Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room

Öykü Kara; Ezgi Seyhan Ak

doi:10.31020/mutftd.1549201

Monografi

BibTex

RIS

Kaynak Göster

Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room

Yıl 2025, Cilt: 15 Sayı: 2, 389 - 399, 30.05.2025

Öykü Kara , Ezgi Seyhan Ak

https://doi.org/10.31020/mutftd.1549201

Öz

The biggest threat to global health in the 21st century is climate change. Greenhouse gas emissions, one of the biggest causes of climate change, originate 4 to 10% from healthcare services. These emissions cause negative environmental impacts by increasing the carbon footprint. Operating rooms, with their large share in energy and resource consumption, make the biggest contribution to the increase in carbon footprint in healthcare services. Transforming operating rooms into green operating rooms that adopt and implement measures against climate change significantly contributes to maintaining and improving global health, protecting natural resources, and ensuring sustainability. In order to reduce emissions from operating rooms, reusable products should replace single-use products, medical and surgical gas usage should be reduced, and the right anesthesia and sterilization methods should be selected. In addition, reducing the length of hospital stay, waste and energy consumption, and digitalizing documentation and communication are additional measures to lower emissions. In reducing the carbon footprint and ensuring sustainability, it is crucial that these practices are understood and adopted by the operating room team and that green operating rooms are created. This study aims to examine the carbon footprint in the operating room in line with the literature, practices, and sustainability to reduce the carbon footprint and to convey what needs to be known on the way to becoming a green operating room.

Anahtar Kelimeler

Carbon footprint, Climate change, Operating room, Sustainability, Green operating room

Kaynakça

1. World Health Organization. COP24 Special Report Health & Climate Change 2018;1-74. [updated 2018; cited 2024 Aug 4] Available from: https://apps.who.int/iris/bitstream/handle/10665/276405/9789241514972-eng.pdf?sequence=1&isAllowed=y
2. World Health Organization, (2023). Climate change. [updated 2023; cited 2024 Aug 4] Available from: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
3. MGM, Meteoroloji Genel Müdürlüğü Araştırma Dairesi Başkanlığı Klimatoloji Şube Müdürlüğü. Yeni senaryolar ile Türkiye iklim projeksiyonları ve iklim değişikliği TR2015-CC [updated 2015; cited 2024 Aug 1] Available from: https://www.mgm.gov.tr/iklim/iklim-degisikligi.aspx
4. Pradere B, et al. Sustainability task force of the french association of urology. Climate-smart actions in the operating theatre for improving sustainability practices: A systematic review. Eur Urol 2023;83(4):331-42.
5. Watts N, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet 2021;397(10269):129-170.
6. Tennison I, et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. The Lancet Planetary Health 2021;5(2): e84-e92.
7. Chung JW, Meltzer DO. Estimate of the carbon footprint of the US health care sector. Jama 2009;302(18):1970-1972.
8. World Health Organization, (2022). Alliance for transformative action on climate and health. [updated 2022; cited 2024 Aug 4] Available from: https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health
9. United Nations-UN, New York. The Paris Agreement. Article 2 [updated 2015; cited 2024 July 27] Available from https://unfccc.int/sites/default/files/english_paris_agreement.pdf
10. National Health Service. Delivering a ‘net zero’ National Health Service. London: NHS England and NHS Improvement. [updated 2020; cited 2024 Aug 5] Available from: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf
11. İnan G, Özköse Şatırlar Z. Anestezinin küresel ısınmaya etkisi ve sürdürülebilir anestezi gerçeği. Journal of Anesthesia 2023;31(4):253-266.
12. MacNeill AJ, et al. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health 2017;1(9): e381-e388.
13. Rizan C, et al. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. Journal of the Royal Society of Medicine 2023;116(6):199-213.
14. Wormer BA, et al. The green operating room: simple changes to reduce cost and our carbon footprint. The American Surgeon 2013;79(7):666-671.
15. Whiting A, et al. Surgery and the NHS carbon footprint. The Bulletin of the Royal College of Surgeons of England 2020;102(5):182-185.
16. de’Angelis N, et al. Systematic review of carbon footprint of surgical procedures. Journal of Visceral Surgery 2023;161(2):7-14.
17. Robinson PN, et al. The carbon footprint of surgical operations: a systematic review update. The Annals of The Royal College of Surgeons of England 2023;105(8):692-708.
18. Papadopoulou A, et al. Environmental sustainability in robotic and laparoscopic surgery: systematic review. British Journal of Surgery 2022;109(10):921-932.
19. Cannon J, et al. Carbon footprint of tonsillectomy. The Surgeon 2024;22(4):242-247.
20. John JB, et al. The carbon footprint of the perioperative transurethral resection of bladder tumor pathway. BJU International 2024; 1-10.
21. Pascual-Prieto J, et al. The carbon footprint of cataract surgery in Spain. Archivos de la Sociedad Española de Oftalmología 2023;98(5):249-253.
22. Tsagkaris C, et al. Eco-friendly and COVID-19 friendly? decreasing the carbon footprint of the operating room in the COVID-19 era. Diseases 2023;11(4):157-1-13.
23. Woods DL, et al. Carbon footprint of robotically‐assisted laparoscopy, laparoscopy and laparotomy: a comparison. The International Journal of Medical Robotics and Computer Assisted Surgery 2015;11(4):406-412.
24. Drew J, et al. Operating in a climate crisis: a state-of-the-science review of life cycle assessment within surgical and anesthetic care. Environmental Health Perspectives 2021;129(7):076001-1-18.
25. World Health Organization. WHO Infection Control Guidelines for transmissible spongiform encephalopathies: report of a WHO consultation, Geneva, Switzerland, 23-26 March 1999 (No. WHO/CDS/CSR/APH/2000.3). World Health Organization. [updated 2000; cited 2024 Aug 5] Available from: https://iris.who.int/handle/10665/66707
26. Maria-Alexandra P, Malherbe S. Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice. Canadian Journal of Anesthesia 2020;67(8):1044-1063.
27. Sherman JD, et al. Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes. Anesthesia & Analgesia 2018;127(2):434-443.
28. Hauser OP, et al. Cooperating with the future. Nature 2014;511(7508):220-223.
29. White SM, et al. Principles of environmentally‐sustainable anesthesia: a global consensus statement from the World Federation of Societies of Anesthesiologists. Anesthesia 2022;77(2):201-212.
30. Bhutta MF. Our overreliance on single-use equipment in the operating theatre is misguided, irrational and harmful to our planet. The Annals of The Royal College of Surgeons of England 2021;103(10):709-712.
31. Rizan C, Bhutta MF. Strategy for net-zero carbon surgery. British Journal of Surgery 2021;108(7):737-739.
32. Sathe TS, et al. Instrument and supply variability: an opportunity to reduce the carbon footprint of the operating room. Journal of Surgical Research 2024; 295:732-739.
33. Chang JH, et al. Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use. The Surgeon 2024;22(4):236-241.
34. Vozzola E, et al. An environmental analysis of reusable and disposable surgical gowns. AORN Journal 2020;111(3):315-325.
35. US Food and Drug Administration. Medical gowns Silver Spring FDA, MD [updated 2018; cited 2024 Aug 4] Available from: https://www.fda.gov/medical-devices/personalprotective-equipment-infection-control/medicalgowns
36. Yates EF, et al. Empowering surgeons, anesthesiologists, and obstetricians to incorporate environmental sustainability in the operating room. Annals of Surgery 2021;273(6):1108-1114.
37. McGain F, et al. Why be sustainable? The Australian and New Zealand College of Anesthetists Professional Document PS64: Statement on environmental sustainability in anesthesia and pain medicine practice and its accompanying background paper. Anesthesia and Intensive Care 2019;47(5):413-422.
38. McEvoy B et al. Advancing the sustainable use of ethylene oxide through process validation. Biomedical Instrumentation & Technology 2021;55(s3):35-44.
39. McGain F, et al. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesthesia & Analgesia 2012;114(5):1073-1080.
40. Jehle K, et al. Clean and green: saving water in the operating theatre. The Annals of The Royal College of Surgeons of England 2008;90(1):22-24.
41. McGain F, et al. Hospital steam sterilizer usage: could we switch off to save electricity and water? Journal of Health Services Research & Policy 2016;21(3):166-171.
42. McGain F, et al. Environmental sustainability in anesthesia and critical care. British Journal of Anesthesia 2020;125(5):680-692.
43. Lee S, et al. Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest. Environmental Monitoring and Assessment 2018; 190:1-9.
44. Traversari AA, et al. Effect of switching off unidirectional downflow systems of operating theaters during prolonged inactivity on the period before the operating theater can safely be used. American Journal of Infection Control 2017;45(2):139-144.
45. Teke A, Timur O. Assessing the energy efficiency improvement potentials of HVAC systems considering economic and environmental aspects at the hospitals. Renewable and Sustainable Energy Reviews 2014; 33:224-235.
46. Lin J et al. Applied patent RFID systems for building reacting HEPA air ventilation system in hospital operation rooms. Journal of Medical Systems 2012; 36:3399-3405.
47. Jarvis I, Vahabi F. Operating room ventilation systems best practices guide for energy efficiency, health and safety, a greening health care research project. Greening Health Care 2017;1-18.
48. Holzmueller CG, How health care organizations can reduce their carbon footprint. Quality Management in Healthcare 2021;30(1):46-48.
49. Buhre W, et al. The Glasgow declaration on sustainability in anesthesiology and intensive care. Eur J Anesthesiol 2023;40(7):461-4.
50. Mills A. Health care systems in low-and middle-income countries. N Engl J Med 2014;370(6):552-557.
51. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018;6(11): e1196-e1252.
52. Herr MM, et al. Lost in the ether: the environmental impact of anesthesia. Operative Techniques in Orthopedics 2022;32(4):100997-1-8.
53. Bernat M, et al. Reducing the carbon footprint of general anesthesia: a comparison of total intravenous anesthesia vs. a mixed anesthetic strategy in 47,157 adult patients. Anesthesia 2024;79(3):309-317.
54. McGain F, et al. The microbiological and sustainability effects of washing anesthesia breathing circuits less frequently. Anesthesia 2014;69(4):337-342.
55. Yeoh CB, et al. Tollinche LE. Challenges of going green in the operating room. Anaesth Surg Open Access J 2020;2(1):000527.
56. Rizan C, et al. The carbon footprint of waste streams in a UK hospital. Journal of Cleaner Production 2021; 286:125446-1-10.
57. Petre MA, et al. A national survey on attitudes and barriers on recycling and environmental sustainability efforts among Canadian anesthesiologists: an opportunity for knowledge translation. Canadian Journal of Anesthesia 2019;66(3):272-286.
58. Gordon D. Sustainability in the operating room: reducing our impact on the planet. Anesthesiol Clin 2020; 38(3):679-92.
59. Salgueirinho C, Pereira H. The anesthesiologist and global climate change: An ethical obligation to act and being scientifically rigorous. Eur J Anesthesiol 2022;39(10):840.
60. Waspe J, Orr T. Environmental risk assessment of propofol in wastewater: a narrative review of regulatory guidelines. Anesthesia 2023;78(3):337-42.
61. Snowden C, Swart M. Anesthesia and perioperative medicine: GIRFT Programme national specialty report. London, UK: Getting It Right First Time, NHS England and NHS Improvement. [updated 2021; cited 2024 July 24] Available from: https://gettingitrightfirsttime.co.uk/
62. Van Hove M, et al. Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint. Anesthesia 2024;79(3):284-292.

Ameliyathanede Karbon Ayak İzi ve Sürdürülebilirlik: Yeşil Ameliyathane Olma Yolunda Bilinmesi Gerekenler

Yıl 2025, Cilt: 15 Sayı: 2, 389 - 399, 30.05.2025

Öykü Kara , Ezgi Seyhan Ak

https://doi.org/10.31020/mutftd.1549201

Öz

XXI. yüzyılda küresel sağlık için en büyük tehdit iklim değişikliğidir. İklim değişikliğinin en büyük nedenlerinden biri olan sera gazı emisyonlarının %4 ila 10’u sağlık hizmetlerinden kaynaklanmaktadır. Bu emisyonlar, karbon ayak izini artırarak olumsuz çevresel etkiye neden olmaktadır. Sağlık hizmetlerinde karbon ayak izinin artışına en büyük katkıyı, enerji ve kaynak tüketimindeki büyük pay ile ameliyathaneler sağlamaktadır. Ameliyathanelerin iklim değişikliğine karşı önlemler alan ve uygulayan yeşil ameliyathanelere dönüştürülmesi küresel sağlığın korunması ve iyileştirilmesine, doğal kaynakların korunmasına ve sürdürülebilirliğin sağlanmasına önemli katkı sağlamaktadır. Ameliyathane kaynaklı emisyonları azaltmak için tek kullanımlık ürünler yerine tekrar kullanılabilir olanlar tercih edilmeli, tıbbi ve cerrahi gaz kullanımının azaltılmalı, doğru anestezi ve sterilizasyon yöntemleri seçilmelidir. Ayrıca; hastanede kalış süresinin, atıkların ve enerji tüketiminin azaltılması, dokümantasyon ve iletişimin dijitalleştirilmesi emisyonların azalmasını sağlayan diğer önlemlerdendir. Karbon ayak izinin azaltılmasında ve sürdürülebilirliğin sağlanmasında, bu uygulamaların ameliyathane ekibi tarafından anlaşılması, benimsenmesi yeşil ameliyathenelerin oluşturulması büyük öneme sahiptir. Bu çalışmanın amacı ameliyathanedeki karbon ayak izini literatür, uygulamalar ve sürdürülebilirlik doğrultusunda inceleyerek karbon ayak izini azaltmak ve yeşil ameliyathane olma yolunda bilinmesi gerekenleri aktarmaktır.

Anahtar Kelimeler

Karbon ayak izi, İklim değişikliği, Ameliyathane, Sürdürülebilirlik, Yeşil ameliyathane

Etik Beyan

Destekleyen Kurum

Teşekkür

Kaynakça

1. World Health Organization. COP24 Special Report Health & Climate Change 2018;1-74. [updated 2018; cited 2024 Aug 4] Available from: https://apps.who.int/iris/bitstream/handle/10665/276405/9789241514972-eng.pdf?sequence=1&isAllowed=y
2. World Health Organization, (2023). Climate change. [updated 2023; cited 2024 Aug 4] Available from: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
3. MGM, Meteoroloji Genel Müdürlüğü Araştırma Dairesi Başkanlığı Klimatoloji Şube Müdürlüğü. Yeni senaryolar ile Türkiye iklim projeksiyonları ve iklim değişikliği TR2015-CC [updated 2015; cited 2024 Aug 1] Available from: https://www.mgm.gov.tr/iklim/iklim-degisikligi.aspx
4. Pradere B, et al. Sustainability task force of the french association of urology. Climate-smart actions in the operating theatre for improving sustainability practices: A systematic review. Eur Urol 2023;83(4):331-42.
5. Watts N, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet 2021;397(10269):129-170.
6. Tennison I, et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. The Lancet Planetary Health 2021;5(2): e84-e92.
7. Chung JW, Meltzer DO. Estimate of the carbon footprint of the US health care sector. Jama 2009;302(18):1970-1972.
8. World Health Organization, (2022). Alliance for transformative action on climate and health. [updated 2022; cited 2024 Aug 4] Available from: https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health
9. United Nations-UN, New York. The Paris Agreement. Article 2 [updated 2015; cited 2024 July 27] Available from https://unfccc.int/sites/default/files/english_paris_agreement.pdf
10. National Health Service. Delivering a ‘net zero’ National Health Service. London: NHS England and NHS Improvement. [updated 2020; cited 2024 Aug 5] Available from: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf
11. İnan G, Özköse Şatırlar Z. Anestezinin küresel ısınmaya etkisi ve sürdürülebilir anestezi gerçeği. Journal of Anesthesia 2023;31(4):253-266.
12. MacNeill AJ, et al. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health 2017;1(9): e381-e388.
13. Rizan C, et al. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. Journal of the Royal Society of Medicine 2023;116(6):199-213.
14. Wormer BA, et al. The green operating room: simple changes to reduce cost and our carbon footprint. The American Surgeon 2013;79(7):666-671.
15. Whiting A, et al. Surgery and the NHS carbon footprint. The Bulletin of the Royal College of Surgeons of England 2020;102(5):182-185.
16. de’Angelis N, et al. Systematic review of carbon footprint of surgical procedures. Journal of Visceral Surgery 2023;161(2):7-14.
17. Robinson PN, et al. The carbon footprint of surgical operations: a systematic review update. The Annals of The Royal College of Surgeons of England 2023;105(8):692-708.
18. Papadopoulou A, et al. Environmental sustainability in robotic and laparoscopic surgery: systematic review. British Journal of Surgery 2022;109(10):921-932.
19. Cannon J, et al. Carbon footprint of tonsillectomy. The Surgeon 2024;22(4):242-247.
20. John JB, et al. The carbon footprint of the perioperative transurethral resection of bladder tumor pathway. BJU International 2024; 1-10.
21. Pascual-Prieto J, et al. The carbon footprint of cataract surgery in Spain. Archivos de la Sociedad Española de Oftalmología 2023;98(5):249-253.
22. Tsagkaris C, et al. Eco-friendly and COVID-19 friendly? decreasing the carbon footprint of the operating room in the COVID-19 era. Diseases 2023;11(4):157-1-13.
23. Woods DL, et al. Carbon footprint of robotically‐assisted laparoscopy, laparoscopy and laparotomy: a comparison. The International Journal of Medical Robotics and Computer Assisted Surgery 2015;11(4):406-412.
24. Drew J, et al. Operating in a climate crisis: a state-of-the-science review of life cycle assessment within surgical and anesthetic care. Environmental Health Perspectives 2021;129(7):076001-1-18.
25. World Health Organization. WHO Infection Control Guidelines for transmissible spongiform encephalopathies: report of a WHO consultation, Geneva, Switzerland, 23-26 March 1999 (No. WHO/CDS/CSR/APH/2000.3). World Health Organization. [updated 2000; cited 2024 Aug 5] Available from: https://iris.who.int/handle/10665/66707
26. Maria-Alexandra P, Malherbe S. Environmentally sustainable perioperative medicine: simple strategies for anesthetic practice. Canadian Journal of Anesthesia 2020;67(8):1044-1063.
27. Sherman JD, et al. Life cycle assessment and costing methods for device procurement: comparing reusable and single-use disposable laryngoscopes. Anesthesia & Analgesia 2018;127(2):434-443.
28. Hauser OP, et al. Cooperating with the future. Nature 2014;511(7508):220-223.
29. White SM, et al. Principles of environmentally‐sustainable anesthesia: a global consensus statement from the World Federation of Societies of Anesthesiologists. Anesthesia 2022;77(2):201-212.
30. Bhutta MF. Our overreliance on single-use equipment in the operating theatre is misguided, irrational and harmful to our planet. The Annals of The Royal College of Surgeons of England 2021;103(10):709-712.
31. Rizan C, Bhutta MF. Strategy for net-zero carbon surgery. British Journal of Surgery 2021;108(7):737-739.
32. Sathe TS, et al. Instrument and supply variability: an opportunity to reduce the carbon footprint of the operating room. Journal of Surgical Research 2024; 295:732-739.
33. Chang JH, et al. Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use. The Surgeon 2024;22(4):236-241.
34. Vozzola E, et al. An environmental analysis of reusable and disposable surgical gowns. AORN Journal 2020;111(3):315-325.
35. US Food and Drug Administration. Medical gowns Silver Spring FDA, MD [updated 2018; cited 2024 Aug 4] Available from: https://www.fda.gov/medical-devices/personalprotective-equipment-infection-control/medicalgowns
36. Yates EF, et al. Empowering surgeons, anesthesiologists, and obstetricians to incorporate environmental sustainability in the operating room. Annals of Surgery 2021;273(6):1108-1114.
37. McGain F, et al. Why be sustainable? The Australian and New Zealand College of Anesthetists Professional Document PS64: Statement on environmental sustainability in anesthesia and pain medicine practice and its accompanying background paper. Anesthesia and Intensive Care 2019;47(5):413-422.
38. McEvoy B et al. Advancing the sustainable use of ethylene oxide through process validation. Biomedical Instrumentation & Technology 2021;55(s3):35-44.
39. McGain F, et al. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesthesia & Analgesia 2012;114(5):1073-1080.
40. Jehle K, et al. Clean and green: saving water in the operating theatre. The Annals of The Royal College of Surgeons of England 2008;90(1):22-24.
41. McGain F, et al. Hospital steam sterilizer usage: could we switch off to save electricity and water? Journal of Health Services Research & Policy 2016;21(3):166-171.
42. McGain F, et al. Environmental sustainability in anesthesia and critical care. British Journal of Anesthesia 2020;125(5):680-692.
43. Lee S, et al. Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest. Environmental Monitoring and Assessment 2018; 190:1-9.
44. Traversari AA, et al. Effect of switching off unidirectional downflow systems of operating theaters during prolonged inactivity on the period before the operating theater can safely be used. American Journal of Infection Control 2017;45(2):139-144.
45. Teke A, Timur O. Assessing the energy efficiency improvement potentials of HVAC systems considering economic and environmental aspects at the hospitals. Renewable and Sustainable Energy Reviews 2014; 33:224-235.
46. Lin J et al. Applied patent RFID systems for building reacting HEPA air ventilation system in hospital operation rooms. Journal of Medical Systems 2012; 36:3399-3405.
47. Jarvis I, Vahabi F. Operating room ventilation systems best practices guide for energy efficiency, health and safety, a greening health care research project. Greening Health Care 2017;1-18.
48. Holzmueller CG, How health care organizations can reduce their carbon footprint. Quality Management in Healthcare 2021;30(1):46-48.
49. Buhre W, et al. The Glasgow declaration on sustainability in anesthesiology and intensive care. Eur J Anesthesiol 2023;40(7):461-4.
50. Mills A. Health care systems in low-and middle-income countries. N Engl J Med 2014;370(6):552-557.
51. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018;6(11): e1196-e1252.
52. Herr MM, et al. Lost in the ether: the environmental impact of anesthesia. Operative Techniques in Orthopedics 2022;32(4):100997-1-8.
53. Bernat M, et al. Reducing the carbon footprint of general anesthesia: a comparison of total intravenous anesthesia vs. a mixed anesthetic strategy in 47,157 adult patients. Anesthesia 2024;79(3):309-317.
54. McGain F, et al. The microbiological and sustainability effects of washing anesthesia breathing circuits less frequently. Anesthesia 2014;69(4):337-342.
55. Yeoh CB, et al. Tollinche LE. Challenges of going green in the operating room. Anaesth Surg Open Access J 2020;2(1):000527.
56. Rizan C, et al. The carbon footprint of waste streams in a UK hospital. Journal of Cleaner Production 2021; 286:125446-1-10.
57. Petre MA, et al. A national survey on attitudes and barriers on recycling and environmental sustainability efforts among Canadian anesthesiologists: an opportunity for knowledge translation. Canadian Journal of Anesthesia 2019;66(3):272-286.
58. Gordon D. Sustainability in the operating room: reducing our impact on the planet. Anesthesiol Clin 2020; 38(3):679-92.
59. Salgueirinho C, Pereira H. The anesthesiologist and global climate change: An ethical obligation to act and being scientifically rigorous. Eur J Anesthesiol 2022;39(10):840.
60. Waspe J, Orr T. Environmental risk assessment of propofol in wastewater: a narrative review of regulatory guidelines. Anesthesia 2023;78(3):337-42.
61. Snowden C, Swart M. Anesthesia and perioperative medicine: GIRFT Programme national specialty report. London, UK: Getting It Right First Time, NHS England and NHS Improvement. [updated 2021; cited 2024 July 24] Available from: https://gettingitrightfirsttime.co.uk/
62. Van Hove M, et al. Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint. Anesthesia 2024;79(3):284-292.

Toplam 62 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Ekoloji, Sürdürülebilirlik ve Enerji, Cerrahi Hastalıklar Hemşireliği
Bölüm	Monografi
Yazarlar	Öykü Kara 0000-0003-3125-9632 Ezgi Seyhan Ak 0000-0002-3679-539X
Erken Görünüm Tarihi	28 Mayıs 2025
Yayımlanma Tarihi	30 Mayıs 2025
Gönderilme Tarihi	12 Eylül 2024
Kabul Tarihi	4 Mart 2025
Yayımlandığı Sayı	Yıl 2025 Cilt: 15 Sayı: 2

Kaynak Göster

APA	Kara, Ö., & Seyhan Ak, E. (2025). Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi, 15(2), 389-399. https://doi.org/10.31020/mutftd.1549201
AMA	Kara Ö, Seyhan Ak E. Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. Mayıs 2025;15(2):389-399. doi:10.31020/mutftd.1549201
Chicago	Kara, Öykü, ve Ezgi Seyhan Ak. “Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi 15, sy. 2 (Mayıs 2025): 389-99. https://doi.org/10.31020/mutftd.1549201.
EndNote	Kara Ö, Seyhan Ak E (01 Mayıs 2025) Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi 15 2 389–399.
IEEE	Ö. Kara ve E. Seyhan Ak, “Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room”, Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi, c. 15, sy. 2, ss. 389–399, 2025, doi: 10.31020/mutftd.1549201.
ISNAD	Kara, Öykü - Seyhan Ak, Ezgi. “Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi 15/2 (Mayıs 2025), 389-399. https://doi.org/10.31020/mutftd.1549201.
JAMA	Kara Ö, Seyhan Ak E. Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2025;15:389–399.
MLA	Kara, Öykü ve Ezgi Seyhan Ak. “Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi, c. 15, sy. 2, 2025, ss. 389-9, doi:10.31020/mutftd.1549201.
Vancouver	Kara Ö, Seyhan Ak E. Carbon Footprint and Sustainability in The Operating Room: What to Know on the Road to Becoming a Green Operating Room. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2025;15(2):389-9.

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