Tray Rationalization in Pediatric Day Surgery: A Sustainable Quality Improvement Project

Climate change poses a major threat to human health. The decontamination of used surgical equipment has been identified as a "carbon hotspot" in theaters. Surgical tray rationalization, which removes enough instruments to shrink the tray size, has a significant impact on carbon footprint, providing that there is not an increase in individually wrapped instruments used.

Using the sustainability in quality improvement framework, we rationalized the surgical tray used for pediatric open herniotomies at the Oxford University Hospitals John Radcliffe site. Data on instrument utilization and individually wrapped instruments were prospectively collected. Our tray redesign had no threshold utilization rate for instrument exclusion and focused on removing enough instruments to reduce the tray size. To calculate impact, we used established data on carbon emissions and financial cost and surveyed staff attitudes toward the redesigned tray.

The tray at baseline included 55 instruments. The tray size was reduced by 50% with the removal of 22 instruments. Following our intervention, the median instrument utilization rate increased from 27% to 74% with no significant increase in individually wrapped instruments. The redesigned tray reduced carbon emissions from 4243 gCO₂e to 2559 gCO₂e and reduced financial cost from £48.66 to £29.63 per tray per decontamination cycle, approximating to 383,952 gCO₂e and £4338.84 saved annually. All surveyed staff members (n = 25) agreed that the redesigned tray was easy to prepare and felt positive about the effort to reduce environmental impact.

This quality improvement project shows the impact possible by using an established simple and effective framework that can be replicated by healthcare professionals without a background in planetary health to ensure future surgical tray rationalization efforts that maximize environmental impact.