The Centro Hospitalar do Entre Douro e Vouga (CHEDV) reduced to a minimum the consumables used in cataract surgery, thanks to a protocol that, if replicated in national public hospitals, would avoid 13 tons of plastic per year.
This is the conclusion of the coordinators of the experience carried out throughout 2021 in the hospitals of Santa Maria da Feira and São João da Madeira, both in the Aveiro district, and distinguished this month in Dubai as “one of the eight best projects worldwide among around 400 applicants” to the awards of the International Hospital Federation.
This is a new protocol for “Waste Reduction in Cataract Surgery”, which in the CHEDV hospitals consisted of eliminate a number of disposable utensils which, “by tradition”, were applied to the patient for the intravenous administration of drugs, but which, in practice, were unnecessary and redundant.
Marcos Pacheco, coordinator of the aforementioned project and director of the CHEDV Anesthesiology Service, explained to Lusa that the previously adopted procedure involved, for each operated user, a 136.7-gram kit containing a serum bag, an administration system vertical, a faucet, transporter, catheter, adhesive to fix to the skin and even liquid paracetamol – the latter in the average price of 15 euros per dose???????? With the change now in place, however, the intervention now involves just 47.7 grams, as the list of consumables has been reduced to a catheter, adhesive, and a paracetamol tablet, which, in solid state, implies greater advance because it has to be managed. 30 minutes before surgery, but, on the other hand, it only costs 15 cents????????
Considering the universe of 1,877 cataract surgeries performed at CHEDV in 2021, this change means that, in a single specific surgery, the home hospitals obtained “exactly the same clinical results” producing “167 kilograms less plastic waste” than in previous years .
The anesthesiologist Nuno Alçada, who worked on the same project, admits that reducing 89 grams in each surgery may not seem very impressive, but he points out that the new procedure gains another dimension if it is replicated nationally and internationally. The doctor has already done the math, in fact, and, based on data from the General Directorate of Health and the statistics service of the European Union, adds: “Only with cataract surgery, in Portugal it would correspond to what hospitals do from the public network to produce 13,000 kg less plastic per year???????? In Europe, with the same change, 418,000 tons of plastic were avoided”.
Born with the intention of reducing the financial costs of surgical production at CHEDV, the “Reduction of Waste in Cataract Surgery” project ended up focusing only on the environmental aspect of this specific intervention, which was chosen as the object of the experiment because was “very fast” with a average duration of 15 to 20 minutes, and every year it is performed “in large numbers”, always on an outpatient basis.
For Marcos Pacheco, the transformation carried out was “very simple in logistical terms”, but “very complicated behaviour” due to the difficulty of attracting health professionals to the process and convincing them of the relevance of the change.
“Everything is a matter of mentality and philosophy,” says Marcos Pacheco. “People were used to that procedure, to the use of all those objects, and they didn’t question whether they were really necessary. resistant to change and the biggest struggle was to make them see how that implied so much waste”, he reveals.
The anesthesiologist adds that most of the professionals approached argued that “what has always been done in the same way should not be changed” and they did not realize that “the solution does not lie so much in taking a giant step as in adding many small steps” about the day-to-day.
“That is why the focus should not be on reducing financial costs, because then the professional sees his effort as something that only leads the State to withdraw money from Health to apply it in other areas; the angle should be at preservation of the environment and the planetbecause that way the doctors, nurses and everyone involved understand that they are taking care of what is left here for their children and for the next generations”, he says.
After the presentation of the “Residue Reduction in Cataract Surgery” project in Dubai, the project coordinators have already been consulted with a view to Replication of the experience in a hospital in Singapore and in units represented by the Portuguese Group of Implant-Refractive Surgery.
The CHEDV is also preparing an identical protocol change “in other rapid and frequent surgeries that only require local anesthesia”, such as those aimed at eliminating dermatological signs and those related to carpal tunnel syndrome.
Hoping that the example of the Feira and São João da Madeira hospitals can inspire more environmental efficiency in other units, Nuno Alçada points to three more statistical data to highlight why the reduction of hospital waste is particularly urgent: “The sector Health is one of the fastest growing industries in the world, it is responsible for almost 5% of greenhouse gases worldwide and, if it were a country, it would be the fifth polluter on the planet”.
Source: Observadora
