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

THE DEVELOPMENT OF AN IMPROVED MULTILAYER CVD COATING FOR METALCUTTING APPLICATIONS

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THE DEVELOPMENT OF AN IMPROVED MULTILAYER CVD COATING FOR METALCUTTING APPLICATIONS

Un revêtement expérimental multicouche (Al2O3) a été appliqué sur des inserts d'outil de coupe en utilisant un équipement CVD de production automatisé. Les tests d'usinage d'acier 1045 révèlent une résistance à l'usure en cratère supérieure à celle des nuances commerciales (monocouche ou multicouche) en Al2O3. Cette résistance est fonction de l'épaisseur du revêtement. La résistance à l'usure en dépouille est proportionnelle à l'épaisseur de la couche sous jacente (TiC et/ou TiC,N). Pour une épaisseur de 5 à 6 µm de cette dernière, l'outil expérimental présente une résistance à l'usure exceptionnelle.An experimental multilayer Al2O3 coating was applied to machine tool inserts using automated, production scale CVD equipment. In machine tests using 1045 steel, the experimental tool demonstrated crater wear performance superior to commercially available monolayer and multilayer Al2O3 grades. Resistance to crater wear was determined to be a function of Al2O3 coating thickness. Resistance to flank wear was found to be proportional to thickness of the backing layer (TiC and/or TiC,N). Thus, the relatively thick (5.5-6.0µm) backing layer of the experimental tool provided exceptional wear resistance