Prakash Rohan, Nasser Ahmed, Sharma Akshat, Eastwood Deborah, Reed Mike, Agrawal Yuvraj
Department of Trauma & Orthopaedics, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
Department of Trauma & Orthopaedics, The Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK.
Bone Jt Open. 2024 Dec 18;5(12):1108-1113. doi: 10.1302/2633-1462.512.BJO-2024-0167.R1.
Arthroplasty has been shown to generate the most waste among all orthopaedic subspecialties, and it is estimated that hip and knee arthroplasty generate in excess of three million kg of waste annually in the UK. Infectious waste generates up to ten times more CO2 compared with recycled waste, and previous studies have shown that over 90% of waste in the infectious stream is misallocated. We assessed the effect of real-time waste segregation by an unscrubbed team member on waste generation in knee and hip arthroplasty cases, and compared this with a simple educational intervention during the 'team brief' at the start of the operating list across two sites.
Waste was categorized into five categories: infectious, general, recycling, sharps, and linens. Each category was weighed at the end of each case using a digital weighing scale. At Site A (a tertiary orthopaedic hospital), pre-intervention data were collected for 16 total knee arthroplasy (TKA) and 15 total hip arthroplasty (THA) cases. Subsequently, for ten TKA and ten THA cases, an unscrubbed team member actively segregated waste in real-time into the correct streams. At Site B (a district general hospital), both pre- and post-intervention groups included ten TKA and ten THA cases. The intervention included reminding staff during the 'team brief' to segregate waste correctly.
Active real-time waste segregation reduced infectious waste by a mean of 2.51 kg (95% CI 1.492 to 3.542) in TKA, and 1.83 kg in THA cases (p = 0.004). Educational intervention reduced infectious waste by a mean of 3.52 kg in TKA and 2.09 kg in THA cases (p = 0.026). Total waste was significantly reduced in both groups post-intervention for TKA cases.
Simple educational measures alone can significantly reduce the amount of infectious waste. Extrapolated nationally, our results would yield a reduction of approximately 315,004 kg to 594,577 kg of CO2 annually, which equates to 70 to 132 gasoline-powered passenger vehicles driven for a year.
关节置换术已被证明在所有骨科亚专业中产生的废物最多，据估计，在英国，髋关节和膝关节置换术每年产生超过300万千克的废物。与回收废物相比，感染性废物产生的二氧化碳多达其十倍，先前的研究表明，感染性废物流中超过90%的废物被错误分类。我们评估了未洗手的团队成员进行实时废物分类对膝关节和髋关节置换术病例中废物产生的影响，并将其与在两个地点手术清单开始时的“团队简报”期间进行的简单教育干预进行比较。
废物分为五类：感染性、一般性、可回收、锐器和织物。每个病例结束时使用数字秤对每类废物进行称重。在A地点（一家三级骨科医院），收集了16例全膝关节置换术（TKA）和15例全髋关节置换术（THA）病例的干预前数据。随后，对于10例TKA和10例THA病例，一名未洗手的团队成员实时将废物主动正确分类到相应的类别中。在B地点（一家地区综合医院），干预前和干预后组均包括10例TKA和10例THA病例。干预措施包括在“团队简报”期间提醒工作人员正确分类废物。
主动实时废物分类使TKA病例中的感染性废物平均减少2.51千克（95%置信区间1.492至3.542），THA病例中减少1.83千克（p = 0.004）。教育干预使TKA病例中的感染性废物平均减少3.52千克，THA病例中减少2.09千克（p = 0.026）。干预后，两组TKA病例的总废物量均显著减少。
仅通过简单的教育措施就能显著减少感染性废物的量。在全国范围内推断，我们的结果将使每年减少约315,004千克至594,577千克的二氧化碳，这相当于70至132辆汽油动力乘用车行驶一年所产生的二氧化碳量。
