A New Method to Improve the Environmental Sustainability of the Operating Room: Healthcare Sustainability Mode and Effect Analysis (HSMEA)

Abstract

The purpose of this study was to describe a new method to effectively improve the environmental impact of operating rooms through a systematic approach. A proven successful prospective risk analysis tool to improve the safety of complex healthcare processes (Healthcare Failure Mode and Effect Analysis) was adapted to reduce the environmental impact of surgical waste. For this novel method, named the Healthcare Sustainability Mode and Effect Analysis (HSMEA), a multidisciplinary team, using a structured step-by-step approach, systematically inventories surgical waste, quantifies its environmental impacts, identifies hotspots, and provides solutions for improvement. The five steps of the HSMEA are described (definition of the topic, team assembly, flowchart creation, hazard analysis, actions and outcome measures) and the surgical procedure of a caesarean section was used as a case study to assess the applicability of this method to improve its environmental impact. Applying the HSMEA to caesarean sections resulted in a 22% volume reduction and a 22% carbon footprint reduction in surgical waste. This was achieved by revising the disposable custom pack in order to reduce the overage that was present, and by intensifying waste stream segregation for plastic and paper recycling. The HSMEA is a practical work floor tool to aid in the reduction of the environmental impact of surgical waste that is applicable to all types of operations. It is reproducible, and because it identifies carbon hotspots, it enables an efficient approach to the issue of operating room pollution.

Environmental sustainability in obstetrics and gynaecology: A systematic review

“…De Ridder et al 38 found that cotton gauzes and disposable surgical gowns were a carbon footprint hotspot for caesarean section at a university hospital. Blue wraps, used to pack surgical instruments, represented the greatest environmental burden in the preparation room.…”

“…The included articles were published from 2004 onwards, with the majority of studies published in recent years (2020 to 2022; Table 1). The environmental impact regarding the following services, procedures or products within the specialty of obstetrics and gynaecology was reported (Figure 1): mode of delivery (n = 3, 17.6%), [36][37][38] hysterectomy (n = 3, 17.6%), [39][40][41] staging procedure for endometrial cancer (n = 1, 5.8%), 42 vaginal specula (n = 1, 5.8%), 43 menstrual products (n = 6, 35.2%), [44][45][46][47][48][49] gynaecological oncology consultation (n = 1, 5.8%) 50 and general principles relevant to obstetric and gynaecological surgery (n = 2, 11.7%). 51,52…”

“…Implementing the use of reusable gowns could lead to a 66% reduction in GHG emissions, and an 84% reduction of solid waste, in addition to being previously described as more comfortable by surgeons. 21 De Ridder et al 38 found that cotton gauzes and disposable surgical gowns were a carbon footprint hotspot for caesarean section at a university hospital. Blue wraps, used to pack surgical instruments, represented the greatest environmental burden in the preparation room.…”

The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment

“…37 Ideally, all plastic disposables should be made from either bioplastics or recycled plastic (and go on to be recycled), and instrument packs should be evaluated to ensure that only essential instruments are included. Notably, Ridder et al 10 reduced their carbon footprint of caesarean birth by 2.5 kgCO 2 e by adjusting the contents of the surgical pack.…”

Study on Sustainable Development Oriented Community Public Hospital in China Based on Optimal Decision Making Model for Environment Renovation

“…(2) Environmental variables affect the degree of satisfaction of patients and employees [10][11][12]. (3) Key departments include ICU, emergency [13], and operation rooms [14]. But, there are few pieces of research on community public hospitals.…”