Sustainability
Report, which saves space in the operating theatre build. However, it is controversial because induction of anaesthesia requires a calm environment for the patient and may also take some time – especially if regional anaesthesia becomes more common. Inducing the patient in the theatre, which saves a second anaesthetic circuit being filled with gases, means a noisy environment for the patient and also potentially an undignified one. There are suggestions too, that the manifold containing nitrous oxide should be discontinued and the supply fed by cylinders on the anaesthetic machine instead, due to the amount of NO2
which leaks from the piped supply.
Circular economy Discussion regarding a circular economy for products used during surgery is an important aspect of choosing a product to purchase. A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs throughout the lifetime of the item. In contrast, in a linear supply chain, the product is single use and disposed of. Healthcare, over the past thirty years, has become far more reliant on single use items managed by just-in-time principles to reduce stock holdings and to rely on frequent deliveries. This often shows frailties when there are disruptions and fluctuations (such as PPE supplies during the COVID-19 pandemic). There are barriers to circularity – such as difficult to clean items, infection prevention and control, as well as behaviours of medical device manufacturers. The law has something to contribute to the general disregard of re-using single use disposable items, which is common practice in the US. Single use of a vast range of different
products is not good use of global resources and we must re-think this activity. We create a great deal of waste from single use products, some of which contain rare metals or items that have a longer life than we use them for. An example of this is the lithium-ion batteries in single use vaping products. Testing has shown that the batteries have a life far longer than the product is used for and is discarded. It is estimated that 1.3 million are discarded each week, in the UK, creating toxic waste11
without
saving the precious lithium – a finite global resource. Complex medical products may also contain rare resources often unknown to their users and discarded often with a cost to waste disposal and the planet. However, there needs to be capacity for
switching back to reusable products in the cleaning and sterilisation processes making
There needs to be capacity for switching back to reusable products in the cleaning and sterilisation processes making them fit for re-use. It is not simple moving from single use to re-usable products; many are not available as re-useable or are a second-rate product for the patient or patient safety.
them fit for re-use. It is not simple moving from single use to re-usable products; many are not available as re-useable or are a second-rate product for the patient or patient safety. Take for example a single use port for laparoscopic surgery; they are sharp in order to pierce the skin, therefore causing the patient as little damage as possible. Those they replaced were re-usable but, after frequent use, these became difficult to get through the patient’s skin and had the potential to cause harm to the bowel or other structures, due to handling difficulties. They also leaked gas into the faces of the team using them, as part of the port was a small, replaceable washer which did not always get replaced between uses. The Green Surgery Report cites average
reductions in carbon footprint of 38%-56% achieved through switching from single use to reusable equipment. It is the author’s belief that there is traction to be gained but much more research is required, especially on difficult-to- clean items such as cannula, needles and small lumened items, as well as many other modern instruments and medical device equipment. The report suggests we use the 5Rs when considering a product as part of the circular economy – which may also be labelled as the ‘whole life’ of a product: refuse, reduce, reuse, renew and recycle.
The Association of British Healthcare Industries (ABHI) suggests that, when considering new products to purchase, the price is the main element for choice. The environmental impacts of a product need to be part of the overall consideration in order to contribute to long-term Net Zero. Carbon Reduction Plans are to be introduced which will indicate that all suppliers will be required to publicly report targets, emissions and publish a Carbon Reduction Plan for their scope 1, 2 and 3 emissions.12
Surgical specialties Many surgical specialties have a range of instruments which, over the past twenty years, have been replaced with a single use product. These are what need to be considered in the light of carbon reduction and the 5Rs. For example, some scissors – particularly for use in laparoscopic surgery – have become single use items replacing less sharp scissors, which were reusable. Surgeons have got used to the scissors being sharp and cutting the first time – it would be difficult to go back. Another consideration is poor or interrupted insulation on some diathermy products, during laparoscopic surgery, which can cause arcing or tissue burns. Single use diathermy handpieces were substituted for reusable ones when the
July 2024 I
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