Ledda Virginia, Ademuyiwa Adesoji, Adisa Adewale, Bhangu Aneel, Ghosh Dhruv, Haque Parvez David, Ingabire J C Allen, Ntirenganya Faustin, Picciochi Maria, Suroy Atul, Lillywhite Robert, Nepogodiev Dmitri
NIHR Global Health Research Unit on Global Surgery, University of Birmingham, United Kingdom.
Nigeria Hub, NIHR Global Health Research Unit on Global Surgery, University of Lagos, Lagos, Nigeria.
JAMA Netw Open. 2025 Aug 1;8(8):e2525355. doi: 10.1001/jamanetworkopen.2025.25355.
The Cheetah randomized trial demonstrated that changing sterile gloves and instruments before wound closure reduces surgical site infections (SSI) in abdominal surgery. However, its environmental impact remains unclear.
To estimate the global carbon footprint associated with changing sterile gloves and instruments before closure abdominal wound.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytic model compared the carbon footprint of a glove and instrument change intervention against a control (no glove and instrument change). Model parameters were sourced from a large cluster randomized trial conducted in 7 low- and middle-income countries (LMICs) between June 2020 and March 2022, as well as data from stakeholder engagement and existing research. Boundaries included the trial intervention and in-hospital resources used to manage SSI. The analysis was stratified by wound contamination status (clean-contaminated, contaminated-dirty) and country-income classification.
Average per-patient wound-specific carbon footprint, calculated as the sum of the carbon footprint of glove and instrument change and SSI. Sensitivity analyses were based on the lowest and highest possible values for key model parameters: intervention effectiveness, intervention carbon footprint, and SSI carbon footprint. The best-case analysis was based on highest possible intervention effectiveness, lowest possible intervention carbon footprint, highest possible SSI carbon footprint. The worst-case analysis was based on lowest intervention effectiveness, highest intervention carbon footprint, and lowest SSI carbon footprint.
In LMICs, the difference in carbon footprints between the intervention and control groups was 10.97 kg CO2 equivalents (kgCO2e) (scenario range, -2.53 to 33.50 kgCO2e) for clean-contaminated and 22.60 kgCO2e (scenario range, -1.62 to 61.17 kgCO2e) for contaminated-dirty surgeries. In high-income countries, differences were 4.14 kgCO2e (scenario range, -3.38 to 17.95 kgCO2e) and 10.48 kgCO2e (scenario range, -3.06 to 37.62 kgCO2e), respectively. Country-level modeling found the intervention to be consistently associated with a lower wound-specific carbon footprint across all countries.
In this decision analytic model, sterile glove and instrument change before wound closure was associated with a reduced wound-specific carbon footprint across all country income settings. Alongside clinical and economic benefits, this intervention may support more sustainable surgical care; national associations and governments should consider its adoption to improve outcomes for both patients and the planet.
猎豹随机试验表明，在伤口缝合前更换无菌手套和器械可降低腹部手术的手术部位感染（SSI）。然而，其对环境的影响仍不明确。
估计在腹部伤口缝合前更换无菌手套和器械所产生的全球碳足迹。
设计、背景和参与者：该决策分析模型将手套和器械更换干预措施的碳足迹与对照组（不更换手套和器械）进行了比较。模型参数来源于2020年6月至2022年3月在7个低收入和中等收入国家（LMICs）进行的一项大型整群随机试验，以及利益相关者参与和现有研究的数据。范围包括试验干预措施和用于管理SSI的医院资源。分析按伤口污染状况（清洁-污染、污染-脏污）和国家收入分类进行分层。
按患者计算的平均伤口特异性碳足迹，计算方法为手套和器械更换以及SSI的碳足迹总和。敏感性分析基于关键模型参数的最低和最高可能值：干预效果、干预碳足迹和SSI碳足迹。最佳情况分析基于最高可能的干预效果、最低可能的干预碳足迹、最高可能的SSI碳足迹。最坏情况分析基于最低干预效果、最高干预碳足迹和最低SSI碳足迹。
在低收入和中等收入国家，清洁-污染手术中干预组和对照组的碳足迹差异为10.97千克二氧化碳当量（kgCO2e）（情景范围为-2.53至33.50 kgCO2e），污染-脏污手术中为22.60 kgCO2e（情景范围为-1.62至61.17 kgCO2e）。在高收入国家，差异分别为4.14 kgCO2e（情景范围为-3.38至17.95 kgCO2e）和10.48 kgCO2e（情景范围为-3.06至37.62 kgCO2e）。国家层面的模型发现，在所有国家，该干预措施始终与较低的伤口特异性碳足迹相关。
在这个决策分析模型中，在伤口缝合前更换无菌手套和器械与所有国家收入水平下伤口特异性碳足迹的减少相关。除了临床和经济效益外，这种干预措施可能支持更可持续的手术护理；国家协会和政府应考虑采用该措施，以改善患者和地球的结局。
