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

The spreading of East Coast Fever into Great Bahr- El Ghazal Region, North West of South Sudan

Theileriosis is a fatal tick-borne disease caused by Theileria parva (T.parva) and affecting cattle mainly in East and Central Africa. A cross-sectional survey was conducted during June to November 2015 in 12 localities of Great Bahr- El Ghazal Region, South Sudan to investigate the prevalence of East Coast Fever in indigenous zebu (Nilotic) cattle kept under traditional management system. A total of 600 blood and 105 lymph node smears were collected from cattle. Microscopic examination of Giemsa stained blood smears revealed prevalence of 8.7% for Theileria spp piroplasms. Surprisingly, all the105 lymph node smears were negative for Theileria schizonts. In addition, out of 599 blood samples examined, 464 (77.5%) were positive for Theileria parva DNA using p104 nested polymerase chain reaction (nPCR) with significant differences (P < 0.001) between the localities of the study areas. Out of eight pooled ticks species that were identified (Amblyomma variegatum, Rhipicephalus evertsi evertsi, R. decoloratus, Hyalomma rufipes, R.annulatus, H. truncatum, R. sanguineus group and R. praetextus), one tick species (Amblyomma variegatum) was positive for Theileria parva DNA. The study concluded that T. parva is endemic in the region in spite of the absence of R. appendiculatus. Detection of T. parva DNA in A. variegatum may indicate the role of this tick species in transmission of T. parva among cattle. However, a need for further investigationemploying more samples and using more advanced techniques is highly recommended. Keywords: Epidemiology, East Coast fever; Bahr- El Ghazal; South Sudan