Operating theatres
between 150-170kgC02e, equivalent to driving 450 miles in an average petrol car.13 Sustainable, washable products that can
be reused are essential in reducing waste, which is why many hospitals are evaluating reusable equipment and textiles. As highlighted at the start of this article, The Royal College of Surgeons has acknowledged the urgent need to address environmental concerns, and they have developed a Green Theatre Checklist to guide surgical teams in adopting sustainable practices in operating departments. Reusable theatre hats are among the key items recommended within this checklist. While some hospitals have successfully
transitioned to reusable textiles, others have faced various challenges. Changing from disposable items to reusables which require laundering involves significant logistical planning. The process of collection, washing and delivery for large staff numbers must be carefully managed, and the complexity increases if the products need to be sterilised. Cost is another major consideration. Disposable items are typically less expensive upfront compared to reusable alternatives, which require a laundry-managed service, so this involves an additional outlay. There is also a need for a culture shift to understand that, although the initial investment in reusable products like theatre hats may be higher, the long-term savings become apparent over the lifetime of the product. This type of financial planning is different from the typical short-term expenditure model that hospitals are accustomed to. Moreover, the financial barriers are compounded by logistical challenges, such as the lack of a reusable product framework in some purchasing systems like NHSSC. These barriers, along with the complexities of laundering and managing reusable equipment, must be navigated for hospitals to realise the long-term environmental and financial benefits.
Operating theatres are facing increasing pressure to move to more sustainable, reusable solutions, to reduce the impact of the NHS on the environment. Reusable hats could help to reduce the waste associated with disposables.
Infection Control All hospitals have different infection control teams who have their unique views and beliefs on taking theatre attire home to wash. Many infection prevention teams will not allow the home laundering of hats. Some IPC teams express that there is a good reason why surgical scrubs are not taken home to wash and that effective decontamination of attire in the surgical environment is essential to reduce the risk of cross-contamination. Others argue that staff are trusted to take their underwear home to wash so why not their hats? When clinicians ask how the badges from the badge hats are cleaned (once detached from the hats) my reply is always “How do you wash your current name badges?” to which the initial response is often a paused silence, combined with a confused expression, closely followed by “I have never (or rarely) cleaned my current name badge”. At first, I found this surprising. However, this appears to be a standard reply by many theatre staff. Studies suggest that lanyards are rarely if
ever, cleaned. One study found that only 16% of lanyards had ever been washed. Those cleaned recently had lower bacterial counts.14
In another
study conducted on lanyards, the mean age of lanyards was 22 months and 91% had never been laundered. Nine staff (8.8%) had laundered their lanyard, ranging from one week to one year previously.15
In a microbial study, which Eco
Ninjas conducted with Birmingham University, it was found that a non-worn, ‘clean’ disposable theatre cap had more microbes on it than used fabric hats after being worn for a full shift. It was hypothesised that this may be due to
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cross-contamination of dipping fingers inside the box of single-use caps. Hand washing before retrieving a disposable cap from a box is not mandatory. In contrast, the badges from the badge hats can be washed with any hard surface wipe, or with soap and water and the hats can be laundered like scrubs. Infection control measures would be improved if staff were compliant with this recommendation. Because press studs are simple and have no intricate parts that can trap dirt or bacteria, they are generally considered hygienic. In contrast to buttons, press studs are less likely to harbour pathogens when used in environments where cleanliness is paramount. Press studs are simple to fasten and unfasten, making them a practical option for busy healthcare environments where staff may need to quickly attach their badges and remove them after a busy shift.
Efficacy and testing We anticipated questions concerning the potential of the badges falling off into the sterile field, so we performed a peel test conducted by an independent test centre in Cambridge. A team of expert engineers measured the force in Newtons to remove several badges from the hats. The forces on the first removal were not significantly different to the 400th removal and none of the press studs failed during the tests. This fixation method provided a secure, reliable closure without the need for complicated mechanisms. A degradation test was also conducted on the badges by experts, in which they were submerged in various cleaning chemicals for 25 hours. The results showed that the badges maintained their quality, with no
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