The carbon footprint of the operating room related to infection prevention measures: a scoping review

  • A. Bolten
    Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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  • D.S. Kringos
    Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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  • I.J.B. Spijkerman
    Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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  • N.H. Sperna Weiland
    Corresponding author. Address: Department of Anaesthesiology/Centre for Sustainable Healthcare, Amsterdam UMC, Room H1-125, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands. Tel.: +31 20 5669111.
    Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands

    Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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      Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear.


      To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems.


      A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included.


      Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems.


      Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.


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