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

Patogenicidade de um isolado de Trypanosoma evansi em ratos inoculados com o parasito em sangue in natura e criopreservado Trypanosoma evansi pathogenicity strain in rats inoculated with parasite in fresh and cryopreserved blood

O objetivo deste estudo foi investigar a patogenicidade do isolado de Trypanosoma evansi (LPV-2005), em ratos (Rattus norvergicus), sob influência da imunidade passiva, de diferentes concentrações e de meios de conservação. Para tanto, foram utilizados 36 Rattus norvergicus, fêmeas, separados em seis grupos homogêneos. Os roedores dos grupos A e B foram infectados com 10(5) T. evansi, e os animais dos grupos C e D foram infectados com 10(6) tripomastigotas/animal. Os grupos E e F foram utilizados como grupo controle negativo, isto é, inoculados com sangue in natura e criopreservado sem o parasito, respectivamente. O grupo A foi formado por ratos filhos de fêmeas infectadas com protozoário, mas curadas após tratamento. Os grupos B, C e D continham roedores que nunca tiveram contato com o isolado LPV-2005. Os grupos B e C diferiram quanto à dose inoculada do flagelado mantida em cultura viva (ratos Wistar). Já os ratos do grupo D foram infectados com sangue criopreservado em nitrogênio líquido. A patogenicidade do isolado foi avaliada a partir do período pré-patente, da evolução da parasitemia e da longevidade dos animais. O grupo D apresentou um período pré-patente superior aos demais grupos. Em relação à longevidade dos animais de cada grupo, foi verificada diferença estatística significativa (P<0,05). O grupo D apresentou um período de vida de 27,8 dias, e o grupo C, de apenas 4,8 dias. Os ratos de ambos os grupos controle mantiveram-se vivos por 50 dias, quando foram eutanasiados. Portanto, a preservação do inóculo testado e a dose infectante de T. evansi influenciam a patogenicidade do isolado LPV-2005 para ratos. A presença de anticorpos maternos em ratos não impede a infecção e mortalidade por T. evansi.<br>This study aimed to evaluate the Trypanosoma evansi strain pathogenicity (LPV-2005) in rats under passive immunity influence, of different concentrations and media preservation. Thirty six adult female Rattus norvergicus were separated in six equal groups. Groups A and B were inoculated with 10(5) T. evansi and groups C and D with 10(6) blood trypomastigotes per animal. Groups E and F were used as negative control in which the animals were inoculated with fresh and cryopreserved blood, without the parasite. Group A were composed of T. evansi infected born rats and cured females. Groups B, C and D were composed with animals never exposed to the LPV-2005 strain. All groups B and C animals received different doses of blood trypomastigotes kept in Wistar rats, while animals from group D were infected with cryopreserved blood kept in liquid nitrogen. The the strain pathogenicity was estimated by prepatency evaluation period, levels of parasitemia and animals longevity. Group D showed a longer prepatency period in comparison with other groups. The longevity of group D (27.8 days) was significantly different (P<0.05) from group C (4.8 days). Rats of the control group were euthanized 50 days postinfection. In conclusion, the tested inoculum-preservation methods and the infective dose of T. evansi influenced the pathogenicity of the LPV-2005 strain in rats. The presence of maternal antibodies did not prevent the infection and mortality of the rats by T. evansi