Innovations towards achieving environmentally sustainable operating theatres: A systematic review

Perry, Helen; Reeves, Nicola; Ansell, James; Cornish, Julie; Torkington, Jared; Morris, Daniel S.; Brennan, Fiona; Horwood, James

doi:10.1016/j.surge.2022.04.012

Cited by 21 publications

(26 citation statements)

References 41 publications

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“…Indeed, inadequate knowledge (60%) was identified as one of the main barriers to implement environmentally sustainable practices [ 21 ]. This evidence is confirmed by other studies in literature, that agree that education of all levels in the healthcare system is important in order to drive and maintain change [ 27 , 28 ].…”

Section: Discussionsupporting

confidence: 85%

Waste Management and the Perspective of a Green Hospital—A Systematic Narrative Review

Lattanzio

Stefanizzi

D’Ambrosio

et al. 2022

IJERPH

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The concept of a “green hospital” is used in reference to a hospital that includes the environment as part of its quality services and one that pays attention to the sustainable design of buildings. Waste disposal represents a potential risk for the environment; therefore, waste collection from healthcare centers is a key environmental issue. Our study aims to systematically review the experiences acquired in worldwide nosocomial settings related to the management of healthcare waste. Nineteen studies, selected between January 2020 and April 2022 on Scopus, MEDLINE/PubMed and Web of Science databases were included in our systematic narrative review. Operating room and hemodialysis activities seem to be the procedures most associated with waste production. To deal with waste production, the 5Rs rule (reduce, reuse, recycle, rethink and research) was a common suggested strategy to derive the maximum practical benefit while generating the minimum amount of waste. In this context, the COVID-19 pandemic slowed down the greening process of nosocomial environments. Waste management requires a multifactorial approach to deal with medical waste management, even considering the climate change that the world is experiencing. Education of health personnel and managers, regulation by governmental institutions, creation of an “environmental greening team”, and awareness of stakeholders and policymakers are some of the measures needed for the greening of healthcare facilities.

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Section: Discussionsupporting

confidence: 85%

Waste Management and the Perspective of a Green Hospital—A Systematic Narrative Review

Lattanzio

Stefanizzi

D’Ambrosio

et al. 2022

IJERPH

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“…The CO 2 equivalent emissions impact of NHS travel represents 17 per cent of the NHS carbon footprint, whilst the supply chain adds up to 24 per cent to the total NHS CO 2 equivalent emissions (Figure 4). 2,3,22,29 There are over 9.5 billion NHS-related road miles per year in England, which makes up around 3.5 per cent of all road travel in England per annum. Staff, visitor and patient travel negatively affect air quality, with an estimated economic impact of £345 million for the potential mortality effects and costs to society of air pollution resulting directly from NHS-related travel.…”

Section: Resultsmentioning

confidence: 99%

Delivering a net zero National Health Service: where does otorhinolaryngology – head and neck surgery stand?

Spinos,

Doshi,

Garas

2023

J. Laryngol. Otol.

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Objective The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. Method Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. Results The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. Conclusion Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

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“…These services include surgeries, MRI services 11 , and dialysis 8 , 20 . Within the surgical services, the operating theatre has been consistently quoted as a highly resource-intensive and therefore a high environmental impact area of healthcare 3 , 10 , 21 – 23 . Studies looking at the impact of various operations, such as cataracts, hysterectomies, and dermatologic procedures, have identified common sources of high emissions; particularly, single-use surgical tools, energy needed for ventilation and heating/cooling, and anaesthetic gas use 3 , 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Previous systematic reviews have investigated how the impact of the operating theatres on the environment could be reduced 23 , 27 – 30 . These reviews concluded that many strategies to reduce environmental impacts rely on ongoing behavioural changes 6 , 23 . Therefore, many interventions to reduce the environmental impact of operating theatres relate to behaviour change, such as the use of regional or local anaesthesia rather than general 27 , scrubbing with alcohol instead of handwashing 23 , and dispensing of waste appropriately 22 .…”

Section: Introductionmentioning

confidence: 99%

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Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework

Almukhtar,

Batcup,

Bowman

et al. 2023

International Journal of Surgery

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Background: The health sector contributes significantly to the climate crisis. Operating theatres in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. We systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in operating theatres, categorising these using the Theoretical Domains Framework (TDF). Materials and methods: Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 – June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. Results: Twenty-one studies were selected for analysis and assessment (seventeen surveys and four interview studies) comprising 8286 participants, including surgeons, nurses and anaesthetists. Eighteen themes across ten TDF domains were identified. The most common barriers to adoption of green behaviours in operating theatres were in domains of: ‘knowledge’ (N=18) e.g. knowledge of sustainable practices; ‘environmental context and resources’ (N=16) e.g.‘personnel shortage and workload and inadequate recycling facilities; ‘social influences’ (N=9) e.g. lack of leadership/organisational mandate or support; ‘beliefs about consequences’ (N=9) e.g. concerns regarding safety. Intention was the most common facilitator, with eleven studies citing it. Conclusions: Despite intentions to adopt sustainable practices in operating theatres, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff’s knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the Hospital and Trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise operating theatres.

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Innovations towards achieving environmentally sustainable operating theatres: A systematic review

Cited by 21 publications

References 41 publications

Waste Management and the Perspective of a Green Hospital—A Systematic Narrative Review

Waste Management and the Perspective of a Green Hospital—A Systematic Narrative Review

Delivering a net zero National Health Service: where does otorhinolaryngology – head and neck surgery stand?

Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework

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