5 例全膝关节置换术的手术废物审核。
Surgical waste audit of 5 total knee arthroplasties.
机构信息
The Schulich School of Medicine and Dentistry, Western University, London, Ont.
Department of Orthopaedic Surgery, London Health Sciences Centre, London, Ont.
出版信息
Can J Surg. 2013 Apr;56(2):97-102. doi: 10.1503/cjs.015711.
BACKGROUND
Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution's ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management.
METHODS
We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008-2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada.
RESULTS
The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008-2009 was 407 889 kg by weight and 15 272 m3 by volume.
CONCLUSION
Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care.
LEVEL OF EVIDENCE
Level IV, case series.
背景
手术室（OR）据估计产生了医院废物的三分之一。在伦敦健康科学中心，假体和植入物占该机构生态足迹的 17%。为了调查全膝关节置换术（TKA）相关的废物产生情况，我们进行了手术废物审计，以评估该手术的环境影响并制定改善废物管理的策略。
方法
我们对 2010 年 2 月由一名外科医生进行的 5 例初次 TKA 进行了废物审计。废物分为 6 类：常规固体废物、可回收塑料、生物危害废物、已清洗的亚麻布、锐器和蓝色无菌包裹。对每一类的体积和重量进行了量化。我们使用加拿大关节置换登记处的数据（2008-2009 年）来估计加拿大所有 TKA 的年度废物重量和体积总和。
结果
每例 TKA 的平均手术废物（不包括已清洗的亚麻布）为 13.3 千克，其中 8.6 千克（64.5%）为普通固体废物，2.5 千克（19.2%）为生物危害废物，1.6 千克（12.1%）为蓝色无菌包裹，0.3 千克（2.2%）为可回收物，0.3 千克（2.2%）为锐器。塑料包装、一次性手术衬垫和个人防护设备对总废物量有很大贡献。我们估计，2008-2009 年加拿大所有 47429 例 TKA 的垃圾填埋废物重量为 407889 千克，体积为 15272 立方米。
结论
全膝关节置换术产生大量手术废物。环保型手术产品和废物管理策略可能使手术室能够在不影响患者护理的情况下减少废物产生的负面影响。
证据等级
IV 级，病例系列。
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