A paradigm change: from disposable to reusable instruments usage in the Ophthalmology Department

Project completed as part of the 2023-4 Northampton General Hospital NHS Trust Green Team Competition.

Team members

• Tristan McMullan, Consultant Opthamologist
• Gabriele Quaranta, Oculoplastics Fellow

Setting / patent group: Ophthalmology outpatient department, with a patient turnaround of approx. 100-200 patients per day, seeing over 25.000 patients per year.

Issues:

1. Many procedures in our department use single-use items but could be performed equally well using reusable instruments. While we have replaced some single use with reusable items in the past, the reusable option has not been optimised. For example, we currently use reusable scissors in our ophthalmology sets, however they are blunt.
2. In ophthalmology, we routinely administer/prescribe dilating eye drops (tropicamide). This is administered via single dose minims. There are more sustainable alternatives to minims. By administering drops from multidose bottles that can be used safely with multiple patients we will significantly reduce packaging. Rahemtulla et al 2021 compared annual financial costs between multidose bottles and single-use minims finding use of multidose bottles was $22,481 CAD (approximately £13,250) cheaper than minims in their Department. This is a cost saving but also avoids a huge amount of plastic waste.

Intervention:

1. To replace high volume single use items (forceps and scissors) with reusable items in clinic
2. To replace a high-volume single use item (sponge holders) with reusable in theatres
3. To switch from single use eye drop minims to multidose bottles

We have purchased reusable sponge holders, forceps and scissors. The new forceps will be used in clinic. The sponge holders will be used in theatre sets. The new scissors will be used in theatre sets, replacing our current reusable scissors which are bunt. The worn scissors will be sent to clinic to be used for suture removal as that task is much less demanding than a surgical operation, and blunt scissors will not impact.

We gained infection prevention and control (IPC) approval for the changes, including eye drops. We are awaiting pharmacy approval to trial this change.

We plan to trial the items and gain feedback from staff before rolling out the changes. In future we would like to replace more disposable items with reusable (e.g. sterile drapes), and spread the changes to other surgical departments.

Outcomes:

There will be no changes to clinical outcomes for patients. For patients, eye drops will be more comfortable if combined, as this reduces the drops administered for the patient from 2 drops per eye to 1 single drop per eye.

Replacing the scissors in theatre will make operating more pleasant without requiring asking for a new pair of scissors for almost any oculoplastic operation. The reusable scissors will be easier for the team to use as the disposable ones are very sharp and small, therefore not ideal for the kind of procedures that we commonly perform.

Across a year, we will save 1,065 kgCO2e from a switch to reusable scissors, forceps and sponge holders. This carbon saving is equivalent to driving 3144 miles in an average car.

While a switch to multi use drops would bring further carbon savings, we are still collating data to estimate the carbon footprint of a multi-use bottle.

Financially we will save £18,412 in one year from the switch to reusables. As the reusable items are expected to last for 4.8 years, the savings will increase in subsequent years. Our savings will increase by a further £8,370 with a switch to multi use drops.

Key learning point 

The key elements that contributed to successes and learning in this project was the critical evaluation of our practice to understand how we do things and how we can do them in a more environmentally friendly way, maintaining patient safety all the while.

We learned that we need to be proactive in order to start a change that will then become common and accepted practice, although there can be some resistance initially.  Encouraging staff to see this as a common goal rather than a veiled criticism of their current practice is key.