Environmental impact of single-use items and their contamination levels in elective orthopaedic surgery

Single-use items have dominated operating theatres since the 1980s, initially perceived to carry a lower risk of surgical site infection and occupational blood exposure while maintaining hospital expenditure. The topic of reusable surgical gowns and drapes has naturally emerged due to discussions regarding climate change. Considering reusable alternatives is the next step in reducing the carbon footprint of operating theatres.

Clinical waste attributable to single-use items was collected from 93 cases in an elective orthopaedic hospital over four weeks, comprising knee arthroplasty and arthroscopy, hip arthroplasty, foot and ankle and upper limb. Tourniquet use, operation time and blood loss were other parameters collected in each operation. Disposable gowns were visually examined and graded by contamination level. Clinical waste was weighed using a handheld electronic scale.

The mean waste from knee, hip and minor (upper limb, foot and ankle) operating theatres was 3533g, 3966g and 2349g respectively. The average number of gowns used per case was four, as was the number of drapes. Minor operating theatres had the lowest levels of contamination, with 84.34 % of gowns not contaminated at all. Tourniquet use was associated with less waste, carbon emissions, and gown contamination.

A large proportion of operating theatre waste is attributable to disposable items such as gowns and drapes. In the elective orthopaedic setting, these are not heavily contaminated, especially in procedures where tourniquets are utilised. Given the environmental impact of clinical waste, we advocate for the use of reusable alternatives in these procedures.