Hand unit greener surgery

Team members 

• Mr Samuel Norton.  

• Mr Ken Wong. 

• Miss Jasmine Crane.  

• Mr Thomas Barber. 

• Miss Rebecca Fish. 

• Miss Dominique Dennis. 

Setting / patient group:   Patients undergoing hand surgery in NNUH ambulatory procedure unit (APU). 

Issue: 

Surgical activity generates between 20-30% of total hospital waste and is 3 to 6 times more energy- intensive than any other hospital department.  Single-use surgical instruments are one of the most carbon-intense products used within healthcare.  Using reusable equipment, reducing open but unused instruments and reducing unnecessary prescriptions can reduce the environmental impact, improve cost efficiency and maintain high standards of patient care. 

Aims: 

• Replace single use hats and gowns with reusable items. 

• Replace masks with attached visors for standard masks. 

• Streamline sterile packs and surgical sets. 

• Transition scrubbing practice to use sanitising gel. 

• Cease routine prescription of paracetamol and ibuprofen routinely post-operatively. 

• Eliminate bottled water provision post-operatively. 

Intervention:  

Mask visors were replaced with standard masks, with associated staff education and a pilot was instigated to reduce sterile pack size.  Reviews have commenced to identify the equipment required in surgical sets and sterile services engaged with regarding this project’s feasibility.  Hand sanitiser has replaced traditionally scrubbing in all but the first scrub. 

Bottled water routinely offered to patients post-operatively has been replaced with drinking water and existing reusable water jugs.  Reusable cup options are being explored to replace single use ones.  Routine post-operative prescribing of paracetamol and ibuprofen was stopped, and patients are advised pre-operatively to obtain over-the-counter analgesia. Charitable funds have been identified to procure reusable hats and staff engagement is currently ongoing to ensure compliance of washing procedures.   

Outcomes: 

Clinical Outcomes 

• No negative impact on patient care, with no complications or adverse events. 

Environmental Outcomes  

• Annual emissions savings for swapping to reusable gowns and removing visors is 6,104 kgCO2e and 2,530 kgCO2e respectively. 

• Hand disinfectant to replace traditional scrubbing for 8,640 scrubs per year will save 2,177 kgCO2e per year in hot water consumption. 

• Streamlining sterile packs is estimated to save 9,716 kgCO2e annually. 

• Removing post-operative paracetamol and ibuprofen and bottled water is estimated to save 304 kgCO2e annually. 

• Savings from re-usable hats and surgical sets cannot be quantified yet. 

• A total annual saving is estimated at 20,831 kgCO2e, the equivalent of driving 61,286 miles in an average car. 

Financial Outcomes 

• Visor Masks: Annual cost saving predicted at £630.96. 

• Sterile Pack and gowns: Saving £8.43/pack, equating to £28,325 annually 

• Scrubbing: Reducing water usage will save £672.19 annually. 

• Surgical Sets and re-usable hats: Financial impact not yet available. 

• Post-op bottled water will save £2,160 annually and simple analgesia £914.36. 

• Overall, the projected financial saving is £32,702 annually. 

• This figure does not account for efficiency savings from reduced staff time required and improved workflow. E.g. using hand disinfectant instead of a full scrub save could save 648 hours per year. 

Social Outcomes 

• There have been no disruptions to patient experience. 

• Improved morale from greater understanding of environmental responsibility. 

• Potential time and efficiency savings with reduced hand scrubbing (unverified). 

Key learning point  

• This project demonstrates that significant cost and environmental benefits can be achieved without compromising safety or standards of care.  

• Key factors contributing to success included whole-team engagement, structured education, and clear communication. 

• Surgical sets and hats present ongoing challenges.  Hats require funding to be secured and surgical set redesign requires further work with sterile services and surgeons.