Westwood Elizabeth, Walshaw Josephine, Boag Katie, Chua WeiYing, Dimashki Safaa, Khalid Hammaad, Lathan Ross, Wellington Jack, Lockwood Sonia, Yiasemidou Marina
General Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom.
Department of Health Research, University of York, York, United Kingdom.
Front Surg. 2023 Oct 24;10:1260301. doi: 10.3389/fsurg.2023.1260301. eCollection 2023.
Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice.
A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate "Green Theatre Checklist" was taken as an audit standard, focusing on "preparing for surgery" and "intraoperative equipment" subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration.
Datasets 1 ( = 23) and 2 ( = 23) included open ( = 22), laparoscopic ( = 24), elective ( = 22) and non-elective ( = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively.
This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.
气候变化是一个具有时代意义的健康问题，而与医疗保健相关的排放却反常地加剧了负面影响。英国国家医疗服务体系（NHS）的碳足迹占英国总量的5%，手术室是公认的碳排放热点地区。英国国家医疗服务体系英格兰分部的目标是到2045年实现净零排放。因此，英国皇家外科医学院发布了相关指南，以促进外科手术实践中基于证据的可持续转型。
开展了一项单中心质量改进项目，旨在概述当地的可持续实践情况。将校际间的“绿色手术室检查表”作为审核标准，重点关注“手术准备”和“术中设备”部分。任何普通外科手术均符合纳入标准。记录可重复使用纺织品、非无菌手套、导管、抗生素的使用情况，以及酒精与水基擦洗技术的使用情况、皮肤消毒选择和皮肤缝合材料。在3周的时间内收集基线数据，随后通过临床治理会议和海报展示在当地传播结果。使用相同的方法和时长对实践进行重新审核。
数据集1（n = 23）和数据集2（n = 23）包括开放手术（n = 22）、腹腔镜手术（n = 24）、择期手术（n = 22）和非择期手术（n = 24）病例。在可重复使用纺织品方面表现出良好做法（手术巾96%、78%，手术单100%、92%），然而采购问题导致数据集2中原本良好的可重复使用手术衣使用率降低（90%、46%）。未发现不必要的导管使用情况，并且一致使用了宽松的皮肤准备方法。酒精基擦洗技术的采用率较低（15%、17%），在超过30%的手术中观察到不必要的非无菌手套使用情况。所有腹腔镜端口和剪刀均为一次性使用。数据集1和数据集2的碳足迹分别为128.27 kgCO₂e和117.71 kgCO₂e。
该项目证明了良好做法以及未来当地在提高可持续性方面的重点关注领域。采用混合腹腔镜器械、避免不必要的设备开封以及标准化可重复使用材料可大幅减少碳和环境影响。成功实施需要周全的采购做法、提高认识和教育水平、明确的领导以及医疗保健社区内持续的文化转变。专业机构之间的合作以及获取支持性证据对于推动参与并使临床医生能够将与当地相关的变革变为现实至关重要。
