Sterile Gloves Research Articles

A Five-Bundle Intervention to Improve Blood Culture Use in a Tertiary Hospital in Romania

Objectives: The aims of this study were to evaluate the efficacy of a five-bundle intervention and to decrease the number of cases in which only one set of blood cultures is collected prior to starting antimicrobials. Methods: The study group consisted of the two hospital wards that have the highest collection rate (120 blood cultures/1000 patient days and 121.4 blood cultures/1000 patient days, respectively), and the control group consisted of the other three adult wards. The collection protocol was changed, and a bundle of five measures was introduced: one-on-one discussions with the nurses, 2% chlorhexidine in 70% alcohol for disinfection, ensuring the use of sterile gloves, sterile wipes, a checklist for the materials needed, and a copy of the collection protocol. The impact of these changes was followed over a 5-month period. Results: Prior to the intervention, the contamination rate was higher in the control group (6.5%) versus the study group (4%), p = 0.00578. The before–after analysis revealed a significantly reduced contamination rate in the control group (4.6% vs. 6.5% p = 0.0099), but it was above the one obtained in the study group (3.1% vs. 4%, p = 0.1635). The number of infectious episodes in which one blood culture set was collected decreased significantly in the study group (77/311 vs. 139/456, p = 0.041). Conclusions: The intervention decreased the contamination rate and the number of infectious episodes in which one blood culture set is collected.

The Transformation of Acupuncture Practice Using Ultrasonography: Expert Opinions.

The rapidly growing use of ultrasound in South Korea has revolutionized the real-world application of acupuncture, making it a safer, more accurate treatment. However, little is known about the challenges Korean medicine doctors (KMDs) encounter, as well as the procedures and resources necessary for hygienic, safe ultrasound-guided acupuncture. This study aimed to investigate the purpose, indications, and procedure for ultrasound-guided acupuncture in Korean medicine (KM) practice and the challenges KMDs encounter in using ultrasonography. Eleven KMDs with expertise in practicing or teaching ultrasonography were consulted in detail. The purpose of ultrasonography in real-world practice, the overall process, resources utilized in ultrasound-guided procedures, and the unaddressed needs of KMDs were investigated. Ultrasound guidance, employed for various diseases in KM practice, is crucial for pharmacopuncture and acupotomy to increase accuracy and safety. Ultrasoundguided acupuncture involves covering the probe, putting on sterile gloves, and scanning with disinfectants, though the exact steps vary among experts. They also suggested that a lack of insurance coverage was a common obstacle for KMDs utilizing ultrasonography. Acupuncture with ultrasound guidance has become a prevalent procedure in South Korea. Standard procedure guidelines and insurance coverage for ultrasonography used for acupuncture procedures are essential to ensure safe, accurate procedures.

Impact of sterile gloving during proximal manipulation of central line catheter hub: the multicenter observational study CleanHandPROX

BackgroundPatients with central lines face an increased risk of developing bacteremia. Preventing late-onset catheter-related infections relies on implementing various measures during manipulations of the catheter hub of central lines (e.g., during connections, disconnections, blood withdrawals, pulsed rinses, or injections performed at the first connection after the central catheter). French guidelines include, among these measures, the requirement to put on sterile gloves immediately before proximal manipulation to help prevent contamination of the catheter hub during preparation. To our knowledge, no study has reported compliance with wearing sterile gloves during these manipulations, nor the impact of not wearing sterile gloves on the cleanliness of the fingers of healthcare workers (HCWs) just before manipulating the connectors.MethodsWe conducted a two-part study to assess compliance with sterile gloving and to provide direct microbiological evidence of bacterial contamination on HCWs’ hands immediately before the manipulation of central lines when sterile gloving is not used. First, the use of sterile gloves was observed during proximal manipulations of central lines using a standardized grid. Second, we examined the microbial flora present on the fingers of each observed HCW just before proximal manipulation.ResultsA total of 260 HCWs from 35 healthcare institutions were observed during proximal manipulation. The HCWs were distributed into three groups: 188 used sterile gloves (72%), 23 used nonsterile gloves (9%), and 49 did not wear gloves (19%). The swabbing of the fingertips revealed microbial cultures from 72 samples (28%). A total of 97 microorganisms were identified, all of which are well-recognized agents responsible for catheter-related bacteremia, predominantly coagulase-negative staphylococci (n = 36) and Bacillus sp. (n = 31). Fingertip contamination was lower for HCWs wearing sterile gloves (27/188; 14%) than for those wearing nonsterile gloves (12/23; 52%) or not wearing gloves (33/49; 67%) (p < 0.001). The contaminants were similar across the three groups.ConclusionsOur data support the positive impact of sterile gloving in ensuring clean fingertips during proximal manipulation of central lines, a key measure in preventing late-onset catheter-related bacteremia. The contamination of sterile gloves in one out of seven HCWs highlights the need for a clean care environment and minimal contact with the patient’s skin and surroundings during proximal manipulation.

Short-Cycle Autoclave Sterilization of Instruments in Same-Day Ophthalmic Surgeries

What Is the Issue? The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada. Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice. Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes. Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear. What Did We Do? To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave. For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device. One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table. We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments. What Does This Mean? Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings. Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries. In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.

Comparison of Infection Rate Between Sterile and Nonsterile Gloves During Mohs Micrographic Surgery: An Updated Systematic Review and Meta-Analysis.

Mohs micrographic surgery (MMS) is a well-established technique for the removal of various types of skin cancers. While sterile gloves (SG) are commonly used in skin surgeries such as MMS, additional understanding of their effectiveness compared to nonsterile gloves (NSG) in preventing local infection is required. We aimed to perform an updated systematic review and meta-analysis comparing the use of SG with NSG for local infection rate post-MMS and point out cost discrepancies between these 2 scenarios. We searched MEDLINE, Embase, and Cochrane for studies published up to August 2023 comparing the use of SG with NSG during MMS that reported the outcome of wound infection. A total of 4 studies with 10,644 MMS were included, of which 7512 (70.6%) were performed with SG and 3132 (29.4%) were done with NSG. In the SG group, 232 out of 7512 cases (3.1%) developed infection compared to 64 out of 3132 (2.0%) in the NSG group [odds ratio (OR) 1.14; 95% confidence interval (CI) 0.85-1.52; P = .39; I2 = 0%]. Therefore, the post-MMS infection rates were not significantly different between SG and NSG groups, including in the excision (OR 0.92; 95% CI 0.48-1.79; P = .81; I2 = 0%) and reconstruction (OR 1.17; 95% CI 0.85-1.60; P = .34; I2 = 0%) subanalysis. Regarding the mean cost of the gloves, the NSG pair was $0.24, approximately 10% of the price of the SG pair ($2.27). The results support that, compared to SG, NSG are equally effective in preventing infections during MMS while offering significant cost savings without compromising patient outcomes.Protocol registration: PROSPERO, CRD42023458525.

FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience

Abstract Aims Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus. Methods The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024). Results 54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection. Conclusions With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.

FP6.2 - A survey of the estimated cost of consumables amongst UK medical students

Abstract Aims With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Despite this, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students. Methods An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price. Results Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97). Conclusions We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school curricula, improving cost-awareness amongst students and doctors.

A Prospective Clinical Audit of Sterile Surgical Glove-Donning Practices Among Young Surgeons at a Tertiary Care Hospital in Sudan.

Background Adherence to aseptic protocols and proper sterilization is critical for optimal patient recovery post-surgery. The standard procedure for donning sterile surgical gloves helps manage infection risk and maintain surgical site cleanliness by following aseptic principles. This study evaluates adherence to these protocols among young surgeons at a tertiary care hospital in Sudan. Methods This prospective audit included 42 young residents and house officers at a tertiary care hospital in Sudan, following ethical clearance. Compliance with sterile surgical glove-donning practices was assessed using the World Health Organization (WHO) pre- and post-intervention criteria. Participants were observed in the operating room without prior notice. The intervention comprised a video presentation and a live demonstration. Results Pre-intervention adherence to standard criteria for donning sterile surgical gloves was 73.4% (n= 31). This rate increased significantly to 91.4% (n= 38) following the intervention and showed marked improvement. Conclusion The audit demonstrated a significant improvement in adherence to donning sterile surgical gloves practices after the intervention. Implementing WHO guidelines effectively enhances compliance, reduces infection risks, and increases awareness of aseptic practices.

52445 Comparison of infection rate between sterile and non-sterile gloves during Mohs Micrographic surgery: a systematic review and meta analysis

52445 Comparison of infection rate between sterile and non-sterile gloves during Mohs Micrographic surgery: a systematic review and meta analysis

Sterile gown and drape, and bouffant cap for thyroid FNA: preventing infections or producing unnecessary medical waste?

Ultrasound-guided fine needle aspiration (FNA) is a very low-risk procedure. Despite this, there remains great variability in the use of protective equipment. Given the monetary and environmental costs of protective equipment, the difference in infection rates with full versus limited protective equipment was assessed. A total of 857 consecutive patients were retrospectively reviewed after undergoing thyroid FNAs at the main hospital and outpatient clinic siteperformed from 12/1/2020 to 11/30/2023. The hospital site operated with full protective equipment (bouffant, sterile gown, sterile gloves, and full body sterile drape), and the outpatient site with limited (sterile gloves, limited sterile paper drape) protective equipment. Two patients were excluded as no procedure was performed. Review for signs of infection within 30days of procedure was performed using medical records, which was blinded to the extent of protective equipment utilization. No infections were identified in either group, with 0/629 (0%, 95%CI 0-1%) in the full protective equipment group vs. 0/226 (0%, 95%CI 0-2%) in the limited protective equipment group. There was no statistically significant difference in infection rate between full and limited protective equipment use in thyroid FNA in the included 855 procedures (95%CI 0-1%). Two patients out of 629 (0.3%) in the full protective equipment group developed mild allergic reaction to topical antiseptic. The 226 procedures with limited protective equipment represent a saving of at least 204,530g of CO2 equivalents, equivalent to driving a car for almost 3000 miles. Reducing the extent of protective equipment does not adversely affect the infection rate in thyroid FNAs. Given the inherent costs involved in the procurement and waste of protective equipment, reducing protective equipment use is warranted to reduce both the monetary and environmental impacts of waste.

Extended spectrum and metalo beta lactamase producing gram negative bacterial pathogens from cockroaches collected at hospital, Southern Ethiopia

BackgroundCockroaches can pose a significant health risk in hospital environments because they may serve as reservoirs and vectors for nosocomial pathogens. Cockroaches harbor epidemiologically significant extended spectrum and metalo beta lactamase producing Gram negative bacterial pathogens, which complicate nosocomial infections.ObjectivesThe main aim of this study is to determine aetiology and phenotypic extended spectrum and metalo beta lactamase producing Gram negative bacteria pathogens from cockroaches collected in hospitals.MethodsA cross-sectional study was employed from February to May 2022 to determine the antibiotic resistance producing bacterial isolates from cockroaches by giving special emphasis to metalo beta lactamase and extended spectrum beta lactamase production from different wards of WSUCSH. Cockroaches were collected with hands wearing sterile gloves. External homogenate was prepared and incubated microbiologically by using different culture media and differentiated biochemically. Antimicrobial susceptibility testing was performed by disk diffusion method. ESBL production was conducted using double disc synergy method and double disk method was used to detect MBL enzyme detection. Descriptive statistics was used to determine prevalence and percentage.ResultOut of 245 cockroaches, 108 Gram negative bacteria were isolated. K. pneumoniae 29(26.9%) was the most predominant bacteria and Enetrobacter spp. 8(7.4%), was the least. All, K. pneumoniae, P. mirabilis, and Enterobacter isolates were pan-resistant to Ampicillin. P.aeruginosa and P.mirabilis antibiotics showed ≥ 80% resistant for amoxicillin/clavulanic acid antibiotics. Cefotaxime, ceftazidime, ceftriaxone and imipenem showed relative efficacy compared with other antibiotics. Out of 78 amoxicillin-clavulanic acid resistant isolates, 42(34.7%) were ESBL producers. ESBL production is more depicted by P. aeruginosa, A. baumannii, K. pneumoniae and E. coli. The overall prevalence of MBL production is 29(23.1%). K. pneumoniae P. aeruginosa, E.coli, A. baumannii, Enterobacter spp and K.oxytoca revealed MBL production.ConclusionThe overall prevalence of ESBL and MBL producing nosocomial agents from hospital cockroaches was 34.7% and 23.1% respectively. P.aeruginosa, A.baumannii, K.pneumoniae and E.coli showed pronounced ESBL production. All bacterial isolates except P. mirabilis and C. freundii showed MBL production. The needed to evaluate our antibiotic stewardship program and antibiotic resistance detection for treatment is mandatory. The impact of cockroach as a source of AMR should be sought.

Post-procedural infection rate after minor surgical procedures performed with and without sterile gloves: a systematic review and meta-analysis.

Post-procedural infection has been a top priority for the perioperative team. The use of sterile gloves to counter this became popular and was routinely used, but randomized studies have shown that the benefit that was thought to be added by the use of sterile gloves is insignificant and that not all procedures require the use of sterile gloves. Prospective protocol registration was and electronic databases were searched without using any search filters. Screening was performed by independent reviewers, and data was extracted from selected studies. Heterogeneity was assessed by the I2 test, and the effect model was chosen accordingly. The odds ratio was used as an effect measure as the variables in this study were dichotomous. Forest plots and funnel plots were used to give visual feedback. This meta-analysis included 14 comparative studies that involved a total of 12625 patients. Analysis of post-procedural infection outcome showed no significant difference between the procedure performed using sterile gloves and without using sterile gloves (OR: 0.88; 95% CI: 0.71-1.10; n=12625; I2=0%; P-value=0.26). Sensitivity analysis and subgroup analysis for randomized studies only, surgical site infection, and patients that did not receive prophylactic antibiotics showed no variations. The use of sterile gloves did not show any extra benefit for controlling infection during wound repair, excision and suturing, cystoscopy, and urinary catheterization. The use of sterile gloves does not have any extra benefit for preventing infections when minor surgical procedures are performed.

156 A Survey of the Estimated Cost of Consumables Amongst UK Medical Students

Abstract Aim With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Unfortunately, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students. Method An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price. Results Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97). Conclusions We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school, improving cost-awareness amongst students and doctors.

Impact of Changing Sterile Glove at the Time of Wound Closure to Reduce Surgical Site Infection in Women Undergoing Elective Cesarean Section; a Prospective Randomized Controlled Clinical Trial

Objective: Surgical site infections (SSIs) among surgical patients are the most common nosocomial infection, accounting for 38 percent. It is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year. We aimed to assess the impact of changing sterile gloves at the time of wound closure to reduce SSI in women undergoing elective cesarean section (CS). Patients and Methods: The study was done from February 2023 to July 2023 at Ain Shams University Hospital. 220 Women were randomly distributed and blindly allocated into two groups. Group A (operative glove changing group “n=110”), Group B (usual care group “n=110”). Postoperative febrile morbidity, cellulitis, need for antibiotics for skin- or wound-related infection, and endometritis were compared between study groups. Results: Postoperative wound complications were statistically significantly higher among cases not subject to a change of sterile gloves, 28.0% vs. 9.8%. On the other hand, no differences were noted between study groups regarding operative duration 61.39 ± 7.76 vs. 59.35 ± 8.11 minutes. Conclusion: Changing sterile gloves at the time of wound closure reduces surgical site infection and associated morbidity in women undergoing elective CS.

Evaluation of sterile glove usage on digital tactile sensitivity using the Grating Orientation Task.

Surgical glove use may be associated with a decrease in tactile sensitivity, with thicker gloves or double-gloving techniques further altering sensation. This study evaluates digital tactile sensitivity by use of a Grating Orientation Task (GOT) with multiple sterile gloving techniques (no gloves, single standard gloving, double standard gloving, orthopedic gloves, and micro-thickness gloves). Each participant performed the GOT at increasing grating widths until correctly noting orientation in ≥8 of 10 trials with multiple glove types or double-gloving technique. Glove order was randomly assigned and participants were blinded to the orientation and dome size. All gloves except micro-thickness gloves showed increased threshold sensitivity values (i.e. worse fingertip sensitivity) when compared to control (micro:control, p = 0.105, others:control, p < 0.05). Single-layer gloves showed no significant difference in sensitivity when compared to orthopedic (p = 0.06) or double-layer latex gloves (p = 0.26). Standard latex gloves decreased fingertip sensitivity when evaluated with the GOT. Double-layer and orthopedic latex gloves do not decrease sensitivity when compared with single-layer gloving. Micro-thickness gloves may provide similar tactile sensitivity to no surgical glove.

Factors responsible for student nurses' use of non-sterile gloves: An exploratory qualitative study.

Disposable non-sterile gloves are part of the personal protective equipment (PPE) to be considered to protect oneself from the risk of infection. They have subsequently become the topic of concern related to increased use, inappropriate use, and potentially increasing the risk of cross-infection and environmental impact of plastic waste. This study aimed to explore the views of pre-registration student nurses about non-sterile glove use in clinical practice and to identify the factors that impact student nurses' decision on whether to wear non- sterile gloves. Using a social constructivist approach, the study was organised in a higher education institution. Semi-structured interviews were conducted with second year student nurses, utilising a theoretical domains framework (TDF). The key findings showed that students had limited awareness of the national infection prevention and control best practice procedures. The primary influential factors for non-sterile gloves use behaviour were personal protection, the type of care interventions required and the observations of peers and role models. The study found limited awareness on the importance of infection prevention and control precautions, including the correct procedure for donning, and doffing of personal protection equipment, along with a lack of confidence to challenge non-compliance.

A Comparative Study to Evaluate Safety and Performance of Sterile Surgical Gloves

A Comparative Study to Evaluate Safety and Performance of Sterile Surgical Gloves

Environmentally Sustainable Skin Surgery: Staff Perception, Attitude and Practices at a Dermatology Department in the United Kingdom

Introduction: The National Health Service (NHS) has set the goal of reaching net zero emissions by 2040. Within dermatology, minor skin surgery is particularly energy- and resource-intensive. As we approach the 1-year mark since the publication of the British Society for Dermatological Surgery (BSDS) sustainability guidance 2022, there is a need to assess dermatology staff’s awareness, attitudes and practice towards environmentally sustainable minor skin surgery. Methods: A single-centre service evaluation study was conducted at South Warwickshire University NHS Foundation Trust (SWFT). A 12-question structured questionnaire was distributed to all medical and nursing staff that undertake skin surgery (n = 14 medical and n = 5 nursing staff) between 10 and 21 July 2023, with a response rate of 11 out of 19 (58%). The skin surgery waste disposal practices were evaluated between 14 June and 11 July 2023 where the weights of waste generated from seven skin surgery lists (each lasting 4 h) involving a total of 29 procedures were evaluated using a digital scale accurate to the nearest 100 g. Results: Out of 11 respondents, 9 (82%) stated that they were aware of the BSDS sustainability guidance 2022, but only 4 (36%) respondents had read the guidance. Seven (64%) stated that they used absorbable and non-absorbable sutures for surface wound closure, whereas 4 (36%) respondents stated that they exclusively used non-absorbable sutures for surface wound closure. Eight (73%) stated that they exclusively used sterile gloves for skin surgery, and 3 (27%) stated using a mixture of sterile and non-sterile nitrile gloves depending on the situation. In the free text responses, 8 (73%) respondents stated they exclusively used sterile gloves for all skin surgery procedures, and 3 (27%) stated using both sterile and non-sterile nitrile gloves depending on the situation. Waste generated per procedure averaged 0.54 kg (0.05 kg sharps waste, 0.36 kg clinical waste, and 0.13 kg recycling waste). The recycling rate averaged 24.0%. Conclusions: Our study identified a high level of awareness of the BSDS sustainability guidance, but few had actually read the guidance itself. Staff is engaging with recycling of waste from minor skin surgery. Staff education on National Institute for Health and Care Excellence (NICE) guidance on hand disinfection in minor procedures and the BSDS sustainability guidance could further promote staff transition into more environmentally sustainable minor skin surgery practices.

Environmental Sustainability in Curette and Cautery Skin Surgery: A Quality Improvement Project on Single-Centre Transformation to Sustainable Practices

In this sustainability quality improvement project, we proposed a new lean pathway for performing curette and cautery minor skin surgery and evaluated our project’s social, patient, economic, environmental and population outcomes. If the new lean pathway is embedded into routine clinical practice, this could potentially lead to £4.08 (excluding VAT) and 1.24 kgCO2e per procedure of costs and carbon emissions savings, respectively. Surgical site infection rates for procedures performed with sterile gloves (n = 12) and non-sterile nitrile gloves (n = 8) were both at 0%. Our small single-centre study demonstrated that transforming to sustainable practices for curette and cautery procedures can lead to significant triple-bottom-line benefits with no obvious adverse postoperative infection risks. We encourage dermatology staff from the public and private sectors, as well as staff from other specialties, to consider adopting the recommendations from the British Society of Dermatological Surgery sustainability guidance when performing curette and cautery procedures.

Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation.

To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. This is a life cycle assessment (LCA) modeling study. Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. NA Laryngoscope, 134:3206-3214, 2024.