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

Evaluation of knowledge and practice of pharmaceutical waste disposal in hospitals and pharmacies within Lagos State, Nigeria

Background: Treatment and disposal of waste is a major challenge in most developing countries, including Nigeria. Improper disposal of pharmaceutical waste could have negative impact on the environment and human health as they can cause harmful effects.Objectives: This study assessed the knowledge and practise of healthcare personnel in Lagos State, Nigeria towards pharmaceutical waste disposal.Methods: The study was a cross-sectional descriptive survey carried out using structured questionnaires. Target respondents were healthcare workers involved in the use and disposal of pharmaceutical waste in several hospitals and pharmacies located within the State. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20 and presented as tables and charts using descriptive and inferential statistics.Results: There was 83.3 % response to the questionnaires. Majority of the respondents (63.07 %) dispose refuse via authorized garbage collectors. The survey indicated that the drainage systems of most hospitals and pharmacies are connected to general drainages while 6.2 % have sewage systems installed. Most of the respondents (68.9 %) indicated that there was no waste disposal method in place for pharmaceutical waste. Knowledge of most appropriate disposal method for pharmaceutical waste amongst most of the respondents was poor (30.85 %).Conclusion: Limited knowledge on pharmaceutical waste disposal was evident amongst the respondents. Hence, the need to enlighten health care personnel on proper pharmaceutical waste disposal methods, so as to avoid associated environmental hazards, is recommended.Keywords: Healthcare workers, Pharmaceuticals, Waste disposal, Environmental, Hazar