Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Persistent child malnutrition in Tanzania: risks associated with traditional complementary foods (A review)

African Journal of Food Science, 2010, 4 (11) : 679 - 692Despite numerous nutritional interventions that have taken place in Tanzania, the Country still experiences a high rate of child malnutrition. Millions of children suffer from one or more forms of malnutrition resulting in stunting, underweight, wasting and anemia. The growth of children often declines with the introduction of complementary foods around the age of 6 months and continues to decline up to 24 months that have greater implications for health during adult-hood. Poor breastfeeding and child feeding practices augmented by very early introduction of nutritionally inadequate and contaminated complementary foods are major factors contributing to persistent child malnutrition in Tanzania. These complementary foods comprise mainly cereal-based porridges with little or no vegetables and often lacking animal proteins. The promotion of exclusive breastfeeding during the first 6 months and appropriate feeding practices has been the integral parts of the intervention processes taking place in Tanzania. Food safety education is a critical prerequisite in the child health programs and is a cost effective intervention with long term positive impacts. This paper reviews the persistent child malnutrition in Tanzania and the causative factors to highlight risks associated with use of complimentary

Persistent child malnutrition in Tanzania: risks associated with traditional complementary foods (A review)

African Journal of Food Science, 2010, 4 (11) : 679 - 692Despite numerous nutritional interventions that have taken place in Tanzania, the Country still experiences a high rate of child malnutrition. Millions of children suffer from one or more forms of malnutrition resulting in stunting, underweight, wasting and anemia. The growth of children often declines with the introduction of complementary foods around the age of 6 months and continues to decline up to 24 months that have greater implications for health during adult-hood. Poor breastfeeding and child feeding practices augmented by very early introduction of nutritionally inadequate and contaminated complementary foods are major factors contributing to persistent child malnutrition in Tanzania. These complementary foods comprise mainly cereal-based porridges with little or no vegetables and often lacking animal proteins. The promotion of exclusive breastfeeding during the first 6 months and appropriate feeding practices has been the integral parts of the intervention processes taking place in Tanzania. Food safety education is a critical prerequisite in the child health programs and is a cost effective intervention with long term positive impacts. This paper reviews the persistent child malnutrition in Tanzania and the causative factors to highlight risks associated with use of complimentary

Efficacy of anaerobic methane fermentation system on Shochu waste treatment

This study aimed at evaluating the efficacy of anaerobic methane fermentation on Shochu wastewater treatment and collecting the performance data for this system. The performance data studied include Chemical oxygen demand (CODcr) removal efficiency, methane production rate (MPR) and biogas production rate (BPR). Shochu wastewater contained 43,000mg/l and 36,800mg/l as total CODcr and suspended solids, respectively. Approximately CODcr removal efficiency of 98% could be achieved after 120h of fermentation in a batch reactor. The optimal biogas production was attained at the shochu wastewater to seed ratio of 1:4 (v/v). Undiluted shochu wastewater sample gave the best results indicating that its dilution is unnecessary. Initial material pH value of 6.5 to 7.5 for the shochu wastewater-seed mixture was effective and the pH outside this range resulted in reduced biogas production. Methane (CH4) content in biogas was on average 65.5% regardless of the initial pH value, with exception of pH 5.5 where no CH4 gas was detected. The BPR of 0.95l/ld and MPR of 0.43l/ld were realized with undiluted shochu wastewater at 1:4 (v/v) shochu wastewater to seed ratio. A large fraction of organic matter was effectively degraded

Stability of slightly acidic electrolyzed water on storage and its microbial inactivation effectiveness on the aerobic microflora present on intact spinach (Spinacia oleracea L.) leaves

J. SASJ, Vol. 39, No. 4 2009. 3, 259-267The stability of Slightly Acidic Electrolyzed Water (SAEW) on storage was evaluated. SAEW samples of known initial Oxidation Reduction Potential (ORP, mV), pH and available chlorine concentration (ACC, mg/L) were stored at 25℃ in different containers and changes of ORP, pH and ACC were monitored daily for a period of 10 days. ORP, pH and ACC were respectively maintained at 900-1000mV, 5-6.5 and 10-30mg/L. SAEW was further evaluated for its microbial inactivation effectiveness on the aerobic microflora present on spinach (Spinacia oleracea L.) expressed as aerobic plate count (APC) and was compared to Sodium hypochlorite (NaOCl) solution. The decontamination was done by dipping spinach samples with or without a pre-washing step into treatment solution for 5min. SAEW (pH 5.5, 25mg/L ACC) achieved a significantly higher microbial reduction than NaOCl solution (pH 9.9, 103mg/L ACC). While pre-washing of spinach in running tap water for 5min increased the microbial reduction by SAEW from 1.3 logo colony forming units (CFU)/g to more than 2 log10 CFU/g at 5min contact time, increasing exposure time did not significantly affect its antimicrobial effectiveness on spinach aerobic microflora

Stability of slightly acidic electrolyzed water on storage and its microbial inactivation effectiveness on the aerobic microflora present on intact spinach (Spinacia oleracea L.) leaves

J. SASJ, Vol. 39, No. 4 2009. 3, 259-267The stability of Slightly Acidic Electrolyzed Water (SAEW) on storage was evaluated. SAEW samples of known initial Oxidation Reduction Potential (ORP, mV), pH and available chlorine concentration (ACC, mg/L) were stored at 25℃ in different containers and changes of ORP, pH and ACC were monitored daily for a period of 10 days. ORP, pH and ACC were respectively maintained at 900-1000mV, 5-6.5 and 10-30mg/L. SAEW was further evaluated for its microbial inactivation effectiveness on the aerobic microflora present on spinach (Spinacia oleracea L.) expressed as aerobic plate count (APC) and was compared to Sodium hypochlorite (NaOCl) solution. The decontamination was done by dipping spinach samples with or without a pre-washing step into treatment solution for 5min. SAEW (pH 5.5, 25mg/L ACC) achieved a significantly higher microbial reduction than NaOCl solution (pH 9.9, 103mg/L ACC). While pre-washing of spinach in running tap water for 5min increased the microbial reduction by SAEW from 1.3 logo colony forming units (CFU)/g to more than 2 log10 CFU/g at 5min contact time, increasing exposure time did not significantly affect its antimicrobial effectiveness on spinach aerobic microflora

Efficacy of anaerobic methane fermentation system on Shochu waste treatment

This study aimed at evaluating the efficacy of anaerobic methane fermentation on Shochu wastewater treatment and collecting the performance data for this system. The performance data studied include Chemical oxygen demand (CODcr) removal efficiency, methane production rate (MPR) and biogas production rate (BPR). Shochu wastewater contained 43,000mg/l and 36,800mg/l as total CODcr and suspended solids, respectively. Approximately CODcr removal efficiency of 98% could be achieved after 120h of fermentation in a batch reactor. The optimal biogas production was attained at the shochu wastewater to seed ratio of 1:4 (v/v). Undiluted shochu wastewater sample gave the best results indicating that its dilution is unnecessary. Initial material pH value of 6.5 to 7.5 for the shochu wastewater-seed mixture was effective and the pH outside this range resulted in reduced biogas production. Methane (CH4) content in biogas was on average 65.5% regardless of the initial pH value, with exception of pH 5.5 where no CH4 gas was detected. The BPR of 0.95l/ld and MPR of 0.43l/ld were realized with undiluted shochu wastewater at 1:4 (v/v) shochu wastewater to seed ratio. A large fraction of organic matter was effectively degraded

In vitro inactivation of Escherichia coli, Staphylococcus aureus and Salmonella spp. using slightly acidic electrolyzed water

Journal of Bioscience and Bioengineering VOL. 110 No. 3, 308 – 313In the current study, the effectiveness of slightly acidic electrolyzed water (SAEW) on an in vitro inactivation of Escherichia coli (E. coli), Staphylococcus aureus (S. aureus) and Salmonella spp. was evaluated and compared with other sanitizers. SAEW (pH 5.6, 23 mg/l available chlorine concentration; ACC; and 940 mV oxidation reduction potential; ORP) was generated by electrolysis of dilute solution of HCl (2%) in a chamber of a non-membrane electrolytic cell. One milliliter of bacteria suspension (ca. 10–11 log 10 CFU/ml) was mixed with 9 ml of SAEW, strong acidic electrolyzed water (StAEW; ca. 50 mg/l ACC), sodium hypochlorite solution (NaOCl; ca.120 mg/l ACC) and distilled water (DW) as control and treated for 60 s. SAEW effectively reduced the population of E. coli, S. aureus and Salmonella spp. by 5.1, 4.8, and 5.2 log 10 CFU/ml. Although, ACC of SAEW was more than 5 times lower than that of NaOCl solution, they showed no significant bactericidal difference (p N 0.05). However, the bactericidal effect of StAEW was significantly higher (p b 0.05) than SAEW and NaOCl solution in all cases. When tested with each individual test solution, E. coli, S. aureus and Salmonella spp. reductions were not significantly different (p N 0.05). These findings indicate that SAEW with low available chlorine concentration can equally inactivate E. coli, S. aureus and Salmonella spp. as NaOCl solution and therefore SAEW shows a high potential of application in agriculture and food industry as an environmentally friendly disinfection agent

Decontamination of ready-to-eat Japanese mustard green (Brassica japonica) from Escherichia coli using slightly acidic electrolyzed water

African Journal of Microbiology Research, 2009; 3 (10): 649-653In the present study, slightly acidic electrolyzed water (SAEW: pH 5.6 ± 0.21, 22 ± 1.4 mg/L available chlorine concentration; ACC) was evaluated for decontamination of Japanese mustard green (Brassica japonica) from Escherichia coli (E. coli) and its effectiveness was compared to that of sodium hypochlorite solution (NaOCl solution: pH 9.8±0.01, 110 ± 2.3 mg/L ACC). Decontamination of Japanese mustard green inoculated with E. coli was done by dipping samples into SAEW, NaOCl solution and Tap water (control) with stirring for 2, 5, 10 and 15 min. SAEW achieved E. coli reduction of 1.29 -1.64 log10 CFU/g and was not significantly different from that achieved by NaOCl solution (P > 0.05). Increasing the exposure time did not significantly affect its decontamination effectiveness. The results of current study indicate that SAEW with near neutral pH and low available chlorine concentration could be used as an alternative food sanitizer for NaOCl solution to reduce the population of pathogens from the fruits and vegetables in food industry