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

Patient‐worn endoscopy mask to protect against viral transmission

ObjectivesTo design and evaluate patient-worn personal protective equipment (PPE) that allows providers to perform endoscopy while protecting against droplet and airborne disease transmission.Study designSingle subject study.MethodsMask efficacy was evaluated using a cough simulator that sprays dye visible under ultra-violet light. User-testing was performed on an airway trainer mannequin where each subject performed the endoscopy with and without the mask in random orders. Their time to completion and number of attempts before successful completion were recorded, and each subject was asked to fill out a NASA Task Load Index (TLX) form with respect to their experience.ResultsThe mask has a filtration efficiency of 97.31% and eliminated any expelled particles with the cough simulator. Without the mask, a simulated cough is visualized as it progresses away from the cough origin. Subjects who performed trans-nasal endoscopy spent 27.8 ± 8.0 s to visualize the vocal cords for the no mask condition and 28.7 ± 13.6 s for the mask condition (mean ± SD, p > .05). There was no statistically significant difference found in the mental demand, physical demand, temporal demand, performance, effort, and frustration of endoscopy under the no mask and mask conditions (all p > .05).ConclusionThe designed PPE provides an effective barrier for viral droplet and airborne transmission while allowing the ability to perform endoscopy with ease.Level of evidence3 Laryngoscope, 2021

Assessing the Physiological Relevance of Cough Simulators for Respiratory Droplet Dispersion

Various breathing and cough simulators have been used to model respiratory droplet dispersion and viral droplets, in particular for SARS-CoV-2 modeling. However, limited data are available comparing these cough simulations to physiological breathing and coughing. In this study, three different cough simulators (Teleflex Mucosal Atomization Device Nasal (MAD Nasal), a spray gun, and GloGermTM MIST) that have been used in the literature were studied to assess their physiologic relevance. Droplet size, velocity, dispersion, and force generated by the simulators were measured. Droplet size was measured with scanning electron microscopy (SEM). Slow-motion videography was used to 3D reconstruct and measure the velocity of each simulated cough. A force-sensitive resistor was used to measure the force of each simulated cough. The average size of droplets from each cough simulator was 176 to 220 µm. MAD Nasal, the spray gun, and GloGermTM MIST traveled 0.38 m, 0.89 m, and 1.62 m respectively. The average velocities for the MAD Nasal, spray gun, and GloGermTM MIST were 1.57 m/s, 2.60 m/s, and 9.27 m/s respectively, and all yielded a force of <0.5 Newtons. GloGermTM MIST and the spray gun most closely resemble physiological coughs and breathing respectively. In conclusion, none of the simulators tested accurately modeled all physiologic characteristics (droplet size, 3-D dispersion velocity, and force) of a cough, while there were various strengths and weaknesses of each method. One should take this into account when performing simulations with these devices

KN95 and N95 Respirators Retain Filtration Efficiency despite a Loss of Dipole Charge during Decontamination.

N95 decontamination protocols and KN95 respirators have been described as solutions to a lack of personal protective equipment. However, there are a few material science studies that characterize the charge distribution and physical changes accompanying disinfection treatments, particularly heating. Here, we report the filtration efficiency, dipole charge density, and fiber integrity of N95 and KN95 respirators before and after various decontamination methods. We found that the filter layers in N95 and KN95 respirators maintained their fiber integrity without any deformations during disinfection. The filter layers of N95 respirators were 8-fold thicker and had 2-fold higher dipole charge density than that of KN95 respirators. Emergency Use Authorization (EUA)-approved KN95 respirators showed filtration efficiencies as high as N95 respirators. Interestingly, although there was a significant drop in the dipole charge in both respirators during decontamination, there was no remarkable decrease in the filtration efficiencies due to mechanical filtration. Cotton and polyester face masks had a lower filtration efficiency and lower dipole charge. In conclusion, a loss of electrostatic charge does not directly correlate to the decreased performance of either respirator

KN95 and N95 Respirators Retain Filtration Efficiency despite a Loss of Dipole Charge during Decontamination.

N95 decontamination protocols and KN95 respirators have been described as solutions to a lack of personal protective equipment. However, there are a few material science studies that characterize the charge distribution and physical changes accompanying disinfection treatments, particularly heating. Here, we report the filtration efficiency, dipole charge density, and fiber integrity of N95 and KN95 respirators before and after various decontamination methods. We found that the filter layers in N95 and KN95 respirators maintained their fiber integrity without any deformations during disinfection. The filter layers of N95 respirators were 8-fold thicker and had 2-fold higher dipole charge density than that of KN95 respirators. Emergency Use Authorization (EUA)-approved KN95 respirators showed filtration efficiencies as high as N95 respirators. Interestingly, although there was a significant drop in the dipole charge in both respirators during decontamination, there was no remarkable decrease in the filtration efficiencies due to mechanical filtration. Cotton and polyester face masks had a lower filtration efficiency and lower dipole charge. In conclusion, a loss of electrostatic charge does not directly correlate to the decreased performance of either respirator

Endotracheal tube forces exerted on the larynx and a novel support device to reduce it

Abstract Objective Endotracheal tubes (ETTs) are commonly associated with laryngeal injury that may be short lasting and temporary or more severe and life altering. Injury is believed to result from forces that these ETTs exert on the larynx. Here we quantify the forces of ETTs of various sizes on the laryngotracheal complex to gain a more quantitative understanding of these potential damaging forces. Here we also perform preclinical testing of a novel support device to offload these forces. Methods Endotracheal intubation was performed on a fresh human cadaver using various ETT sizes. A strain‐sensitive graphene nanosheet sensor and a commercially available force sensing resistor were secured behind the larynx, anterior to the prevertebral fascia. The forces exerted on the larynx were measured for each of the commonly used ETTs. A novel support device, ETT clip (Endo Clip), was attached to the ETTs and changes in these forces were observed. Results Forces exerted on the laryngotracheal complex by various ETTs were observed to increase with increasing tube size. This pressure can be significantly reduced with a novel ETT clip. Conclusion Here we demonstrate the first quantitative measurement of forces that ETTs exert on the larynx. We demonstrate a novel device that can easily clip onto an ETT reducing pressure on the laryngotracheal complex. This preclinical test paves the way for a human clinical trial. Level of evidence 5

Integrated Patient Coordination System (IntPaCS): a bespoke tool for surgical patient management.

© 2016, BMJ Publishing Group. All Rights Reserved.Background Efficient handover of patient information is fundamental for patient care and service efficiency. An audit exploring surgeons’ views on written handover within a Trust’s surgical specialties concluded that clear deficiencies existed. Such concerns have been echoed in the General Medical Council’s guidance on safe surgical handover. Aims To design and implement bespoke software for surgical handover using the audit results of surgeons’ perceptions of existing processes. To gain feedback from the surgical department on this new software and implement a long-term sustainability strategy. Methods Following an initial review, a proposal was presented for a new patient management tool. The software was designed and developed in-house to reflect the needs of our surgeons. The bespoke programme used open-source coding and was maintained on a secure server. A review of surgical handover occurred 12 and 134 weeks post-implementation of the new software. Results Integrated Patient Coordination System (IntPaCS) was successfully developed and delivered. The system is a centralised platform that enables the visualisation, handover and audit/research of surgical inpatient information in any part of the hospital. Feedback found that clinicians found it less stressful to create a post-take handover (60% vs 36%) than using a Word document. IntPaCS was found to be quicker to use too (15 min (SD 4) vs 24 min (SD 7.5)). Finally, the new system was considered safer with less reported missing/ incorrect patient data (48% vs 9%). Conclusions This study has shown that careful use of emerging technology and innovation over time has the potential to improve all aspects of clinical governance