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

Biotechnology for environmental quality: Closing the circles

This paper examines the impact of biotechnology for enhancing the quality of the environment, and the necessity of encouraging holistic approaches to environmental problem solving. Current actions are considered wanting because they place insufficient attention on the causes of environmental degradation. In this context, a number of issues and research agendas are presented, a consideration of which leads me to opine that urgent priorities for ensuring lasting sustainable development must include the widespread adoption of clean technology and ecosystem restoration. Biotechnology has a particularly decisive role to play in realizing clean processes and clean products, and this role is illustrated with reference to clean technology options in the industrial, agroforestry, food, raw materials, and minerals sectors. A quarter of a century ago Commoner (1971) used the metaphor of a closing circle to draw attention to incompatibilities of modern industrial society and ecological health. The second part of this paper argues that, as biotechnology has matured, a circle of synergistic flows of materials, services and ideas has been established between it and biodiversity and suggests a more optimistic scenario to that portrayed by Commoner. The closing of the biotechnology-biodiversity circle is manifest in the following terms: search and discovery; detection, circumscription and phylogeny; ecosystem function and restoration; industrial ecology; and the gearing provided by molecular biology. Finally, the North-South biotechnology-biodiversity circle presents critical problems of commercial exploitation and intellectual property rights in relation to the gene pools of the megadiversity but predominantly developing countries of the world

Interactions of Staphylococci with Osteoblasts and Phagocytes in the Pathogenesis of Implant-Associated Osteomyelitis

In spite of great advancements in the field of biomaterials and in surgical techniques, the implant of medical devices is still associated with a high risk of bacterial infection. Implant-associated osteomyelitis is a deep infection of bone around the implant. The continuous inflammatory destruction of bone tissues characterizes this serious bone infectious disease. Staphylococcus aureus and Staphylococcus epidermidis are the most prevalent etiologic agents of implant-associated infections, together with the emerging pathogen Staphylococcus lugdunensis. Various interactions between staphylococci, osteoblasts, and phagocytes occurring in the pen-prosthesis environment play a crucial role in the pathogenesis of implant-associated osteomyelitis. Here we focus on two main events: internalization of staphylococci into osteoblasts, and bacterial interactions with phagocytic cells