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

Integrated, Decentralized Wastewater Management Use to Improve the Environmental Health of Khartoum Locality Sudan

The management of water resources and the related disposal of wastewater are essential for human existence and the advancement of contemporary society. Collecting and managing wastewater has a significant effect on local and global economies as well as the environment. Innovation in the field of the environment is of utmost importance in reducing the environmental impacts on systems and in making them more sustainable economically, environmentally and socially. Decentralization is considered an appropriate solution to sustainability problems in liquid waste management programs because it focuses on treating liquid waste on-site, recycling it locally, and taking advantage of the local resources available in domestic wastewater. This research analyzes the needs, appropriate technical methods, and support for water management through decentralized systems. Three considerations will be used to support the choice of a decentralized wastewater treatment system in the Khartoum Locality: $106,000,000. According to the BioWin results, the effectiveness of each alternative household wastewater treatment was comparable. Software such as MapInfo, GPS Area Calculator, BioWin, and GIS was used to reach the targets. Additionally, the results revealed that the decentralized wastewater treatment method, considering its costs, land requirements, and slope effects on the environment, is preferable to centralized wastewater treatment systems. These results serve as a guide for choosing the best wastewater treatment option to increase access to safe sanitation and to integrate decentralized wastewater management to upgrade and improve the environment in the Khartoum Locality