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

Factors Influencing the Layer Thickness of Poly-L-glutamates Grafted from Self-Assembled Monolayers

Factors influencing the thickness of polypeptide layers grafted from self-assembled monolayers were investigated by varying the initiator site density and the reactivity of the N-carboxyanhydride monomer. To vary the density of initiating sites and to match the steric requirements of the growing polymer chain, mixed self-assembled monolayers were prepared with terminal amino groups. These SAMs were prepared by coadsorption of bromine- and methyl-terminated silanes and a subsequent in-situ modification. Polymerization experiments with these SAMs reveal an influence of initiator site density on the polymer layer thickness. SAMs prepared with 60% functionalized silane showed an optimum thickness. The variation in layer thickness due to the variation of initiator site density is smaller than the influence of the monomer reactivity