Cataract surgeons on operating theater waste: less is often more
Reviewed by David F. Chang, MD
A recent study1 of cataract surgeons and nurses have found that most are concerned about operating room waste and believe that having more reusable products in the operating room is a step in the right direction.
The survey was developed by the Ophthalmic Instrument Cleaning and Sterilization Working Group, which includes representatives from the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology (AAO), the Outpatient Ophthalmic Surgery Society and the Canadian Ophthalmic Society.
The survey was distributed to members of the 4 companies.
An impetus for the investigation came from 2 published studies of the Aravind hospital system in India.
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The first report of 20172 found that their carbon footprint for phacoemulsification was one-twentieth that of the US and UK, largely because they reuse as many surgical supplies and drugs as possible.
A second study in 20193 found that despite such widespread reuse, the endophthalmitis rate in the Aravind system was 0.01%, lower than in the United States with the AAO IRIS registry rate of 0.04%.
“The results suggest that a large portion of our surgical waste due to one-time use of everything is excessive and has an unproven benefit for the prevention of endophthalmitis,” said David F. Chang, MD, clinical professor of ophthalmology, University of California, San Francisco, investigative report co-author with Cassandra Thiel, PhD, assistant professor, New York University School of Medicine.
What generates waste?
Respondents believed the main factors behind operating room waste were waste of single-use items (71%), hospital / regulatory policies (74% and 82%, respectively) which limit surgeon discretion in the reuse of supplies, the manufacturer mandates in the instructions for single use (IFU) for single use products to limit liability (70%) and manufacturers who are pushing the market towards more profitable single use products (77%).
Surgeon or patient preference for single-use products was only felt to be a determining factor by 26% and 7%, respectively.
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Support for reuse of devices and supplies
Surgeons strongly / somewhat agreed that manufacturers of devices and supplies should use recycled content in the packaging of medical supplies (90%) and that they should consider the environmental / carbon footprint in product design (92%).
“However,” Chang said, “the real impact would be to offer more optional reusable instruments and supplies (94%) and allow surgeons more discretion within their IFUs for the reuse of supplies. (93%). “
Other areas that surgeons strongly / somewhat agreed with were greater surgical discretion in reuse of supplies by regulators (95%) and advocacy by medical companies to reduce the carbon footprint in wards. operation (87%).
Regarding the use of topical and intraocular pharmaceuticals, 98% and 95%, respectively, would consider using them in multiple patients; there was also strong agreement for the reuse of compound pharmaceuticals (86%). Most surgeons send or would consider sending pharmaceuticals home with patients in the operating room (93%).
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Surgeons were very willing to reuse phaco tips (92%), phaco tubes and irrigation vials (77%), cystotomes (72%), disposable metal cannulas and blades (74%), iris retractors (72%) and unused suture halves (59%).
During cataract surgeries, 91% consider or would consider using short cycle sterilization, and 56% would consider simultaneous sequential cataract surgery, although 34% are unwilling to do so.
Among other conservation proposals, elimination of the entire operating field was supported at 95%, not putting the patient in a gown was supported at 90%, and the use of the same surgical mask throughout. the day by the operating room staff at 95%.
Two-thirds of the respondents were willing not to change their surgical gown between each case, but 77% would not be willing to reuse the surgical gloves.
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The risks of endophthalmitis (48%) and toxic anterior segment syndrome (43%) and malpractice liability (51%) were factors that decreased willingness to use supplies and medications on many patients.
Factors likely to lead to single-use instruments included reduced staff processing requirements (45%) and improved operating room efficiency (37%).
“However, the main factors prompting manufacturers to promote single-use devices were increased profits (62%), reduced liability (66%) and an easier regulatory approval path (65%)” Chang said.
According to Chang, the results showed that more than 90% of surgeons are concerned about global warming, excessive waste in the operating room, the need for more reusable and multi-use options, a strong preference for reusable instruments by compared to disposable instruments, the discretion of regulators and manufacturers in the reuse of materials. , and greater consideration of the carbon footprint by manufacturers.
David F. Chang, MD
e: [email protected]
This article is adapted from Chang’s presentation at the American Academy of Ophthalmology 2020 Virtual Annual Meeting. He has no financial interest in this topic.
1. Chang DF, Thiel CL; Ophthalmic Instrument Cleaning and Sterilization Working Group. Survey of the attitudes of cataract surgeons and nurses towards operating room waste. JuCataract refraction surgery. 2020; 46 (7): 933-940. doi: 10.1097 / j.jcrs.00000000000000267
2. Thiel CL, Schehlein E, Ravilla T, et al. Cataract Surgery and Environmental Sustainability: Waste and Life Cycle Assessment of Phacoemulsification in a Private Healthcare Facility. Cataract refraction surgery J. 2017; 43 (11): 1391-1398. doi: 10.1016 / j.jcrs.2017.08.017
3. Haripriya A, Chang DF, Ravindran R. Reduction of endophthalmitis with intracameral moxifloxacin in the eyes with and without surgical complications: results of 2 million consecutive cataract surgeries. Cataract refraction surgery J. 2019; 45 (9): 1226-1233. doi: 10.1016 / j.jcrs.2019.04.018