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

Bacillus cereus in Brazilian Ultra High Temperature milk Bacillus cereus em leite UHT brasileiro

Brazilian Ultra High Temperature (UHT) milk consumption has increased during the last decade from 187 to 4,200 million liters. In the continuous UHT process, milk is submitted for 2-4 s to 130-150ºC, in a continuous flow system with immediate refrigeration and aseptical packing in hermetic packages. This research had the purpose to verify the incidence of B. cereus species from the B. cereus group, in UHT milk. In 1998 high indexes of these organisms were reported, reaching 34.14% of the analyzed samples. Beyond this fact, there was the need to establish methods and processes adjusted for correct identification of B. cereus. Thus, commercial sterility tests of 6,500 UHT milk packages were investigated in two assays, after ten days incubation at 37ºC and 7ºC to germinate all possible spores and/or to recuperate injured vegetative cells followed by pH measurement. Samples (1,300 packages each) from five Brazilian UHT plants of whole UHT milk processed by direct steam injection, packaged in carton were investigated for the presence of Bacillus cereus through phenotypic and genetic (PCR) tests. Values of pH were different for the samples, ranging between 6.57 and 6.73. After storage of the samples, only four packages with pH measurement below the lower limit of 6.5 were found and analyzed for the presence of B. cereus. This organism was not detected in any of the samples indicating that the five Brazilian UHT milk processors control pathogenic microorganisms and it can be said that the consumption of UHT milk does not present safety problems to consumers. Fourier Transform Infrared Spectroscopy (FTIR) and PCR tests were efficient and must be adopted to confirm the biochemical series for B. cereus.<br>O consumo de leite ultra-alta temperatura (UHT) brasileiro aumentou, durante a última década, de 187 milhões de litros para 4,200 milhões de litros. No processo contínuo de leite UHT o leite é submetido por 2-4 seg a 130-150ºC, em sistemas de escoamento contínuo com refrigeração imediata e envase asséptico em embalagens herméticas. Esta pesquisa teve a finalidade de verificar a incidência da espécie B. cereus, em leite UHT. Em 1998, foi reportado alto índice destes organismos neste produto atingindo 34,14% das amostras analisadas. Além deste fato, existia a necessidade de se estabelece métodos e processos adequados para correta identificação de B. cereus. Assim, a esterilidade comercial de 6.500 embalagens de leite UHT foi estudada, em dois ensaios, após incubação das amostras a 37ºC e 7ºC por dez dias para germinar todos os possíveis esporos e/ou recuperar células vegetativas injuriadas. Após a incubação, foi realizada a medida de pH. Neste sentido, hum mil e trezentas amostras de cada uma de cinco plantas Brasileiras de processo UHT, que operam com injeção direta de vapor produzindo leite integral em embalagens cartonadas, foram investigadas em relação à presença de Bacillus cereus, através de ensaios fenotípicos e genéticos (PCR). Os valores de pH foram diferentes para as amostras analisadas oscilando entre 6,57 e 6,73. Após a estocagem das amostras, somente quatro embalagens suspeitas, com medida de pH abaixo de 6,5 foram analisadas na procura por B. cereus. Não foi detectado B. cereus em nenhuma amostra indicando que o leite integral UHT Brasileiro, das cinco plantas processadoras, não apresenta o microrganismo patogênico. Somente microrganismos deteriorantes foram isolados indicando que dentro do espaço amostral, o leite UHT analisado não representa riscos e problemas de saúde aos consumidores. A Espectroscopia Infravermelha por Transformada de Fourier (FTIR) e a Reação em cadeia da polimerase (PCR) foram consideradas eficientes e devem ser adotadas para confirmar a série bioquímica de B. cereus