TY - JOUR
T1 - The carbon footprint of the operating room related to infection prevention measures
T2 - a scoping review
AU - Bolten, A.
AU - Kringos, D. S.
AU - Spijkerman, I. J. B.
AU - Sperna Weiland, N. H.
N1 - Funding Information: Another way to reduce waste generation, and hence the carbon footprint of the OR, is by reprocessing single-use devices. US Food and Drug Administration commissions and the US Government Accounting Office have not found evidence to support the opinion that single-use devices reprocessed under approved conditions (including disinfection, cleaning, testing and sterilization) resulted in elevated health risks for patients, although 28% of physicians believe that this would be the case [43,44]. The direct economic savings to hospitals have been estimated to be approximately US$20,000 per operating room annually [45]. However, strict regulations (Medical Device Regulations) are a barrier to the reprocessing of single-use devices.Several barriers to greener policy were identified. Firstly, in recent years, hospitals have based their infection prevention policies on the ALARA (As Low As Reasonably Achievable) principle. As disposable devices are at lower risk for contamination than reusable devices, disposable devices became standard practice. However, risks for contamination of reusable devices are very small in a validated sterilization process of devices designed to be reused. In a risk-based approach, the risk associated with an increased CO2 footprint may outweigh the very small risk of contamination of reusable devices. With regard to air treatment systems, there is no unequivocal evidence that energy-intensive air treatment systems lead to a lower incidence of SSIs than the less-energy-intensive systems that are available. Current international guidelines on air treatment in ORs have been adjusted to make green choices possible. The international guidelines of WHO [84], CDC [85] and the National Institute for Health and Care Excellence [86] note serious shortcomings in the research in this area, and that the (very) low strength of evidence does not support a decision to equip an OR with a unidirectional flow system with high energy consumption. Publisher Copyright: © 2022 The Healthcare Infection Society
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. Aim: To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. Methods: A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. Findings: Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. Conclusion: Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
AB - Background: Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. Aim: To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. Methods: A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. Findings: Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. Conclusion: Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
KW - Carbon footprint
KW - Disposable equipment
KW - Equipment reuse
KW - Operating rooms
KW - Surgical site infections
KW - Sustainable development
UR - http://www.scopus.com/inward/record.url?scp=85137291820&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jhin.2022.07.011
DO - https://doi.org/10.1016/j.jhin.2022.07.011
M3 - Review article
C2 - 35850380
SN - 0195-6701
VL - 128
SP - 64
EP - 73
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
ER -