{"id":44448,"date":"2022-01-01T10:49:03","date_gmt":"2022-01-01T09:49:03","guid":{"rendered":"https:\/\/gestions-hospitalieres.fr\/?p=44448"},"modified":"2022-02-01T15:55:18","modified_gmt":"2022-02-01T14:55:18","slug":"injections-intravitreennes","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/injections-intravitreennes\/","title":{"rendered":"Injections intravitr\u00e9ennes"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 4<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><p>Depuis la r\u00e9volution industrielle il y a 150\u00a0ans, la temp\u00e9rature terrestre moyenne a augment\u00e9 de 1\u00b0C, voire 3\u00b0C au niveau des p\u00f4les. Les scientifiques s\u2019attendent \u00e0 une augmentation de la fr\u00e9quence des catastrophes naturelles\u2009: \u00e9l\u00e9vation du niveau des oc\u00e9ans, inondations, s\u00e9cheresses, incendies, temp\u00eates, augmentation des vecteurs de maladie infectieuses<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(1)<\/sup>\u2026<\/p>\n<p>\u00c0 l\u2019\u00e9chelle mondiale, les services de sant\u00e9 g\u00e9n\u00e8rent des \u00e9missions de gaz \u00e0 effet de serre consid\u00e9rables. L\u2019utilisation croissante de mat\u00e9riel \u00e0 usage unique a aussi pour cons\u00e9quences l\u2019augmentation \u00e0 la fois de la consommation de ressources et de la cr\u00e9ation de d\u00e9chets (deuxi\u00e8me source de d\u00e9chets derri\u00e8re l\u2019industrie alimentaire)<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(2)<\/sup>. Plus pr\u00e9cis\u00e9ment, d\u2019apr\u00e8s des \u00e9tudes, la chirurgie de la cataracte est la plus polluante au monde du fait de l\u2019utilisation importante de mat\u00e9riel \u00e0 usage unique et du grand nombre d\u2019interventions<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(3)<\/sup>.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>En tant qu\u2019ophtalmologistes, nous avons constat\u00e9 l\u2019importante quantit\u00e9 de d\u00e9chets issus d\u2019une session d\u2019injections intravitr\u00e9ennes (IVT) et avons entrepris une \u00e9tude pour d\u00e9terminer l\u2019impact environnemental d\u2019une IVT en France, en analysant les pratiques d\u2019un centre public et celle d\u2019un centre priv\u00e9. Nous avons aussi cherch\u00e9 \u00e0 mod\u00e9liser une IVT \u00e9cocon\u00e7ue qui permettrait d\u2019optimiser la consommation de ressources et la cr\u00e9ation de d\u00e9chets (instruments r\u00e9utilisables, recyclage optimal\u2026).<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h1>M\u00e9thodologie<span class=\"Apple-converted-space\">\u00a0<\/span><\/h1>\n<p>Accompagn\u00e9s par une agence sp\u00e9cialis\u00e9e dans le d\u00e9veloppement durable en sant\u00e9<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(4)<\/sup>, nous avons entrepris une analyse de cycle de vie. Il s\u2019agit d\u2019une m\u00e9thode scientifique qui permet de d\u00e9terminer les \u00e9missions li\u00e9es \u00e0 l\u2019utilisation d\u2019un produit ou d\u2019un service tout au long de son cycle de vie (extraction des mati\u00e8res premi\u00e8res, fabrication, transport, emballage, utilisation, fin de vie). Nous avons utilis\u00e9 la base de donn\u00e9es EcoInvent, la plus exhaustive et la plus robuste.<\/p>\n<p>Nous avons ainsi mod\u00e9lis\u00e9 quatre sc\u00e9narios\u2009:<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<ul>\n<li>une IVT au bloc op\u00e9ratoire et une IVT en salle blanche du CHU de Lille (secteur public)\u2009; deux lieux d\u2019injections diff\u00e9rents selon le jour de la semaine\u2009;<span class=\"Apple-converted-space\">\u00a0<\/span><\/li>\n<li>une IVT \u00e0 l\u2019institut ophtalmique de Somain (secteur priv\u00e9) et une IVT \u00e9cocon\u00e7ue.<\/li>\n<\/ul>\n<p>Le p\u00e9rim\u00e8tre de notre \u00e9tude a englob\u00e9 l\u2019utilisation des consommables, l\u2019\u00e9nergie li\u00e9e \u00e0 l\u2019utilisation de la salle et le transport du patient. Nous avons exclu l\u2019impact des mol\u00e9cules car il n\u2019existe pas de bases de donn\u00e9es pour l\u2019industrie pharmaceutique. Onze indicateurs environnementaux ont \u00e9t\u00e9 pris en compte, dont les \u00e9missions de gaz \u00e0 effet de serre (GES) comme indicateur principal.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<h1>L\u2019impact environnemental<span class=\"Apple-converted-space\">\u00a0<\/span><\/h1>\n<p>En additionnant les impacts de l\u2019ensemble des \u00e9l\u00e9ments concourant \u00e0 la r\u00e9alisation d\u2019une IVT, nous obtenons un impact moyen de 16,81\u00a0kg eqCO<sub>2<\/sub>. Le transport repr\u00e9sente 88\u2009% des \u00e9missions de GES, l\u2019utilisation des consommables 11\u2009% et l\u2019\u00e9nergie de la salle environ 1\u2009%.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Sur la partie des consommables, une IVT dans le centre priv\u00e9 permet une r\u00e9duction de 25\u2009% des impacts par rapport \u00e0 une IVT en centre public (absence d\u2019utilisation d\u2019un pack de d\u00e9tersion, pack IVT sur mesure avec champ de table et de t\u00eate de plus petite dimension). Une IVT \u00e9cocon\u00e7ue permet une r\u00e9duction de 45\u2009% des impacts par rapport \u00e0 l\u2019impact moyen d\u2019une IVT en France (<i>figure 1<\/i>).<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2022_63_01\">figure 1<\/button><div id=\"enc_2022_63_01\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 1<\/span><\/p>\n<h2>\u00c9missions de GES<span class=\"Apple-converted-space\">\u00a0<\/span><\/h2>\n<p><b>Utilisation des consommables par sc\u00e9nario<\/b><\/p>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-44452\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.12.06.png\" alt=\"\" width=\"1236\" height=\"424\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.12.06.png 1236w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.12.06-300x103.png 300w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.12.06-1024x351.png 1024w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.12.06-768x263.png 768w\" sizes=\"(max-width: 1236px) 100vw, 1236px\" \/><\/p>\n<\/div>\n<p>Nous avons remarqu\u00e9 que des objets faisant partie du pack IVT sur mesure n\u2019\u00e9taient pas utilis\u00e9s et qu\u2019ils sont responsables de 28,3\u2009% des \u00e9missions de GES du pack et de 9,3\u2009% des \u00e9missions de GES des consommables d\u2019une IVT. Les packs de d\u00e9tersion, lorsqu\u2019ils sont utilis\u00e9s, sont responsables de 18\u2009% de l\u2019impact environnemental des consommables. Nous avons \u00e9galement remarqu\u00e9 qu\u2019une feuille A4 de 32 \u00e9tiquettes \u00e9tait imprim\u00e9e pour chaque patient alors qu\u2019une seule est utilis\u00e9e en pratique, soit 3\u2009% des \u00e9tiquettes.<\/p>\n<p>Une investigation sur l\u2019origine des produits du pack IVT a permis de retrouver un transport cumul\u00e9 pour chacun des objets du pack de plus de 225\u2009000 km, soit 5,6 fois le tour de la Terre. Les consommables viennent majoritairement d\u2019Asie et principalement de Chine.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>En moyenne, une IVT en France g\u00e9n\u00e8re 434\u00a0g de d\u00e9chets, avec de grandes disparit\u00e9s. En Inde, au Aravind Eye Care System de Pondich\u00e9ry, internationalement reconnu pour la qualit\u00e9 des soins ophtalmologiques prodigu\u00e9s, 128\u00a0g de d\u00e9chets seulement sont g\u00e9n\u00e9r\u00e9s par IVT. De plus, la part de recyclage est bien trop faible (0,8\u2009% dans le centre priv\u00e9 et en salle blanche du CHU) et la proportion de d\u00e9chets d\u2019activit\u00e9 de soins \u00e0 risque infectieux (Dasri) \u2013 qui n\u00e9cessitent un traitement particulier par une technique d\u2019incin\u00e9ration ou de banalisation plus on\u00e9reux \u2013 est bien trop importante (53,5\u2009% dans la salle blanche du centre public\u2009; 92\u2009% de ces objets ne r\u00e9pondaient pas \u00e0 la d\u00e9finition des Dasri).<\/p>\n<h1>Discussion<span class=\"Apple-converted-space\">\u00a0<\/span><\/h1>\n<p>Il est int\u00e9ressant d\u2019extrapoler ces r\u00e9sultats au 1,3 million d\u2019IVT r\u00e9alis\u00e9es chaque ann\u00e9e en France. Nous consid\u00e9rons que 550\u00a0tonnes de d\u00e9chets sont ainsi g\u00e9n\u00e9r\u00e9es (<i>figure 2<\/i>). De m\u00eame, ce sont 2\u2009450\u00a0tonnes eqCO<sub>2<\/sub> de GES qui sont \u00e9mises sur un an rien que pour la partie consommables\u2009; l\u2019\u00e9quivalent de 540\u00a0v\u00e9hicules personnels qui roulent 18000\u00a0km par an ou l\u2019\u00e9quivalent de la captation carbone de 40\u2009000\u00a0arbres qui poussent pendant dix ans. Nous comprenons donc l\u2019importance d\u2019agir chacun \u00e0 notre \u00e9chelle vers une \u00e9coconception des soins car, ensemble, nous avons un v\u00e9ritable impact.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2022_63_02\">figure 2<\/button><div id=\"enc_2022_63_02\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 2<\/span><\/p>\n<h2>Extrapolation des d\u00e9chets<\/h2>\n<p><b>Par site sur un an<\/b><\/p>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-44454\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.15.00.png\" alt=\"\" width=\"1212\" height=\"504\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.15.00.png 1212w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.15.00-300x125.png 300w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.15.00-1024x426.png 1024w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2022\/02\/Capture-d\u2019\u00e9cran-2022-02-01-\u00e0-11.15.00-768x319.png 768w\" sizes=\"(max-width: 1212px) 100vw, 1212px\" \/><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<p>De plus, le d\u00e9veloppement durable (DD) n\u2019est pas synonyme d\u2019augmentation de co\u00fbt, bien au contraire. Au CHU de Lille, en supprimant le pack de d\u00e9tersion et en changeant de solution de rin\u00e7age (actuellement fabriqu\u00e9e au Texas aux \u00c9tats-Unis \u00e0 1,50\u00a0\u20ac\/pi\u00e8ce et qui pourrait \u00eatre remplac\u00e9e par du s\u00e9rum physiologique fabriqu\u00e9 en France \u00e0 6\u00a0centimes\/pi\u00e8ce), ce serait environ 15\u2009000\u00a0euros \u00e9conomis\u00e9s chaque ann\u00e9e.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Nous pourrions \u00e9galement r\u00e9fl\u00e9chir \u00e0 des alternatives au \u00ab\u2009tout-jetable\u2009\u00bb en investissant dans du mat\u00e9riel r\u00e9utilisable qui serait lav\u00e9 et st\u00e9rilis\u00e9 dans les structures de soins ou aupr\u00e8s de partenaires locaux, ce qui permettrait des r\u00e9ductions d\u2019impact environnemental, des r\u00e9ductions de cr\u00e9ation de d\u00e9chets, la cr\u00e9ation d\u2019emplois locaux et une redistribution des richesses localement.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Le d\u00e9veloppement durable n\u2019est pas forc\u00e9ment quelque chose de n\u00e9gatif, mais c\u2019est plut\u00f4t une formidable opportunit\u00e9 de r\u00e9duire notre impact sur la Terre, d\u2019innover, de r\u00e9duire notre d\u00e9pendance aux pays asiatiques. Nous pourrions r\u00e9fl\u00e9chir \u00e0 l\u2019\u00e9laboration de <i>guidelines<\/i> simples, pratiques, applicables par chacun, pour r\u00e9duire, \u00e0 notre \u00e9chelle, notre impact. Et il ne s\u2019agit l\u00e0 que d\u2019un d\u00e9but\u2026Tout le monde devrait \u00eatre impliqu\u00e9 dans cette d\u00e9marche\u2009: m\u00e9decins, personnel param\u00e9dical, industriels, fournisseurs, d\u00e9cideurs politiques, directions d\u2019\u00e9tablissement\u2026 N\u2019oublions pas que nous sommes plus de 7\u00a0milliards d\u2019individus et qu\u2019il n\u2019y a qu\u2019une seule Terre. Nous ne pourrons pas dire \u00e0 nos enfants que nous ne savions pas.<\/p>\n<p><strong>Contact auteur<\/strong> <a href=\"mailto:gabin.momal@gmail.com\" target=\"_blank\" rel=\"noopener noreferrer\">gabin.momal@gmail.com<\/a><\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p>Depuis la r\u00e9volution industrielle il y a 150\u00a0ans, la temp\u00e9rature terrestre moyenne a augment\u00e9 de 1\u00b0C, voire 3\u00b0C au niveau des p\u00f4les. Les scientifiques s\u2019attendent \u00e0 une augmentation de la fr\u00e9quence des catastrophes naturelles\u2009: \u00e9l\u00e9vation du niveau des oc\u00e9ans, inondations, s\u00e9cheresses, incendies, temp\u00eates, augmentation des vecteurs de maladie infectieuses(1)\u2026 \u00c0 l\u2019\u00e9chelle mondiale, les services de sant\u00e9 g\u00e9n\u00e8rent des \u00e9missions de gaz \u00e0 effet de serre consid\u00e9rables. L\u2019utilisation croissante de mat\u00e9riel&hellip; <\/p>\n","protected":false},"author":23133,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[26,2],"tags":[1100,8893,771,8895,2084,8892,8894,6856],"class_list":["post-44448","post","type-post","status-publish","format-standard","hentry","category-dossier","category-gestions-hospitalieres","tag-dasri","tag-dechet","tag-developpement-durable","tag-ges","tag-impact-environnemental","tag-injection-intravitreenne","tag-ivt","tag-ophtalmologie"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Injections intravitr\u00e9ennes - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/injections-intravitreennes\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Injections intravitr\u00e9ennes - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Depuis la r\u00e9volution industrielle il y a 150\u00a0ans, la temp\u00e9rature terrestre moyenne a augment\u00e9 de 1\u00b0C, voire 3\u00b0C au niveau des p\u00f4les. Les scientifiques s\u2019attendent \u00e0 une augmentation de la fr\u00e9quence des catastrophes naturelles\u2009: \u00e9l\u00e9vation du niveau des oc\u00e9ans, inondations, s\u00e9cheresses, incendies, temp\u00eates, augmentation des vecteurs de maladie infectieuses(1)\u2026 \u00c0 l\u2019\u00e9chelle mondiale, les services de sant\u00e9 g\u00e9n\u00e8rent des \u00e9missions de gaz \u00e0 effet de serre consid\u00e9rables. 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