The magnitude of climate change might paralyse us and leave us unsure of how to focus our efforts, especially how to lessen the environmental damages associated with healthcare. Numerous people have enthusiastically questioned me about how they may begin accounting for the carbon footprint of care: I both encourage and dissuade them. We can and should estimate the environmental harm caused by what we do, but it takes a complicated science to correctly and thoroughly analyse a product’s or process’ entire life cycle. In reality, we already have enough data to know some of the guidelines we should adhere to. The assumption that a carbon footprint is proportional to the activity involved in a process or product is reasonable (and possibly self-evident).
By working with public health to prevent patients from developing surgical diseases,1 employing remote consultation to cut down on patient travel,2, and reducing blood testing during the perioperative period, we can reduce activity in care pathways. 3,4 Of course, we will still perform surgery, and there, too, we can make a significant difference, particularly by using less single-use equipment in the operating room.
Surgery Room Single Use Instruments Carbon Footprint
The carbon footprint of a typical UK operation is 173 kg CO2e, or about the same as driving a petrol car from London to Edinburgh. Energy use and anesthetic gases are two major sources of that carbon footprint, but most UK hospitals are moving towards renewable energy sources, and the majority of our anesthetic colleagues have reduced or eliminated the use of substances with strong greenhouse gas potential, like desflurane and nitrous oxide. 7 Single-use equipment is an additional significant source of carbon during an operation, but our surgical community has so far paid little attention. An astounding amount of Single Use Instruments may be found in operating rooms, which typically account for a fifth of all hospital waste. 6 Around 100 discarded plastic pieces can be produced by a straightforward tonsillectomy.
8 Equipment is frequently produced and transported consuming a lot of carbon, so utilizing it just once is terrible for the environment. And as our surgical systems have become more complex, so has the amount of single-use equipment we employ. In the UK, a typical cataract procedure produces 182 kgCO2e9, but in India, the same operation produces only 6 kgCO2e10, a 30-fold reduction that is partly attributable to effective systems and equipment reuse. A vaginal or abdominal hysterectomy in the USA produces about 280–290 kgCO2e, but a laparoscopic method produces about 560 kgCO2e and a robotic hysterectomy produces over 800 kgCO2e. This variance is once more nearly completely attributable to single-use equipment. 11 Although there may be valid therapeutic justifications for choosing one surgical technique over another, this does not necessarily mean that we should utilize a lot of single-use equipment. Just to be clear, recycling alone is not the solution to this issue. Although it should be encouraged, even perfect recycling would only reduce the carbon footprint of a hysterectomy by 5%. 12
Why do we Use so Many Single Use Instruments?
The ideals of “quality” and “safety” may make it appear simple for surgeons to justify their actions, but there is no evidence to back this up. Single use instruments became more popular after the 1996 discovery of variant Creutzfeldt-Jakob Disease (vCJD), a fatal illness brought on by transmissible misfolded proteins (prions) that build up catastrophically in the brains of those with hereditary susceptibility to it. A strategy encouraging single-use rather than re-use of surgical instruments appeared to be a sensible precaution against an unknown risk at the time because UK practice regarding cleaning and sterilization of surgical instruments was variable and frequently inadequate13.
The world has changed, though, and according to current UK rules, all instruments are sterilised by rigorous, audited standards. 14 There have been no confirmed cases of surgically transmitted vCJD disease since exposures that took place in the 1970s, and where transmission of infection has historically been reported, it had been employing procedures inconsistent with such standards15. 16 Since Steril Milano, an Italian company that is no longer in business, was recently accused of falsifying data on the sterilization of products for at least 97 brands17, including many that are used in the UK, it has become clear that many single-use items are sterilized outside of the UK where standards may be less verifiable.
Myths, Dishonest Marketing Techniques
The market for single use instruments was launched by the 1990s events, but it has since expanded due to bad cultural norms. Disposable objects supposedly lower the risk of infection, according to a persistent belief. Nonetheless, the incidence of infectious endophthalmitis was much lower than those reported in the UK in a study of nearly 2 million cataract surgeries done in India primarily utilizing reusable equipment (where single-use products are routinely used). 21 One common misconception is that single-use items are less expensive for the environment or our wallet than reusable ones. This is nonsensical under many conditions and in general.
Although many of us frequently use plastic gallipots, if I place a metal gallipot inside a surgical tray, it will be sterilised along with that tray at a negligible additional environmental or financial cost. But even outside of that setting, reuse is almost always preferable: according to a recent systematic review, reusable medical products are almost always less harmful to the environment than their single-use counterparts22, with one notable exception being a study sponsored by the industry whose methodology was not clear.