Created By

Professor Dr Yasser Helmy

Vice Dean of Faculty of Postgraduate

Professor of Plastic Surgery, Faculty of Medicine

Director of International Excellence Bureau for Al-Azhar University

Rapporteur of the Supreme Committee for CPD, Egyptian Health Council

AIMJ-Editor-in-Chief

Member of American Society of plastic Surgeons, and American Organization for Plastic Surgery; Annual Meeting, Editorial and Former Visiting professor Committees

Member of Egypt Egyptian Society of Plastic & Reconstructive Surgery

Volunteer at Operation Smile Egypt

Cairo in  December 1st, 2022.

Egypt, Naser City, EL-Naser Road, Al-Azhar University, Faculty of Postgraduate, Vice Dean Office, 2nd Floor. Poste code: 11651

dryasserhelmy@gmail.com / dryasserhelmy@azhar.edu.eg

+201004406331 / +2 01009916446

Important Articles

• Scientific article مقالة علمية 
• Conference Completion “تغير المناخ: التحديات والمواجهة
• غرفة عمليات صديقة للبيئة
• Offecial Al-Azhar University Media
• Declaration -Cop27” مؤتمر الطريق إلى COP27  تناولت المحاضرة تأثير نظام الرعاية الصحية على التغيرات المناخية
• Facebook Article
• Facebook post
• El balad news
• video
• غرفة عمليات صديقة للبيئة للأستاذ الدكتور ياسر حلمي 
• Link 2

Egyptian 2030 Health Vision

الصحة من خلال رؤية مصر ٢٠٣٠

Although climate change impacts human health, the healthcare sector itself is a significant contributor to greenhouse gas emissions, coming in second after the food industry. Much of these emissions come from operating theaters and delivery rooms.

The “Healthcare Green Guardians” initiative aims to educate healthcare workers on eco-friendly “green” practices, especially ways to minimize medical waste. A key part of this is promoting the use of environmentally friendly operating theaters.

This initiative was developed and presented by Professor Yasser Helmy Ali at the 3rd International Conference of Al-Azhar University on “Climate Change Challenges and Confrontation”. It was adopted as one of the practical solutions to address climate change’s impact on health.

In Cairo, Al-Azhar University, and Helwan university, committed to implementing this initiative in its own hospital facilities and spreading the idea throughout Egypt and globally. As well as in Giza, AL-Zohor Specialized Hospital where Professor Ali practices his private surgeries. The goal is for the healthcare sector to unite in facing climate change and limiting its effects on humanity.

Surgeons, including plastic surgeons, are motivated by climate change to find initiatives and solutions that promote optimal resource use, sustainable development, and environmental preservation for future generations.

The initiative focuses on small, practical steps healthcare workers can take in daily operating room practices to promote green healthcare, preserve the environment, and support sustainable development.

This initiative was discussed at the innovative zone and featured on Egyptian TV channels during the 2022 COP27 World Climate Summit in Sharm El-Sheikh, Egypt.

Climate change is leading to rising CO2 levels, sea levels, extreme weather, and temperatures. This has several direct impacts on human health:

– Air pollution: Worsening air quality from increased ozone, particulate matter, and pollen aggravates respiratory conditions like asthma, and increases cardiovascular disease. Climate change is expected to further increase air pollutant concentrations.

– Vector-borne diseases: Changes in temperature, precipitation, and seasons are enabling the spread of diseases transmitted by insects like mosquitoes, ticks, and fleas. This can lead to the regional expansion of diseases.

– Food and water security: Climate change threatens crop yields, livestock productivity, and seafood supplies. This can drive food price inflation and shortages, impacting nutrition and health.

– Extreme weather: Hurricanes, floods, and heat waves directly cause injuries, deaths, and mental health impacts like PTSD. Heat waves in particular increase mortality from heat-related illnesses.

– Wildfires: Smoke from wildfires significantly degrades air quality, exposing populations to harmful particulates and gasses.

Overall, these widespread health impacts from climate change pose a major burden on health systems and national budgets as countries work to adapt. The healthcare sector itself is also a significant contributor to greenhouse gas emissions that drive climate change.

The healthcare sector, particularly operating rooms and delivery rooms, has a significant environmental impact and contribution to climate change. This is due to the high resource consumption and waste generation in these medical settings.

Operating rooms are major consumers of energy, water, and single-use disposable materials. The use of anesthetic gases, burning of plastics and other waste, and general waste produced from surgeries all result in substantial greenhouse gas emissions, especially carbon dioxide and methane.

In fact, operating room and delivery room waste alone accounts for nearly 70% of total hospital waste. Healthcare facilities in the United States generate over 6,600 tons of waste per day, amounting to more than 4 billion pounds annually. This medical waste, when incinerated, releases between 0.7 to 1.7 tons of CO2 per ton of waste.

Calculations show that the medical waste generated daily in the US – 6,600 tons – results in approximately 7,920 tons of CO2 emissions per day, or nearly 2.9 million tons per year. This is a significant contribution to the country’s carbon footprint, in addition to emissions from regular human and industrial activities.

The World Health Organization reports that 85% of healthcare waste is non-hazardous, while 15% is hazardous, potentially infectious material. Improper disposal of items like needles and syringes can also lead to the release of harmful substances like dioxins and particulates through incineration.

Overall, the resource-intensive and waste-generating nature of medical facilities, especially operating rooms, is a major driver of climate change that the healthcare sector must address through more sustainable practices.

The negative impacts of operating rooms go beyond just the emissions from waste incineration. There are also significant resource waste issues, especially in poorer countries that rely heavily on water and antiseptics like betadine for surgical scrubbing of staff.

One study in Africa found that for 3,305 surgeries, the total water consumption for surgical hand scrubbing was 200,283 liters. However, the actual necessary amount was only 58,498.5 liters (29.2% of the total). This represents a substantial waste of a precious resource like water.

Additionally, operating rooms consume large amounts of electricity for lighting, medical equipment, air conditioning, and other energy needs. In fact, a 2008 study estimated there are 234.2 million major surgeries performed globally each year. This staggering volume of operative procedures represents a colossal waste of resources.

Beyond just water and electricity waste, the incineration of 6,600 tons of medical waste per day in the US alone is the second highest source of pollution after the food industry. This waste incineration accounts for around 10% of total greenhouse gas emissions and other pollutants harmful to human health.

The unsustainable resource consumption and pollution output of operating rooms impacts both the environment and public health. The combustion byproducts can exacerbate conditions like asthma, allergies, respiratory problems, digestive issues, and skin/eye diseases.

So, the negative effects of operating rooms extend well beyond just carbon emissions, significantly straining both economic resources and human health,

especially in developing regions. Addressing this environmental impact of healthcare is crucial.

Here is a clear rephrasing of the details and steps for implementing an environmentally friendly operating room initiative:

The key components of this “Healthcare Green Guardians” initiative are:

Reduce water usage for surgical scrubbing by transitioning to hand sanitizer-based disinfection methods like Sterillium. This conserves a precious resource, especially important as climate change impacts water availability.

Encourage the use of local anesthesia over general anesthesia whenever feasible. This avoids the emissions from anesthetic gasses and reduces energy consumption from anesthesia equipment.

Minimize the use of disposable plastic medical supplies and instead utilize reusable, sterilizable cotton-based alternatives like gowns, towels, and brushes. This reduces petroleum-derived waste.

Optimize electricity consumption in the operating room by only using necessary lighting and equipment. Simple steps like turning off unused rooms can lead to meaningful energy savings.

Promote a culture of “green” operating room practices among all healthcare staff and hospital leadership.

Establish clear policies and guidelines for sustainable waste management.

To implement this initiative, the key steps are:

Provide awareness training and educational materials on these green practices for surgeons, nurses, and other OR staff.

Develop comprehensive written guides, videos, and digital resources explaining the initiative and implementation guidelines.

Establish formal policies and ethical standards that mandate the adoption of these environmentally friendly operating room procedures.

By taking these actions, the goal is to minimize the substantial environmental footprint and resource consumption of operating rooms, thus promoting greener, more sustainable healthcare delivery. This helps address the critical challenges of climate change and resource scarcity.

Conflict of interest: none

References

Mahmoud Mostafa, we publish the recommendations of the Al-Azhar International Conference on “Climate Change” 03:57 PM Monday 20 December 2021 ;

1. Mahmoud Mostafa, we publish the recommendations of the Al-Azhar International Conference on “Climate Change” 03:57 PM Monday 20 December 2021 go to article

Where Ambition Meets Action. The Leading Forum for Public-Private Partnerships Alongside CO. Go to article

Kwakye G, Brat GA, Makary MA. Green Surgical Practices for Health Care.  Arch Surg.2011;146(2):131–136. doi:10.1001/archsurg.2010.343

ZWE staff. Understanding the carbon impacts of Waste to Energy incineration.Visited February, 2022 Go to article.

Health-care waste. Key facts. WHO website. 2018; Visited February, 20202. Go to article

Climate change. Health topics WHO website. 2018; Visited February, 2022. Go to article

Ahmed A. Surgical hand scrub: lots of water wasted. Ann Afr Med. 2007 Mar;6(1):31-3.

Doi: 10.4103/1596-3519.55733. PMID: 18240489

Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008 Jul 12;372(9633):139-144. doi: 10.1016/S0140-6736(08)60878-8. Epub 2008 Jun 24. PMID: 18582931.

Sarah Alger. Waste generation by hospital emergency departments is highlighted for first time. Massachusetts general hospital. Journal western journal of emergency medicine.

Doi: 10.5811/westjem.2020.6.47900.

Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake Local Anesthesia with No Tourniquet: An Updated Review. Plast Reconstr Surg Glob Open. 2021 Mar 26;9(3): e3507.

doi: 10.1097/GOX.0000000000003507. PMID: 33786267; PMCID: PMC7997095.

Elsadany, A., Helmy, Y., Alshahat, O. (2022). ‘Safety and Efficacy of Auto-lipofilling in Facial Rejuvenation: a meta-analysis study’, Al-Azhar International Medical Journal, 3(1), pp. 7-10. doi: 10.21608/aimj.2021.82971.1523