الفهرس 
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Abstract
Summary
The need for surgery is also increasing. The Lancet Commission on Global Surgery outlined some of the scale of the burden of surgical disease in its report Global Surgery 2030, noting that 143 million additional surgical procedures are needed each year to save lives and prevent disability. This underlines the importance of encouraging sustainable surgical practices. Sustainable surgery is surgery that is both environmentally sound and cost effective (Aldoori, Hartley & MacFie, 2021).
The fundamental principles of reducing waste in the OR are based on the cornerstone strategy of waste minimisation and rely on the principles of “three Rs”: reduce, reuse, and recycle Pradere, et al. (2022). In addition to proper segregation, overall waste reduction is another way in which nurses can “green” the operating room. There are many opportunities to reduce OR waste, which include the following: Fluid management ,Kit reformulation ,Reusable sharps containers ,Reprocessing of medical devices ,Environmentally preferable purchasing (EPP) and Donation programs (Choiniere, 2013).
At the very beginning, Florence Nightingale had stressed the necessity of putting the patient in the healthiest environment for healing the patient. Certainly, nurses own responsibilities of creating a healthier workplace in the hospital and community setting. Further being a member of the green team, nurses can contribute support and inform other staff on environmentally sustainable; institutional practices in various aspects like, recycling, appropriate product selection and disposal according to hospital policy (Josef et al., 2019).
Aim of the study
The aim of this study is to assess the barriers to the green practice regarding waste management among operating room nurses.
Subject and Methods
Research design:
A descriptive exploratory study was used.
Settings:
This study was conducted at general operating rooms in El-Demrdash Hospital affiliated to Ain Shams University, Cairo, Egypt.
Sampling:
All the available nurses assigned to work in the above mentioned settings. The total number of nurses was 45 nurses.
The following tools were used for data collection:
First tool: -Nurse’s self-administrated questionnaire composed of (1) into two parts
Part one: Concerning nurses characteristics as regard their Age; sex; marital status; area of residence; educational level, etc…
Part two: Concerning of nurses knowledge about green practices regarding waste management in the operating room such as its meaning, importance of green practice, etc…
Second tool: -Waste reduction and prevention checklist concerning of nurses practice about green practices regarding waste management in the operating room.
Third tool: -Barriers of green practice regarding waste management questionnaire.
Pilot study:
The pilot study was conducted to test the simplicity of language of tools. A pilot study had been done on 10% of the sample size nurses to test the feasibility of the study, application of tools, content validity and estimate the time required for filling the tool then the necessary modification that had been done as revealed from the pilot study.
The study results can be summarized as follows:
More than one-third of studied nurses were in age between 20-29 years old, and majority of them were female. More than half were holding nursing technical diploma. More than half had not received any training on medical waste and all of nurses had not received any training on green practices in operating rooms.
Studied nurses had unsatisfactory knowledge about climate change, operating room, medical waste, sustainability, green practice (reduce-reuse-recycle), waste classification, waste segregation, waste collection, transportation and storage, and waste treatment and disposal in operating rooms. Studied nurses had unsatisfactory total knowledge about green practices regarding waste management in the operating room.
Studied nurses had unsatisfactory practice about green practice (reduce-reuse-recycle), waste classification, waste segregation, waste collection, transportation and storage, and waste treatment and disposal in operating rooms. Studied nurses had unsatisfactory total practice about green practices regarding waste management in the operating room.
Closer to half of studied nurses reported human barriers (lack of training on green practice-lack of knowledge and awareness-non sustainable practices) as one of the barriers facing the application of green practice regarding waste management in the operating room being the highest percentage achieved among all operating room nurses.
There was statistically significant relation between the studied nurses knowledge and studied nurses educational level (p=.02919). There were no significant statistical relation between the studied nurses practice and studied nurses educational level (p=0.22961).
Also, there were no significant statistical relation between the studied nurses’ knowledge and studied nurses year of experience (p=-0.45885). There were no significant statistical relation between the studied nurses’ practice and studied nurses’ year of experience (p= 0.65480).
Finally there were no significant statistical relation between the studied nurses’ knowledge and studied nurses training (p=-0.55321). There were no significant statistical relation between the studied nurses’ practice and studied nurses training (p= 0.58298). There was a statistically significant weak negative correlation between the studied nurses total knowledge and practice (p=0.10161, r= -0.25).
According to the findings it is recommended that:
1. Nurses should receive specific training regarding the new concept of sustainability and green practice and waste management.
2. Policy maker should be encouraged to purchase environmentally friendly supplies and materials used in operating room.
3. Activating the color code system to dispose of all types of wastes generated inside the operating rooms.
4. Operating room nurses should be encouraged to prevent wasting generation and to decrease surplus materials, and reusable materials should be given preference over disposable materials.
5. Recycling practices can be improved by adopting proper segregation of waste generated all along the patient pathway (before, during, and after the surgery).
6. Efforts should be made to build environment-friendly teams “green team” in the operating rooms to follow green practices and applications.
Recommendations for Future Research
Future studies should target larger numbers of operating room at all hospitals and use larger sample sizes. Studies of environment friendly practices may target all of the units of a hospital and not only ORs.