Sustainability


contingency workarounds all creating additional operational pressure. Resilience therefore deserves greater weighting in procurement evaluation than it has perhaps historically received. Continuity planning has become an increasingly important component of healthcare operations, and textile systems should be considered through this same lens. A resilient system is not necessarily the cheapest at point of purchase. However, resilience can have significant operational downstream value that should not be underestimated.


Operational integration and systems-based thinking One of the key challenges in effectively evaluating surgical textile strategies is that decision-making often occurs within organisational silos. Procurement teams understandably focus on purchase budgets, sustainability leads prioritise carbon reduction and waste, infection control teams are concerned primarily with clinical assurance, and operational leaders are often concerned with continuity, practicality and staff experience. Each of these perspectives is legitimate, but


problems can arise when decisions are viewed through only one lens. Surgical textiles are not simply a procurement category, they are part of an interconnected operational system. This is increasingly recognised within healthcare management, with complex service delivery rarely hinging on isolated product decisions. Instead, outcomes are shaped by how products, processes, people and infrastructure interact. A narrow unit-price procurement decision


can therefore have implications far beyond the purchase ledger. For example: a product with low purchase cost but high disposal burden may increase operational cost; a model requiring substantial on-site stockholding can create space and storage pressures; a poorly integrated supply system potentially increases the risk of emergency ordering or contingency reliance; inadequate governance can lead to assurance and compliance gaps; and inefficient systems may undermine sustainability targets. In contrast, well-designed systems can


generate cumulative benefits across multiple domains, which is why ‘systems-based thinking’ is increasingly relevant in healthcare operations. A systems-based approach encourages organisations to move beyond isolated metrics and consider how decisions affect the wider ecosystem, and surgical textiles are a useful example of why this matters. Increasingly, NHS organisations are being


asked to demonstrate progress across multiple strategic priorities simultaneously, including


44 www.clinicalservicesjournal.com I July 2026


financial efficiency, environmental sustainability, quality improvement and operational resilience. Decisions that support one objective, while undermining another, are unlikely to deliver long-term value. This is why a systems-based approach is becoming essential, enabling Trusts to consider how procurement choices contribute to wider organisational goals rather than assessing products in isolation.


From products to infrastructure As highlighted, the conversation around surgical textiles is changing, and rightly so. For many years, these products have been viewed largely as transactional consumables – necessary operational items selected primarily through procurement metrics. However, that perspective no longer captures the full picture. Surgical textiles intersect directly with infection prevention, governance, waste generation, carbon impact, continuity planning and cost management, and few product categories touch so many strategic priorities simultaneously. Different operational contexts will have


different requirements, constraints and priorities, so this does not mean there is a universal solution suitable for every organisation or theatre environment. However, it does strongly suggest that surgical textiles warrant broader strategic consideration than they have traditionally received. Rather than framing reusable and disposable


items as a simplistic product comparison, healthcare organisations may benefit from asking wider questions. For example: l How is total system value being assessed? l How are lifecycle performance and assurance validated?


l What resilience risks are embedded with the chosen supply model?


l How do surgical textile decisions align with sustainability commitments and Net Zero ambitions?


l Are these decisions being evaluated within an appropriately integrated governance framework?


With the NHS operating under sustained financial pressure, increasing environmental expectations and continued operational complexity, these are all important considerations. Surgical textiles may not command strategic attention by default, but as Trusts continue to balance cost control, sustainability commitments and patient safety, they offer a tangible opportunity for integrated, system-level improvement. If that is the case, are they being discussed at an appropriate strategic level?


About the author


Roberta Charlett is Head of Marketing at Elis UK. She joined the company – then called Guardian Surgical – in 2014, and the business was subsequently acquired by Elis in 2017. A leading international multi-service provider, Elis offers textile, hygiene and facilities management solutions throughout Europe and Latin America. With over 400,000 customers worldwide, it has a presence in 30 countries, employing 55,000 professionals at over 440 production plants and service centres.


CSJ


References 1. NHS England. Delivering a ‘Net Zero’ National Health Service. October 2020.


2. MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres. Canadian Journal of Surgery. 2017;60(2):80-85.


3. Vozzola E, Overcash M, Griffing E. Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives. American Journal of Infection Control. 2018;46(8):881-886.


4. Blazejewski, T, Rothman, R. Life Cycle Assessment of Elis’ Reusable Hospital Gowns – Executive Summary. 2022.


5. Department for Environment, Food & Rural Affairs (DEFRA). Guidance on applying the Waste Hierarchy. 2011.


6. NHS England. Clinical Waste Strategy. 2023. 7. Kagoma YK, Stall N, Rubinstein E, Naudie D. People, planet and profits: the case for greening operating rooms. Canadian Medical Association Journal. 2012;184(17):1905-1911.


8. Rutala WA, Weber DJ. Disinfection, sterilisation and control of hospital waste. 2014.


9. British Standards Institution. BS EN 13795- 1: 2025. Surgical clothing and drapes – Requirements and test methods. BSI, 2025.


10. National Audit Office. Investigation into Government Procurement During the COVID-19 Pandemic. London: NAO; 2020.


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