical equipment does not always result in lower environmental impacts. ...
... The finding that single-use trocar systems have a higher environmental impact than reusable items align with a growing body of literature suggesting that the environmental impact of reusable products used perioperatively is lower than that of single-use alternatives. For example, reusable scissors [10], laryngeal masks [13], laryngoscope blades and handles [14], laparotomy pads [9], anesthetic drug trays [15], gowns and drapes [11], and sharps containers [34] have all been suggested to have a lower environmental impact than single-use alternatives. However, there are studies in which reusable instruments have been suggested to have a larger environmental impact than their single-use alternatives. ...
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Introduction Climate change is one of the 21st century’s biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed countries. About 15 million laparoscopic procedures are performed annually worldwide and single-use medical equipment is increasingly used during these procedures. Little is known about costs and environmental footprint of this change in practice. Methods We employed Life Cycle Assessment method to evaluate and compare the environmental impacts of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies at three hospitals in southern Sweden. The environmental impacts were calculated using the IMPACT 2002+ method and a functional unit of 500 procedures. Monte Carlo simulations were used to estimate differences between trocar systems. Data are presented as medians and 2.5th to 97.5th percentiles. Financial costs were calculated using Life Cycle Costing. Results The single-use system had a 182% higher impact on resources than the reusable system [difference: 5160 MJ primary (4400–5770)]. The single-use system had a 379% higher impact on climate change than the reusable system [difference: 446 kg CO2eq (413–483)]. The single-use system had an 83% higher impact than the reusable system on ecosystem quality [difference: 79 PDF*m²*yr (24–112)] and a 240% higher impact on human health [difference: 2.4x10⁻⁴ DALY/person/yr (2.2x10⁻⁴-2.6x10⁻⁴)]. The mixed and single-use systems had a similar environmental impact. Differences between single-use and reusable trocars with regard to resource use and ecosystem quality were found to be sensitive to lower filling of machines in the sterilization process. For ecosystem quality the difference between the two were further sensitive to a 50% decrease in number of reuses, and to using a fossil fuel intensive electricity mix. Differences regarding effects on climate change and human health were robust in the sensitivity analyses. The reusable and mixed trocar systems were approximately half as expensive as the single-use systems (17360 € and 18560 € versus 37600 €, respectively). Conclusion In the Swedish healthcare system the reusable trocar system offers a robust opportunity to reduce both the environmental impact and financial costs for laparoscopic surgery.
... Currently, hospitals are opting to use non-recyclable products-like gowns, gloves, syringes during surgeries, etc.-and replace them with more environmentally friendly products. A few emerging trends in terms of sustainability are when it comes to reusability, medical tools including stainless steel instruments are common nowadays (Ibbotson et al., 2013). Such measures assist in realizing waste minimization at the onset and transitioning the operation of healthcare systems to the circular economy model as its key framework . ...
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In a world increasingly defined by environmental challenges, public health concerns, and the quest for sustainable industrial practices, the role of biotechnology has never been more critical. Biotechnology for a Green Future explores the groundbreaking advancements at the intersection of biology, technology, and sustainability. This book delves into the innovative applications of microbial systems, nanoparticles, medicinal plants, biocontrol agents, and bioinformatics, offering a comprehensive overview of how these emerging fields are shaping the future of health, agriculture, and industry. With a focus on green and sustainable synthesis techniques, we examine how modern biotechnology harnesses the power of nature to solve pressing global issues, from reducing environmental pollution to enhancing medical therapies. We explore how microorganisms, such as yeasts, bacteria, and fungi, are revolutionizing industrial processes and medicine, while offering eco-friendly alternatives to conventional methods. Furthermore, we discuss the growing role of bioinformatics in drug discovery, providing new tools for precision medicine and personalized healthcare. This book also highlights the challenges that accompany these innovations— scientific, ethical, and regulatory—and presents real-world case studies that demonstrate the potential of biotechnologies to transform industries, improve human health, and protect the planet. As we look to the future, Biotechnology for a Green Future offers insights into the next frontiers of scientific discovery and the ways in which biotechnology will continue to address the complexities of a rapidly changing world.
... Currently, hospitals are opting to use non-recyclable products-like gowns, gloves, syringes during surgeries, etc.-and replace them with more environmentally friendly products. A few emerging trends in terms of sustainability are when it comes to reusability, medical tools including stainless steel instruments are common nowadays (Ibbotson et al., 2013). Such measures assist in realizing waste minimization at the onset and transitioning the operation of healthcare systems to the circular economy model as its key framework . ...
Book
Full-text available
In a world increasingly defined by environmental challenges, public health concerns, and the quest for sustainable industrial practices, the role of biotechnology has never been more critical. Biotechnology for a Green Future explores the groundbreaking advancements at the intersection of biology, technology, and sustainability. This book delves into the innovative applications of microbial systems, nanoparticles, medicinal plants, biocontrol agents, and bioinformatics, offering a comprehensive overview of how these emerging fields are shaping the future of health, agriculture, and industry. With a focus on green and sustainable synthesis techniques, we examine how modern biotechnology harnesses the power of nature to solve pressing global issues, from reducing environmental pollution to enhancing medical therapies. We explore how microorganisms, such as yeasts, bacteria, and fungi, are revolutionizing industrial processes and medicine, while offering eco-friendly alternatives to conventional methods. Furthermore, we discuss the growing role of bioinformatics in drug discovery, providing new tools for precision medicine and personalized healthcare. This book also highlights the challenges that accompany these innovations—scientific, ethical, and regulatory—and presents real-world case studies that demonstrate the potential of biotechnologies to transform industries, improve human health, and protect the planet. As we look to the future, Biotechnology for a Green Future offers insights into the next frontiers of scientific discovery and the ways in which biotechnology will continue to address the complexities of a rapidly changing world.
... The cost of using SU specula was about EUR 24 998 for 15 years, considerably lower than the cost of RU specula, which was about EUR 51 579 for 15 years (Hospodková et al. 2023). This contrasts with other studies comparing other sterile or semi-critical instruments, such as laryngoscopes, and found a lower cost when using RU alternatives (Ibbotson et al. 2013;Unger and Landis 2016;McGain et al. 2017;Rizan and Bhutta 2022;Rizan et al. 2022a). ...
Article
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Abstrac Purpose Awareness is growing about the need for a circular healthcare sector. Choosing between single-use (SU) and reusable (RU) medical instruments should be based on evidence-based reasoning. RU and SU instruments differ in many stages of their life cycle. Vaginal specula are commonly used instruments in hospitals and in primary care. The aim of this study was to compare the environmental and economic cost of RU specula and three types of SU specula. Methods This study evaluated the environmental sustainability of using RU or SU vaginal specula through a cradle-to-grave life cycle assessment (LCA), using the ReCiPe 2016 Midpoint (H) V1.07 method, including 18 midpoints and the three endpoints human health, ecosystem quality, and resource scarcity. One pelvic examination was the functional unit to compare RU stainless steel specula with SU specula made of (i) fossil-based acrylonitrile butadiene styrene (SU ABS), (ii) bio-based polylactic acid (SU PLA), or (iii) polystyrene blades and a polyethylene bolt sterilised with ethylene oxide (SU EO). Alongside the LCA, an economic evaluation was conducted based on the total cost of ownership (TCO). Scenario analyses were performed for the environmental and economic part of the study. Results RU specula scored best for global warming leading to 86% less impact than SU ABS, 78% less than SU PLA specula, and 84% less than SU EO specula in the baseline scenario. RU specula performed better than SU specula from four to seven reuses, depending on the SU type. For the three endpoint estimates, RU specula were most favourable in the baseline scenario. Cost analysis for RU specula resulted in a total cost between € 1.22 and € 1.38 per use and between € 0.75 and € 1.34 per use for SU specula. Labour costs comprised more than half of the overall expenses for RU specula, whereas acquisition cost the main cost driver was for SU specula. Conclusion Environmental and economic hotspots of RU and SU specula were identified and can be used in decision-making about using more RU instruments. Raw materials and manufacturing were the key environmental and economic impact factors of SU specula. Packaging production and waste management were the main drivers of the environmental impact of RU specula but had only a minor economic impact on the TCO.
... Single-use items are prominent contributors to GHG emissions from operating theatres 63 and generate landfill waste, releasing methane gas. Reusable surgical equipment is a low-carbon alternative and can reduce the carbon footprint by 50-97% 63,[66][67][68][69][70] . For instance, reusable surgical gowns have 66% lower GHG emissions than disposable gowns 70 . ...
Article
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Background Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited. Methods A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated. Results The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29–8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29–22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80–49.06 kgCO₂eq) and full-thickness skin graft (31.58–37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England. Conclusion This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis.
... from £1.43 to £0.97 [20]. Ibbotson's LCA found that disposable stainless-steel scissors have a 40% higher CO 2 eq impact than plastic versions and a 94% higher impact than reusable stainless-steel scissors, advocating for a 44% cost reduction with reusable options [81]. McGain et al. performed a LCA and found that disposable drug trays in anesthesia cost twice as much, produced 15% more CO 2 and consumed three times the amount of water compared to reusable trays [82]. ...
Article
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Background Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery. Methods A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics. Results We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO2eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery. Conclusion This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.
... Surgical equipment accounts for a significant portion of the carbon footprint in surgeries, primarily due to the prevalence of disposable items [20]. Transitioning from disposable to reusable or hybrid equipment can positively impact the environment by reducing the carbon footprint [21][22][23]. However, the decontamination process of reusable surgical equipment represents a crucial environmental hotspot in its lifecycle. ...
Article
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Annually, over 300 million surgeries occur globally, requiring numerous surgical instruments. However, many instruments on the tray are returned to the central sterile supply department (CSSD) unused, creating an unsustainable pattern of unnecessary consumption. To address this, we developed a method for optimising surgical instrument trays (SITs) that is straightforward to implement in other hospitals. This optimisation aims to enhance patient safety and sustainability and to improve working conditions and reduce costs. We identified actual instrument usage (IU) in the operating room (OR) and obtained expert recommendations (ERs). Data from both methods were combined in a computer model (CM) to adjust the SITs. The performance of the adjusted SITs was assessed over a year. IU of three different SITs was collected during 16 procedures (mean = 28.4%, SD = 6.4%). Combining IU and ERs resulted in a 36.7% reduction in instruments and a 31.3% weight reduction. These measures contribute to reducing the carbon footprint and enhancing sustainability. During the evaluation of the new SIT contents (n = 7 procedures), mean IU increased from 28.4% (SD = 6.4%) to 46.5% (SD = 11.0%), with no missing instruments during surgery. A one-year follow-up showed no need for further alterations. Combining both methods yields better results than using them individually, efficiently reducing unnecessary items in SITs without compromising patient safety.
... Costs must also be considered, given the overall tight budgets in healthcare. From a hospital perspective, single-use materials are often seen as more economical because of the (significantly) lower market prices and lack of requirements for sterilization or maintenance (Ibbotson et al., 2013). However, indirect costs such as waste disposal are often neglected. ...
Article
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Aim To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single‐use healthcare materials. Design A cross‐sectional multi‐centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials. Methods A hospital survey was conducted to collect the procurement data for single‐use medical materials. Based on consumption and cost, five single‐use medical materials with sustainable alternatives were selected using different reuse strategies. Single‐use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency. Results A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single‐use options. First, an inventory of single‐use medical materials consumed was collected. Next, single‐use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single‐use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material. Conclusion This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide. Impact Patient care involves a large consumption of single‐use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single‐use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single‐use medical materials, thereby yielding positive outcomes for the entire population. Patient or Public Contribution No patient or public contribution.
... Consoli (1993) defined LCA as a process to assess the environmental impacts associated with a process, product, or activity by estimating quantitative values of materials and energy used along with waste and emissions released to the natural environment (Hospido et al., 2003). Over time, LCA has been used for accounting for the environmental impacts generated by various products (Ibbotson et al., 2013;Bhakar et al., 2015), processes (Sangwan et al., 2014;Finkbeiner et al., 2015), etc. In the dairy sector also, various studies have been carried out to understand the environmental burdens of milk production and to incorporate the uncertainties in the ways of milk production (Cederberg and Mattsson, 2000;Hospido et al., 2003;Thomassen et al., 2008a,b;Yan et al., 2011). ...
Article
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Context Assessing the sustainability of milk production in India (the largest milk producer country in the world) is essential to ensure that the dairy industry can meet the growing demands for dairy products while minimizing its negative impact on the environment, society, and the well-being of the people involved in the sector. Objective Current research is intended to compare the emissions associated with packed milk production in two contrasting states, Punjab (an Indian state with helpful agricultural resources and plenty of water) and Rajasthan (a state with a significant desert area) of India. The dairy industry has to undergo different production processes, including livestock, feed, farming, transportation, processing, packaging, and distribution. All of these production steps generate environmental impacts. This study aims to compare the environmental impacts of milk production in Punjab and Rajasthan by understanding the variation in the ecological effects due to the modifications adopted in dairy practices. Methods This study uses Umberto LCA+ with Ecoinvent v3.6 dataset as a Life cycle assessment (LCA) tool and data collected from milk producers and processing plants. The primary data was collected from farmers (milk producers) and dairy plants (processing plants), real-time observations, and inputs from the processing plant staff. The LCA analysis was performed, including parameters such as feed agriculture, milking, storage, transportation, processing, packaging, and distribution. Results and conclusion The analysis results indicate that milk production in Punjab is more environmentally efficient than in Rajasthan, and the feed required for cattle is a critical environmental impact-generating activity along with the selection of packaging material for processed milk. Significance The current article assesses the environmental implications of milk production. The study employs a comprehensive analysis to inform sustainable practices and reduce the ecological footprint of this crucial industry.
... We sought evidence on the relative contribution of different life cycle stages to the carbon footprint of both single-use and reusable medical devices, extracting data from studies in recent systematic reviews. 1,5 We found many published LCA studies were noninformative, because they did not report the breakdown at life cycle stage, 17 incompletely reported it (such as focusing on largest contributing processes), 18 or failed to disaggregate stages (for example combining manufacture and distribution phases, 19 or distribution and packaging phases 20 ). ...
... 10 Using reusable medical equipment as a substitute for single-use surgical instruments has the potential to reduce the carbon footprint of surgical cases by 50-97%. [10][11][12][13] Studies comparing the carbon emissions from surgical procedures between different countries found that developing nations such as India were able to achieve a 30-fold reduction in carbon emissions by using reusable equipment due to saving on the manufacturing and transportation of each item. 14 Despite reusable equipment being a more environmentally sustainable choice, the risk of cross-contamination is often cited as an impediment to change. ...
Article
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Countries worldwide have committed to reducing carbon emissions to mitigate the detrimental effect of climate change on the environment. The UK has committed to net zero carbon emissions by 2050. Significant changes are required across all industries, including healthcare, to achieve this target within the deadline.1 Currently, healthcare systems are estimated to account for 4–5% of the overall global carbon footprint, with surgery identified as a major contributor.2,3 The importance of vascular surgery services working towards reducing their carbon footprint has recently been highlighted in an article by the Vascular and Endovascular Research Network et al.4 In this editorial we discuss how simple small changes such as replacing a ubiquitous single- use surgical instrument with a reusable alternative could make a significant difference to carbon emissions and help achieve improved environmental sustainability.
... Die Hersteller von Medizinprodukten sind hier ebenfalls gefragt. Einmalinstrumente sind eine der Hauptquellen für Umweltemissionen [31,32,33]. Allein der Wechsel von Einmal-auf Mehrweginstrumente kann den medizinischen Abfall im OP um 65% reduzieren [27]. ...
Article
Wir konnten zeigen, dass das Recycling kontaminierter Einweginstrumente in Absprache mit den staatlichen Behörden möglich ist und hierdurch Abfallverbrennung vermieden und CO2-Äquivalente eingespart werden können. Einschränkend auf die Umsetzbarkeit solcher Projekte wirken derzeit noch die deutlich höheren Kosten des Recyclings und die Verpflichtung der krankenhausinternen Dekontamination. Um dies zu ändern, ist der Gesetzgeber gefragt, die derzeitigen Vorschriften zu überdenken und die Hersteller an den Recyclingkosten zu beteiligen, um das riesige Recyclingpotenzial vollständig auszunutzen.
... Accordingly, greenhouse gas emissions emitted by products, processes or systems are equated and summed as CO 2 equivalents. Several studies have shown that, in operating theater, reusable instruments have less impact on the environment than single-use equivalents, including scissors [5], gowns and drapes [6], laparotomy pads [7], sharp containers [8], and anesthetic items [9] (anesthetic drug trays, laryngeal masks, airways [10], laryngoscope handles, and blades [11]). ...
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Background More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). Methods In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien–Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO2 produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO2 consumption for disposal and decontamination was also evaluated. Results Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO2. The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO2. The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. Conclusions RALP generates substantially less CO2 than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.
... 9 Few previous studies [9][10][11] have reported the carbon footprint of individual surgical products, although a carbon footprint of a hysterectomy operation identified production of cotton (used for laparotomy pads and operating towels), spun bound polypropylene (gowns, drapes and instrument tray wrap), and paper and cardboard (packaging) as large contributors. 11 Studies focusing on individual surgical products include those evaluating surgical textiles, 12 surgical scissors 13 and sharps containers, 14 finding lower carbon footprint for reusable compared with single-use equivalents. Strategy towards reducing greenhouse gas emissions associated with the operating room includes reduction, reuse, repair and recycling of products. ...
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Objectives Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots). Design A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England. Setting The carbon footprint inventory was based on direct observation of 6–10 operations/type, conducted across three sites within one NHS Foundation Trust in England. Participants Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 – January 2020). Main outcome measures We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes. Results The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO 2 e (carbon dioxide equivalents); 11.7 kg CO 2 e for inguinal hernia repair; 85.5 kg CO 2 e for knee arthroplasty; 20.3 kg CO 2 e for laparoscopic cholecystectomy; and 7.5 kg CO 2 e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%. Conclusions Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%–42%.
... Sherman et al. (2018) calculated and compared the costs of disposable and reusable laryngoscopes. Ibbotson et al. (2013) performed a similar analysis for disposable and reusable surgical instruments. Research on the cost of GSs using LCC is still limited. ...
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This study discusses the issue of disposable and reusable medical devices in the context of the circular economy. Its objective is to analyze the opinions of physicians in gynecological practice on the use of disposable and reusable gynecological speculums (GS). A questionnaire survey was carried out in a sample of 206 healthcare facilities in the Czech Republic. In addition to this, the cost of both examination methods was calculated and compared using data provided by a gyneco-logical department of a typical district hospital. The calculations and cost analysis were performed using the life-cycle costing (LCC) method. The economic comparison shows that the use of disposable gynecological speculums is less expensive, having, however, a greater negative impact on the environment. The cost of reusable speculums for 25 examinations per day for 15 years is EUR 51,579, while it is EUR 23,998 for disposable speculums for the same use and time horizon. The questionnaire survey shows that both physicians and patients are more likely to prefer disposable speculums for examination, although without a clear rationale.
... During the past decade, there was a large increase in the consumption of disposable medical devices, which are now being replaced by reusable ones. Reuse of material and equipment was evaluated in several studies in surgery [19][20][21][22]. Gastroenterologists have performed a study comparing waste production from reusable versus disposable scopes [18]. ...
... An analysis of the environmental impact when using disposable metal instruments indicated that disposable stainless-steel scissors had the highest negative environmental impact and appeared to have higher total cost of ownership than reusable scissors [14]. In line with these findings it was of interest to investigate other metal disposable instruments used in high quantities in the Operating Room (OR). ...
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Introduction Disposable instruments in healthcare have led to a significant increase of medical waste. The aim of this study is to validate the recycling of disposable Zamak laryngoscope blades into new medical components by using a new ‘all-in-one’ affordable reprocessing setup as alternative for die-casting. Methods A n “all-in-one” casting set-up was designed and built. Laryngoscope blades, recovered from two hospitals, were disinfected, melted and cast into dog-bones and into new instrument parts. The quality of the cast material was evaluated using X-ray fluorescence spectrometry. The mechanical properties were obtained by assessing the Ultimate Tensile Strength (UTS) and tensile tests. Results A recovery of 93 % Zamak was obtained using a melting temperature of 420 ⁰C for three hours. The XRF Spectro data showed higher Zinc and silicon concentrations when compared with Virgin Zamak. The dog-bones tests resulted in an average UTS, Yield Strength (YS) and Young’s Modulus (YM) of 236 ±61 (MPa), 70 ±43 and 9 ±3, respectively, representing 82 %, 103 % and 64 % of the UTS, YS and YM of standard Zamak. Functional instrument parts with extensions and inner chambers were cast with a maximal shrinkage percentage of 1±1 %. Discussion This study demonstrates that the created “all-in-one” reprocessing method can process contaminated disposable Zamak laryngoscope blades into new raw base material and new instrument parts. Although material and surface properties can deteriorate, reprocessed Zamak still has sufficient mechanical properties and can be used to cast complex parts with sufficient dimensional tolerances and minimal shrinkage. Conclusion A micro reprocessing method was designed and used to turn disposed laryngoscope blades into new basis material and semi-finished components. Follow up studies are needed to scale and optimize this process towards a functional alternative for die casting. It should be further investigated how this process can contribute to further medical waste reduction and a circular healthcare economy.
... 19 Similarly, disposable instrument kits for perineal suturing have a carbon footprint dozens of times greater than reusable suture instruments. 20 Exactly the same has been shown for surgical drapes, with disposable drapes having a much greater carbon footprint and environmental impact than reusable textile drapes. 21 Globally, the surgical equipment market is estimated to represent $10 billion in sales each year with further increases likely as the world emerges from the COVID-19 pandemic. ...
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Climate change is considered the greatest long‐term challenge we face, and it comes with a direct impact on women's health and pregnancy outcomes. There are many balances that physicians make in deciding elements of care, but environmental impact has not been a consideration. Health care leaders must recognize the impact of their decisions on carbon footprints and creatively look towards changes that will improve global conditions.
... No proof exists that the use of modern energy devices near the wall of large visceral arteries increases the risk of nonerosive pseudoaneurysm, but experimental evidence shows that these instruments produce lateral thermal spread [47] that, at least in theory, could damage the fragile wall of visceral arteries. Additionally, sparing the use of energy could reduce both costs [48] and CO2 emissions [49]. Reduction of carbon footprint of energy devices is expected to contribute to the implementation of "green operating rooms" [50,51]. ...
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Background Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of “cold” triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC). Methods Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail. Results One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance ( n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33–51). The rate of R1 resection (7 margins < 1 mm) was 44.1%. Conclusion C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC. Graphical abstract
Chapter
The healthcare sector has experienced substantial growth over recent years, effectively addressing various diseases and treatment modalities. However, the flip side of the vast hospital services has been the immense production of hospital waste. Despite the adoption of several hospital waste management strategies, issues still arise pertaining to its impact on the environment. The chapter provides a comprehensive ecotoxicological assessment of hospital waste, focusing on its diverse components, including pharmaceuticals, chemical reagents, infectious materials, and heavy metals. The chapter aims to discuss the importance of ecotoxicity evaluation of hospital waste, and the standard methods applied. Furthermore, the impact of hospital waste on the ecosystem is intricately collated and discussed with the goal of expanding the knowledge base and raising awareness. The chapter underscores the urgent need for stringent waste management protocols, including proper segregation, treatment, and disposal methods to ease the adverse ecological footprint of hospital waste.
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Intensive care medicine is an area with a particularly high consumption of resources. This review presents important new findings relating to the environmental sustainability of intensive care medicine. For example, the drugs used in intensive care medicine can end up in the environment and cause relevant ecotoxicity. The consumption of material items is very high in intensive care medicine and the increasing replacement of reusable items by disposable items is a major problem. Simple measures can reduce the ecological footprint of materials and introduce the recycling of waste in intensive care units. The high energy consumption of air conditioning, lighting and medical technology varies between facilities but in most cases is substantial and can be significantly reduced through appropriate measures. Ideally, the consumption should be measured and analyzed in detail. In the future, support from artificial intelligence is conceivable in this aspect. Sustainability must be given a much higher priority in the training, continued and advanced education in intensive care medicine than it has been to date and in intensive care research sustainability aspects should be given equal consideration alongside economic aspects when it comes to assessing otherwise equivalent treatments. It is particularly important to avoid the misuse and overuse of intensive care. It brings no benefit to patients and hinders needs-based treatment that is oriented towards the patient’s well-being. In addition, misuse and overuse increases costs and drives up the consumption of resources and thus the ecological footprint. Sustainability in the intensive care unit can only be achieved as a team. Various approaches are presented on how a networked Green Team can promote sustainability in the intensive care unit.
Article
Background The evolution of endoscopic surgery has introduced a multitude of instruments, available in both disposable and reusable variants, influencing practices across various surgical specialties. Instrument selection is complex, considering individual preferences and institutional factors such as costs, instrument performance, and factors related to cleaning and sterilization. Notably, environmental sustainability has gained prominence due to the threat of climate change. This review assessed the existing literature to facilitate evidence-informed decision-making, encompassing clinical and economic efficacy, environmental friendliness, and other important criteria. Materials and Methods Following PRISMA guidelines, searches were conducted in Pubmed, Embase, Web of Science, and The Cochrane Library for studies comparing the environmental impact, costs, instrument performance, and contamination risk of disposable versus reusable instruments or new versus reprocessed disposables in endoscopic surgery. Life-Cycle Assessments (LCAs) were included to quantify the climate impact. Exclusions included veterinary studies, general endoscopic procedures, and novel instruments. Conclusion The search yielded 15,809 studies, 53 studies meeting the inclusion criteria: 38 compared disposable versus reusable instruments and 15 examined new versus reprocessed disposables. Reusables and/or reprocessed disposables showed favorable environmental and economic outcomes compared to new disposables. Instrument performance was comparable between the two groups. No studies were identified that investigated the clinical implications of contamination risk of disposables versus reusables. Six studies evaluating contamination risk of reusables and reprocessed disposables showed residual pollution after cleaning and sterilization, although data on clinical outcome lacked. Interpretation This review underscores the environmental benefits of reusables and favors both reusable and reprocessed disposables for their economic advantages. The lack of clear evidence favoring one type over the other in instrument performance necessitates further research. Addressing contamination risks requires additional studies on the clinical impact of residual substances. Future research should report outcomes on environmental sustainability, costs, instrument performance, and contamination risk.
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Background Sphygmomanometers and their cuffs are non-critical items that can act as a fomite for transmission of pathogens which may cause healthcare-associated infection (HAI), leading to an argument that disposable equipment improves patient safety. Aim The aim of this study was to demonstrate that decontamination decreased in microbial contamination of non-disposable sphygmomanometer cuffs, providing evidence to negate the need to purchase, and dispose of, single-patient-use cuffs, reducing cost and environmental impact. Methods A pre–post intervention study of available sphygmomanometer cuffs and associated bedside patient monitors was conducted using a series of microbiological samples in a rural emergency department. A Wilcoxon signed-rank test analysed the effect of the decontamination intervention. To further examine the effect of the decontamination intervention, Mann–Whitney U-tests were conducted for each aspect. Findings Contamination was significantly higher before decontamination than afterwards (Z = −5.14, U = 55.0, P < 0.001, η2 = 0.61 inner; Z = −5.05, U = 53.5, P < 0.001, η2 = 0.59 outer). Discussion Decontamination of non-disposable sphygmomanometer cuffs decreases microbial load and risk of HAI, providing evidence to negate arguments for disposable cuffs while being environmentally sensitive and supportive of a culture of patient safety and infection control.
Article
Introduction The healthcare sector is a major contributor to the climate crisis, and operating theatres (OTs) are one of the highest sources of emissions. To inform emissions reduction, this study aimed to (i) compare the outcomes of interventions targeting sustainable behaviours in OTs using the Triple Bottom Line framework, (ii) categorise the intervention strategies using the 5Rs (reduce, recycle, reuse, refuse, and renew) of circular economy, and (iii) examine Intervention Functions (IFs) using the Behaviour Change Wheel (BCW). Methods Medline, Embase, PsychInfo, Scopus, and Web of Science databases were searched until June 2023 using the concepts: sustainability and surgery. The review was conducted in line with the Cochrane and Joanna Briggs Institution’s recommendations and was registered on PROSPERO. The results were reported in line with PRISMA, Supplemental Digital Content 1, http://links.lww.com/JS9/D210 (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Results Sixteen reviews encompassing 43 life-cycle analyses, 30 interventions, 5 IFs, and 9 BCW policy categories were included. 28/30 (93%) interventions successfully led to sustainability improvements; however, the environmental outcomes were not suitable for meaningful comparisons due to their using different metrics and dependence on local factors. The ‘reduce’ strategy was the most prolific and commonly achieved through ‘ education’ and/or ‘ environmental restructuring’. However, single-session educational interventions were ineffective. Improving recycling relied on ‘ environmental restructuring’ . More intensive strategies such as ‘reuse’ require multiple intervention functions to achieve, either through a sustainability committee or through an intervention package. Conclusion Policymakers must examine interventions within the local context. Comparing the outcomes of different interventions is difficult and could potentially be misleading, highlighting the need for a tool integrating diverse outcomes and contextual factors. ‘Reduce’ strategy guarantees environmental and financial savings, and can be achieved through ‘ Education’ and/or ‘ environmental restructuring’ .
Article
Objective Tonsillectomy is a common procedure performed nationally. The personal protective equipment and surgical gowning practices used during this procedure vary widely. We compiled a survey of ENT specialists to gain a national opinion about gowning in tonsillectomy with the aim of determining whether we could make it more environmentally friendly whilst maintaining the highest safety standards. Method We developed a nine-question survey that was piloted prior to final implementation. The questionnaire was sent to senior registrars and consultant otolaryngologists in the UK. Results The survey was completed by a total of 63 ENT specialists. It was found that 82.54 per cent of clinicians would consider wearing a reusable gown that would be sterilised between each procedure. Conclusion Our survey suggests most ENT clinicians would consider using a more environmentally friendly surgical gown and some may even consider wearing no gown at all, although many are understandably concerned about the transmission of infection or blood splatter.
Article
Objective To determine a break‐even point in the carbon footprint of disposable and reusable instrument sets used in the delivery room. This can aid hospitals in making sustainable choices. Methods Observational study conducted in a university hospital with an obstetric care centre. The study used life cycle assessment (LCA) to compare a reusable (minimal 500 times use) with a disposable instrumental set (single use). LCA quantifies the environmental impact of products over their entire life cycle. The contribution to climate change (i.e., carbon footprint) was used as the environmental indicator [in kg CO 2 equivalent (eq.)]. Primary outcome was to determine a ‘break‐even point’: the number of uses at which the carbon footprint of the two sets was similar. Secondary outcomes: (1) ‘worst case scenario’, in which both sets are only used once; (2) ‘scenario of 500 deliveries’ and (3) annual carbon footprint reduction when switching to the set with the lowest environmental impact. Results After ≥3 times use, the carbon footprint of the reusable set becomes lower than the disposable set. When both sets are used only once, the reusable set had a higher impact on the environment (1.2 kg CO 2 eq. difference). In case of using both sets during 500 deliveries, the difference in kg CO 2 eq. was 400 kg CO 2 eq., corresponding with a 2.3 times lower environmental impact in favour of the reusable set and a reduction of about 1800 kg CO 2 eq. per year. Conclusions Disposable instrumental sets used in the delivery room have a higher impact on the environment compared to reusable sets.
Article
Introduction A flexible cystoscope is an indispensable tool for urologists, facilitating a variety of procedures in both the operating room and at bedside. Single-use cystoscopes offer benefits including accessibility and decreased burden for reprocessing. The aims of this study were to compare time efficiency and performance of single-use and reusable cystoscopes. Methods Ten new AmbuⓇ aScopeTM 4 Cysto single-use and two Olympus CYF-5 reusable cystoscopes were compared in simulated bedside cystoscopy and benchtop testing. Ten urologists performed simulated cystoscopy using both cystoscopes in a randomized order. Times for supply-gathering, setup, cystoscopy, cleanup, and cumulative time were recorded, followed by a Likert feedback survey. For benchtop assessment, physical, optical, and functional specifications were assessed and compared between cystoscopes. Results The single-use cystoscope demonstrated shorter supply-gathering, setup, cleanup, and cumulative times (824 vs 1231s; p<0.05) but a comparable cystoscopy time to the reusable cystoscope (202 vs 212s; p=0.322). The single-use cystoscope had a higher image resolution but a narrower field of view. Upward deflection was greater for the single-use cystoscope (214.50° vs 199.45°; p<0.001) but required greater force (2.5x). Working channel diameter and irrigation rate were greater in the reusable cystoscope. While the single-use cystoscope lacked tumor enhancing optical features, it had higher Likert scale scores for Time Efficiency and Overall Satisfaction. Conclusion The single-use cystoscope demonstrates comparable benchtop performance and superior time efficiency compared to reusable cystoscopes. However, the reusable cystoscope has superior optical versatility and flow rate. Knowledge of these differences allow for optimal cystoscope selection based on procedure indication.
Article
Therapeutic intervention to skin wounds requires covering the affected area with wound dressings. Interdisciplinary efforts have focused on the development of smart bandages that can perform multiple functions. In this direction, here, we designed a low cost (U$0.012 per cm2) multifunctional therapeutic wound dressing fabricated by loading curcumin (CC) into poly(ϵ-caprolactone) (PCL) nanofibers using solution blow spinning (SBS). The freestanding PCL/CC bandages were characterized by distinct physicochemical approaches and were successful in performing varied functions, including controlled release of CC, colorimetric indication of the wound conditions, barrier against microorganisms, being biocompatible, and providing a photosensitive platform for antimicrobial photodynamic therapy (aPDT). The chemical nature of PCL and CC and the interactions between these components allowed CC to be released for 192 h (ca. 8 days), which could be correlated with the Korsmeyer-Peppas model, with a burst release suitable to treat the inflammatory phase. Due to the CC keto-enol tautomerism, an optical indication of the healing status could be obtained using PCL/CC, which occurred immediately, ranging between red/orange and yellow shades. The effect against pathogenic microorganisms evaluated by agar disc-diffusion, affected skin wound simulation (ex vivo), and microbial penetration tests demonstrated the ability to block and inhibit microbial permeation in different environments. The biocompatibilities of PCL and PCL/CC were verified by in vitro cytotoxicity study, which demonstrated that cell viabilities average above 94 and 96% for human dermal fibroblasts. In addition, the proposed bandage responded to aPDT applied to an in vivo assay, showing that, when irritated, PCL/CC was able to reduce the bacteria present on the real wound of mice. In summary, our findings demonstrate that using PCL and CC to produce nonwovens by the SBS technique offers potential for the rapid fabrication of biocompatible and multifunctional wound dressings, paving the way for large-scale production and utilization of such dressings in the treatment of skin wounds.
Article
Background and purpose: Climate change is one of the most important threats to human health nowadays. The healthcare industry produces a significant part of greenhouse gases (GHG) emissions. The aim of this study is to assess direct and indirect GHG emissions due to cataract surgery in Spain to identify opportunities for improving. Methods: This observational case series study estimates and analyses the carbon footprint of a single cataract surgery using phacoemulsification in Ávila Hospital. ISO standard 14064 was applied. Results: The carbon footprint of a single cataract surgery in Ávila Hospital was 86.62 kg CO2eq. Medical and pharmaceutical equipment were responsible for 85% of GHG emissions. Conclusions: Collaboration between pharmaceuticals and ophthalmologists is important to improve the environmental impact of cataract surgery. Future research is needed to introduce changes that do not compromise patient and surgeon safety. Green surgery models could play an encouraging role in the new global health scene.
Article
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.
Article
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Purpose of review The excessive growth of the health sector has created an industry that, while promoting health, is now itself responsible for a significant part of global environmental pollution. The health crisis caused by climate change urges us to transform healthcare into a sustainable industry. This review aims to raise awareness about this issue and to provide practical and evidence-based recommendations for anaesthesiologists. Recent findings We offer seven recommendations for anaesthesiologists that want to transform their own practice. Summary This review offers evidence-based recommendations, along with their financial impact, to improve the sustainability of anaesthesiology practice in the operating room.
Article
Introduction: The use of disposable plastics and their subsequent environmental impacts are topics of increasing concern in modern society. Medical, including veterinary, sectors are major contributors to plastic waste production. While there is an existing body of literature on the use and reduction of disposable plastics in the human medical sector, few studies, if any, have specifically investigated the use of plastics within the veterinary field. The overall aim of this pilot study was to investigate Australian veterinarians regarding their attitudes toward the ways in which they use disposable plastic in their work and personal lives. Materials and methods: Seven veterinarians were interviewed, representing a range of demographics and professional backgrounds from multiple states. Thematic qualitative analysis was employed to organise the data into several major themes encompassing many smaller nodes. Results: The dataset revealed that most, if not all, veterinarians interviewed agree that disposable plastic is used in excess in veterinary medicine, but that veterinarians will never be able to avoid using plastic entirely. Participants supplied differing opinions with respect to the best strategies for reducing plastic waste production within the veterinary field, including recycling, replacing disposable items or improving education. Discussion: Despite different participants suggesting conflicting ideas, most, if not all, of the ideas presented have support in the scientific literature. This supports a hybrid approach involving refining recycling systems, reducing plastic consumption and improving education on plastic waste production. A hybrid top-down-bottom-up approach must include encouraging cooperation among stakeholders, both within and outside the veterinary sector, as this will be a major contributor to progress. In a broader context, this hybrid approach to inciting change at all levels of the veterinary sector will require engagement from many interdependent entities; as such, this study should act as a starting point for an ongoing process of cooperative change. Recommendations for future research include life cycle analyses of reusable versus disposable veterinary materials; exploring ways to expand sustainability education within and beyond the veterinary sector, and examining methods of improving technology and infrastructure.
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BACKGROUND: More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). METHODS: In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien–Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO2 produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO2 consumption for disposal and decontamination was also evaluated. RESULTS: Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO2. The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO2. The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. CONCLUSIONS: RALP generates substantially less CO2 than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.
Article
Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative. In this Personal View, we present an interactive, open-access database designed to support this effort. Functioning as a living repository of environmental impact assessments within health care, the HealthcareLCA database collates 152 studies, predominantly peer-reviewed journal articles, into one centralised and publicly accessible location, providing impact estimates (currently totalling 3671 numerical values) across 1288 health-care products and processes. The database brings together research generated over the past two decades and indicates exponential field growth.
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Background Replacing single-use products with reusable ones may reduce the environmental impact of healthcare. This study aimed to broadly assess the environmental effects of that substitution. Methods A systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products was conducted. The main outcomes assessed were changes in the environmental impact that resulted after switching from single-use to reusable products. As no standardized transparency checklist was available, one was developed here using DIN ISO 14040/14044. The final checklist included 22 criteria used to appraise the included studies. Results After screening, 27 studies were included in the analysis. The healthcare products were assigned to four categories: invasive medical devices, non-invasive medical devices, protection equipment and inhalers. The outcomes revealed a reduction in mean effect sizes for all environmental impacts except water use. Non-invasive medical devices have greater relative mitigation potential than invasive devices. On average, information on 64% of the transparency checklist items was reported. Gaps included the reporting of data quality requirements. Conclusions Switching to reusable healthcare products is likely to reduce most impacts on the environment except water use, but the effect size differs among product categories. Possible study limitations include location bias, no systematic search of the grey literature and small samples for some impacts. This study’s strengths are its approach to product categories and developed transparency catalogue. This catalogue could be useful to inform and guide a future process towards creating a standardized transparency checklist for the systematic reviews of LCAs.
Article
Climate change poses one of the most critical threats to humanity. Surgical care needs to be considered in relation to the impending climate emergency. Little thought appears to have been given to the role of operating departments as a high-yield target for environmental change. This article evaluates the environmental impact of orthopaedic surgery, focusing on anaesthesia, waste management and surgical hardware. Developing ‘green’ operating protocols should be the minimum expectation of orthopaedic departments. Just as the management of complex surgical pathology requires a multidisciplinary approach, mitigating the environmental impact of surgical endeavour requires collective action and buy-in.
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When health care management considers implementing a new technology such as a medical device, it is crucial to take workflow, clinical outcome, economy, and environmental impacts into consideration in the decision-making process. This study outlines the knowledge status of this complex challenge via a systematic literature review (SLR). The SLR found 133 of 1570 screened publications that covered relevant frameworks for choosing hospital equipment (i.e., related economics, life cycle assessment, waste generation and health issues). Yet, just five publications addressed choosing single-use vs. reuse of tubes or similar types of equipment by economic and environmental considerations through a systematic quantitative approach. The SLR reveals few publicly available peer-reviewed studies for the optimal sustainable choice of equipment. This study assesses environmental impacts of carbon dioxide (CO2) emissions as CO2-equivalents and resource consumption of a single-use double-lumen tube (DLT) combined with a reusable bronchoscope were compared to a single-use DLT with an integrated single-use camera. Camera DLTs exclude or minimize the need for a bronchoscope to verify correct tube placement during one-lung ventilation. The life cycle assessment shows that the materials and energy used and needed for personnel protective equipment and cleaning of the reusable bronchoscope contribute significantly to CO2-equivalent emissions. To ensure the sustainable choice of equipment this aspect must not be overlooked. Secondly, future reuse of plastic waste materials from the use can contribute significantly to better environmental performance.
Article
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.
Article
Introduction The NHS accounts for 5.4% of the UK's total carbon footprint, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focussing on the impact of implemented interventions. Methods A systematic review was performed using Pubmed, OVID, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included. Results 675 abstracts were screened with 34 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability. Discussion This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery.
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Rubber glove product Thailand shows the trend of higher growth. Currently, the average export value of rubber glove product is 826.72 US$/year. Thus, the development guideline of this product for Thailand should be concerned. However, rubber glove process caused the environmental and human impacts. Hence, the eco-efficiency concept of rubber glove product was interested. Initial important step of eco-efficiency concept was indicator development. Therefore, this research developed the eco efficiency indicators including economic and environmental indicators of rubber glove product based on the eco-efficiency theory and material flow analysis. The result showed that economic indicators consisted of quantity product and net sale and environmental indicators consisted of material consumption, energy consumption, water consumption, wastewater production, solid waste production, greenhouse gas emission, were selected to eco-efficiency indicators based on eco-efficiency theory and material flow analysis. These eco-efficiency indicators would help to discover more economic and effective ways to improve productivity process and to enhance recyclability or reducing energy and material intensity.
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Intention, Goal, Scope, Background BASF has developed the tool of eco-efficiency analysis to address not only strategic issues, but also issues posed by the marketplace, politics and research. It was a goal to develop a tool for decision-making processes which is useful for a lot of applications in chemistry and other industries. Objectives. The objectives were the development of a common tool, which is usable in a simple way by LCA-experts and understandable by a lot of people without any experience in this field. The results should be shown in such a way that complex studies are understandable in one view. Methods The method belongs to the rules of ISO 14040 ff. Beyond these life cycle aspect costs, calculations are added and summarized together with the ecological results to establish an eco-efficiency portfolio. Results and Discussion The results of the studies are shown in a simple way, the eco-efficiency portfolio. Therefore, ecological data are summarized in a special way as described in this paper. It could be shown that the weighting factors, which are used in our method, have a negligible impact on the results. In most cases, the input data have an important impact on the results of the study. Conclusions. It could be shown that the newly developed eco-efficiency analysis is a new tool, which is usable for a lot of problems in decision-making processes. It is a tool which compares different alternatives of a defined customer benefit over the whole life cycle. Recommendations and Outlook This new method can be a helpful tool in different fields of the evaluation of product or process alternatives. It can be used in research and development as well as in the optimization of customer processes and products. It is an analytical tool for getting more sustainable processes and products in the future
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Since the results of this comparative study are publicly available, a critical review was performed according to ISO 14040 (review by interested parties, using a review panel) after each stage (goal and scope, data inventory, impact analysis/interpretation, eco-efficiency analysis) during the study. Methodology Four types of cups were analysed; the reusable polycarbonate cup (PC), the one-way polypropylene cup (PP), the one-way PE-coated cardboard cup and the one-way polylactide cup (PLA). The functional unit is defined as ‘the recipients needed to serve 100 l of beer or soft drinks at a small-scale indoor respectively a large-scale outdoor event’. This definition included the production of the cups, the consumption stage (at the event) and the processing of the waste. The data inventory focused on specific data supplied by different stakeholders in Flanders (and Belgium). Based on data collected for specific events, an average typical small indoor and large outdoor event was defined, respectively. One important aspect in this context was the trip rate for the reusable cups, meaning the average number of times one cup can be used before disposal. Based on practical experiences combined with literature research, a trip rate was defined for small- and large-scale events, respectively. Since this factor was very important but also very open for debate, a sensitivity analysis was performed on the trip rate. The impact analysis was based on the Eco-Indicator 99 methodology (Hierarchist version H/A; Goedkoop and Spriensma 2000). The main reason for using this methodology was that it allows the calculation of one weighted environmental indicator for each alternative, which was needed as input for the eco-efficiency analysis. The cost indicator, which was based on similar system boundaries and assumptions as the environmental indicator, was calculated from a societal perspective. Both indicators were combined in an eco-efficiency portfolio, with the average in the centre point and the number of standard deviations indicated on the axes. Results and discussion For the environmental profile of the individual cup systems, the total life cycle of the cups was divided in different life cycle stages. Based on the individual profiles it could be concluded that the most important environmental contribution when using reusable PC cups at small indoor events is caused by the production of the cups and the transport of the cups from the distributor to the event and back. On large outdoor events, the (machine) cleaning of the cups also contributes significantly to the total environmental impact. For one-way cups (PP, PE-coated cardboard and PLA) used at small indoor as well as large outdoor events, the production of the cups dominates the environmental profiles. By comparing the environmental impacts of the four types of cups on both types of event, it became clear that none of the cup systems has the highest or the lowest environmental score for all environmental impact categories considered in the study. Based on these comparisons, it was not possible to make a straightforward conclusion for the selection of the most favourable cup system with regard to the environment. When comparing the individual cup systems between small indoor and large outdoor events, the reusable PC cup differs the most between both types of events. The environmental burden increases significantly for PC cups moving to larger scale events. This can be explained by the lower trip rate and the machine cleaning instead of manual cleaning of the cups after large events. For the other types of cup systems, the difference going from a small to a large scale event is negligible. The combination of the environmental and cost indicator in the eco-efficiency analysis led to a different result for small indoor compared to large outdoor events. The eco-efficiency portfolio for small events showed that the reusable PC cup has a significant more favourable environmental score than the one-way cups, but the cost indicator is significantly higher. This may be an argument to initiate a promotion policy for reusable PC cups at small events. For large events, the eco-efficiency portfolio did not result in a significant winner with regard to the environmental or cost indicator. To determine the influence of a change in the inventory data on the results of the impact assessment and eco-efficiency analysis, some sensitivity analyses were performed, for example for a variation in trip rate, a variation in the cleaning of the cups during and after the event (manual versus machine), and a future scenario for the PLA cups (change in production process, end-of-life treatment, etc.). Conclusions The comparative LCA study according to ISO did not provide an overall environmentally superior cup system. In the eco-efficiency analysis, using a subjective weighting step, the reusable PC cup system resulted to be significantly better compared to the other cup systems for small events from an environmental point of view. Two aspects that improved the overall quality of this study are on the one hand the consultation and collaboration of the stakeholders during the process to supply information, check the inventory data and give feedback on the preliminary results and on the other hand the work of the review panel in order to ensure that the provisions from the ISO 14040 series regarding methods, data, interpretations and reporting are taken care of. It was appreciated by the commissioner and all stakeholders that the results of the study are communicated in a transparent way, with a discussion of the necessary differentiations. Recommendations and perspectives From the comparative LCA-study according to ISO, none of the four considered cup systems has overall superior or inferior performance neither at small nor large events. This means that there are no scientific arguments for a policy of encouraging or discouraging one of the four cup systems based on the LCA-results. The eco-efficiency assessment (with its subjective choices and limitations, that the commissioner of the study should realise and support in the context of this study) has shown that in the base case for small events the PC cup system shows a significant more favourable environmental score than the other three cup systems on the market. As the costs of the reusable PC cup system are higher, a policy of promoting the system can be considered based on the more favourable environmental score. Policy makers should agree on the subjective value choices made while weighting different impact or damage categories.
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This paper presents a methodology about how eco-efficiency in extended supply chains (ESCs) can be understood and measured. The extended supply chain includes all processes in the life cycle of a product and the eco-efficiency is measured as the relative environmental and value performance in one ESC compared to other ESCs. The paper is based on a case study of furniture production in Norway. Nine different environmental performance indicators are identified. These are based on suggestions from the World Business Council for Sustainable Development and additional indicators that are shown to have significant impacts in the life cycle of the products. Value performance is measured as inverse life cycle costs. The eco-efficiency for six different chair models is calculated and the relative values are shown graphically in XY-diagrams. This provides information about the relative performance of the products, which is valuable in green procurement processes. The same method is also used for analysing changes in eco-efficiency when possible alterations in the ESC are introduced. Here, it is shown that a small and realistic change of end-of-life treatment significantly changes the eco-efficiency of a product.
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The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.
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Medical waste is a necessary by-product of any hospital environment; however, the majority of regulated medical waste is produced in the OR from the use of disposable surgical supplies (eg, drapes, gowns, basins, gloves, sponges). We conducted a concept comparison project in the ORs of two large medical centers in Bethesda, Maryland, and Washington, DC, to evaluate the effects of using reusable surgical basins, gowns, and table and Mayo stand covers in place of disposable products. Survey results indicated that surgeons and surgical technologists found the reusable products to be preferable to the disposable products currently in use. In addition, using reusable products provided a means to decrease regulated medical waste generated in the OR by an average of 65% as well as reduce the cost of waste disposal. AORN recommends evaluating the environmental effects of using reusable, reposable, and disposable products; our findings provide evidence that may be useful to surgical facilities that seek to adopt a “green” approach.
Written communication Vanguard Integrierte Verorgungssysteme GmbH Eco-efficiency in the production chain of Dutch semi-hard cheese
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OR industry split on merits of disposable/reusable instruments
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Measuring eco-efficiency by a LCC/LCA ratio an evaluation of its applicability A case study at ABB. MSc. Thesis The financial and environmental costs of reusable and single-use plastic anaesthetic drug trays
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