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

The FAO/WHO International Food Safety Authorities Network in Review, 2004-2018:Learning from the Past and Looking to the Future

Contemporary patterns of global food trade necessitate cross-border communication between government authorities when unsafe food enters international commerce. The Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) International Food Safety Authorities Network (INFOSAN), established in 2004, facilitates urgent communication between >600 members from 188 of the 194 FAO and WHO Member States around the world and supports the strengthening of food safety systems in an effort to mitigate the global burden of foodborne disease. For nearly 15 years, INFOSAN has been operating as a global, virtual community of practice (CoP), fostering knowledge transfer and exchange between members, and enabling crucial international communication during food safety emergencies. During this time, a number of important partnerships have been forged, including with other networks like PulseNet International. Complementarity, and cooperation between global networks like INFOSAN and PulseNet is vital to improve the efficiency and effectiveness of global efforts to curb foodborne illness. Since 2011, detailed data related to the patterns of information exchange during 293 food safety emergencies communicated through INFOSAN have been documented systematically. An analysis of these data reveals that a relatively limited number of active members from a select group of Member States contribute the majority of information exchanged through the network. For example, nine (5%) Member States were each involved in 24 or more food safety events communicated through INFOSAN between 2011 and 2017, whereas 123 (65%) Member States were involved in three events or less, including 36 (19%) involved in none. These data also demonstrate that although the overall responsiveness of members during emergencies has improved in recent years, impediments to rapid and efficient information sharing still persist. A number of potential barriers to active participation in INFOSAN have been hypothesized, but members themselves have not been conferred with on their relative importance. As a member-driven network, future research to investigate the experiences of INFOSAN members in a rigorous and systematic manner is recommended. Such work could illuminate the specific areas in which to introduce operational shifts by the INFOSAN Secretariat, to strengthen the global CoP, increase the value of INFOSAN among members, and have a robust and meaningful impact at country level to reduce the burden of foodborne disease globally

Central Bank of Morocco

exterior, partial view of elevation on Avenue Allal Ben Abdellah, 199

Central Bank of Morocco

exterior, windows on Avenue Allal Ben Abdellah facade, 199

Central Bank of Morocco

exterior, elevation on Avenue Allal Ben Abdellah, 199