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

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

Effects of spice oil treatment of rice on moulding and mycotoxin contamination

Moulding and mycotoxin production have been studied during storage of rice at 85 and 90% relative humidity (r.h.) following treatment with cinnamon and clove oils. The clove oil-treated rice was artificially inoculated with Aspergillus flavus. Aflatoxin B1 and ochratoxin A were determined by monoclonal antibody-based enzyme-linked immunosorbent assay. Both moulding and mycotoxin were inhibited by 9 mul cinnamon oil g-1 but, with smaller doses, fungi could be isolated during the early part of storage, but not subsequently. Thus, following treatment with 3 or 6 mul cinnamon oil g-1, fungi were isolated from direct plated grains after 30 days but not after 45 days. Fungi were also isolated from washings of grain up to 30 days after treatment with 3 or 6 mul g-1, although fewer than from untreated grain. Propagules could also be detected up to 15 days after treatment with 9 mul g-1. Clove oil was much less effective than cinnamon oil in preventing moulding. After treatment with 8 mul g-1, the proportion of seeds infected with fungi and numbers of propagules in washings decreased only after 60 days' storage and with 4 mul g-1 after 90 days at both relative humidities. However, aflatoxin contamination could not be detected 90, 60 and 60 days after treatment with, respectively, 2, 4 and 8 mul g-1 at 85% r.h., although ochratoxin A was present in all treatments. At 90% r.h. aflatoxin was absent only after 90 days from treatment with 4 and 8 mul g-1. No T2 toxin was detected

Fungal colonization and mycotoxin contamination of developing rice grain

Fungal colonization and mycotoxin contamination of developing rice grains of two cultivars (IR-20 and Gowrisanna) were studied during the 1990 and 1991 crop seasons. Field and storage fungi invaded florets while they were still concealed within the boot leaf. Field fungi were most numerous from GS 65 to 77 and then decreased towards GS 91 (fully ripe). Storage fungi also decreased towards harvest. Aflatoxin B1 was detected at early growth stages but then decreased with decreasing water content. T-2 toxin increased steadily during grain development, and at harvest there was up to 210 ng toxin g-1 grain. Ochratoxin A was not detected until harvest, The incidence of toxigenic A. flavus isolates in fields of the two cultivars differed slightly, but their growth and toxin-producing ability differed greatly between seasons. A. flavus isolates collected during the 1991 crop season produced 26000 ng aflatoxin B1 ml-1 medium, much more than was produced by isolates collected during the 1990 crop season

Effect of spice essential oils on growth and aflatoxin B1 production by Aspergillus flavus

Aflatoxin B1 production by Aspergillus flavus was studied in yeast extract sucrose broth in the presence of cinnamon, clove, almond and cardamom oils. Growth and aflatoxin B1 production was inhibited by 0.5 mul cinnamon oil ml-1 medium and by 1 mul clove oil ml-1. Almond and cardamom oils only affected growth when their concentration exceeded 1.25 mul ml-1 medium. Aflatoxin B1 production was stimulated by 0.75 and 1 mul almond oil ml-1 medium or by 0.25 and 0.5 mul cardamom oil ml-1