Abstract Background The aim of this study was to estimate the carbon footprint and financial cost of decontaminating (steam sterilization) and packaging reusable surgical instruments, indicating how that burden might be reduced, enabling surgeons to drive action towards net-zero-carbon surgery. Methods Carbon footprints were estimated using activity data and prospective machine-loading audit data at a typical UK in-hospital sterilization unit, with instruments wrapped individually in flexible pouches, or prepared as sets housed in single-use tray wraps or reusable rigid containers. Modelling was used to determine the impact of alternative machine loading, opening instruments during the operation, streamlining sets, use of alternative energy sources for decontamination, and alternative waste streams. Results The carbon footprint of decontaminating and packaging instruments was lowest when instruments were part of sets (66–77 g CO2e per instrument), with a two- to three-fold increase when instruments were wrapped individually (189 g CO2e per instrument). Where 10 or fewer instruments were required for the operation, obtaining individually wrapped items was preferable to opening another set. The carbon footprint was determined significantly by machine loading and the number of instruments per machine slot. Carbon and financial costs increased with streamlining sets. High-temperature incineration of waste increased the carbon footprint of single-use packaging by 33–55 per cent, whereas recycling reduced this by 6–10 per cent. The absolute carbon footprint was dependent on the energy source used, but this did not alter the optimal processes to minimize that footprint. Conclusion Carbon and financial savings can be made by preparing instruments as part of sets, integrating individually wrapped instruments into sets rather than streamlining them, efficient machine loading, and using low-carbon energy sources alongside recycling.

中文翻译：

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最大限度地减少可重复使用手术器械的蒸汽灭菌和包装的碳和财务成本

摘要 背景本研究的目的是估计净化（蒸汽灭菌）和包装可重复使用的手术器械的碳足迹和财务成本，表明如何减轻这种负担，使外科医生能够推动净零碳手术的行动。 方法使用英国典型的医院灭菌装置的活动数据和预期机器装载审核数据来估算碳足迹，其中仪器单独包装在柔性袋中，或成套放置在一次性托盘包装或可重复使用的刚性容器中。建模用于确定替代机器负载、在操作过程中打开仪器、简化设备、使用替代能源进行净化以及替代废物流的影响。 结果当仪器成套使用时，净化和包装仪器的碳足迹最低（每台仪器 66-77 g CO2e），而当仪器单独包装时，碳足迹增加两到三倍（每台仪器 189 g CO2e）。如果手术需要 10 件或更少的器械，则获得单独包装的物品比打开另一套更好。碳足迹很大程度上取决于机器负载和每个机器槽位的仪器数量。碳和财务成本随着设备的精简而增加。废物的高温焚烧使一次性包装的碳足迹增加了 33-55%，而回收则减少了 6-10%。绝对碳足迹取决于所使用的能源，但这并没有改变最小化碳足迹的最佳流程。 结论通过将乐器准备为套件的一部分、将单独包装的乐器集成到套件中而不是简化它们、高效的机器装载以及在回收的同时使用低碳能源，可以节省碳和资金。