P44 Can dermatologists help save the planet?

Abstract

Abstract The National Health Service (NHS) is England’s largest contributor to public greenhouse gas emissions, accounting for 6.3% of the country’s carbon footprint (Tennison I, Roschnik S, Ashby B et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021; 5:e84–92). Promoting sustainable practices within dermatology is often overlooked and remains an understudied area of research. Dermatologists should consider environmental sustainability when choosing their day-to-day personal protective equipment (PPE). An over-reliance on sterile PPE for minor surgical practices costs millions of pounds annually, ultimately occupying landfills and causing detrimental effects to our ecosystem. Are these sterile practices really improving clinical outcomes and reducing the prevalence of surgical site infections (SSIs)? Over the last decade, there has been an emphasis on comparing the use of sterile vs. nonsterile gloves and associated SSI rates in dermatology and Mohs micrographic surgery (MMS). MMS is often conducted with two sterile gloves and two surgical gowns. According to the sustainability guidance published by the British Society for Dermatological Surgery, surgical aprons and nonsterile gloves are preferred to surgical gowns and sterile gloves in procedures such as diagnostic biopsies, simple excision, tumour extirpation stages in MMS and outpatient reconstructive surgeries (https://bsds.org.uk/wp-content/uploads/2022/09/2022-BSDS_Sustainability_Guidance.pdf). Based on this guidance and to reduce our carbon footprint, we decided to use two plastic aprons, one pair of nonsterile and one pair of sterile gloves from August 2020 to September 2022. Of 410 MMS procedures conducted, only 1.7% resulted in a minor postoperative complication related to infection. Our data suggest no significant difference in postoperative wound infections with the use of nonsterile PPE vs. sterile PPE. Moreover, the use of nonsterile PPE has saved our department £1471.90, allowing funding to be distributed to other areas. In line with the NHS multiyear plan to become the world’s first carbon net zero national health system by 2040, we should invest in processes that facilitate sustainable alternatives to construct a fully operational eco-friendly healthcare system. By using less PPE in reconstructive surgeries, we reduce plastic waste. Despite not being able to remove PPE completely, we can make dermatology more sustainable, to help save the planet we live on.