NEWS & OPINION 44 EWAP DECEMBER 2023 Contact information Elferink: sjoerd.elferink@gmail.com Sood: shefalisood12@gmail.com Eliminating operating room waste: A paradigm-altering global movement among ophthalmologists In 2022, the Dutch healthcare sector accounted for 7.3% of the national climate change footprint and 4.2% of waste generated. 1 Almost 5,000 miles away, approximately 10% of greenhouse gas emissions and more than 4 billion pounds of waste in the U.S. were produced by its own healthcare sector. 2,3 A significant portion of healthcare-associated waste (>~70%) is generated from ORs. In 2019, it was estimated that annually, unused pharmaceutical products during cataract surgery generated 23,000 to 105,000 metric tons of unnecessary CO2 eq emissions in the U.S. 4 The environmental impact of the waste generated in ORs has not gone unnoticed by ophthalmologists. In a landmark study conducted by the Ophthalmic Instrument Cleaning and Sterilization (OICS) Task Force, investigators surveyed the attitudes of cataract surgeons belonging to the American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO), the Outpatient Ophthalmic Surgery Society (OSS), and the Canadian Ophthalmology Society (COS) toward OR policies, surgical waste, sustainability, and climate change. 5 Approximately 86% of respondents to this initial survey practiced in North America. A follow-up study using an identical questionnaire was disseminated to members of the European Society of Cataract and Refractive Surgeons (ESCRS) to investigate consensus in attitudes and foster global alliances among North American and European ophthalmologists. 6 Approximately 1,241 ophthalmologists participated in the OICS study and 458 in the ESCRS study. The cohorts were demographically similar; however, while a majority of ESCRS respondents performed cataract surgery in hospitals, a majority of OICS respondents operated in ASCs. Despite differences in practice location, opinions about and behaviors toward surgical waste were similar between the cohorts, demonstrating universal deviations from conventional beliefs about single-use products and traditional operating room policies. More than 90% of respondents from both cohorts expressed concern about global warming/climate change and thought that surgical waste generated during cataract surgery was excessive. More than 60% of respondents in both cohorts thought that the main drivers of OR waste stemmed from perceived safety benefits of single-use items and that manufacturers: 1) produce these single-use items with packaging creating unnecessary waste, 2) drive the market toward more profitable, single-use products to limit liability, and 3) lack environmental/carbon footprint considerations. One noteworthy difference in opinion between the OICS and ESCRS cohorts was that ESCRS respondents ascribed less impact on surgical waste to hospital/facility policies and regulatory agencies to reuse supplies. Despite this, both OICS and ESCRS respondents advocated for similar global strategies for reducing surgical waste, including regulatory bodies allowing more surgeon discretion in reusing products and that manufacturers consider environmental impact, such as using recycled materials and offering more reusable instruments /supplies. Single - use instruments are a major cause of surgical waste, and most respondents to both surveys either reuse or are willing to reuse surgical products, pharmaceuticals, and instruments. A minority of respondents thought that patient preference was a major driver of single-use instruments. More ESCRS members were currently reusing intraocular pharmaceuticals like lidocaine, antibiotics, and capsular dye. Of note, more than 20% of ESCRS respondents reused phacoemulsification and I/A tubing and irrigating solution compared to less than 8% of their OICS counterparts. Both OICS and ESCRS participants were interested in eliminating the full-body drape and making use of short cycle autoclave sterilization processes for by Sjoerd Elferink, MD, and Shefali Sood, MD This article originally appeared in the September 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
RkJQdWJsaXNoZXIy Njk2NTg0