Sustainable Switches: A Move To Recyclable Cloth Scrub Hats In The Ophthalmology Department

Minimising single-use products in the operating theatre represents an important target to achieve a net-zero carbon healthcare. Single-use PPE is responsible for a significant portion of the surgical carbon foot-print and there has been a move towards using recyclable textiles including hats, drapes and gowns. In the U.K, most surgical units use non-recyclable, disposable bouffant or tie back theatre hats. Literature has demonstrated there is no increased incidence of surgical site infections when comparing reusable and single-use hats. In fact, one study suggested cloth hats are superior to disposable hats in reducing microbial shedding.

Our aim was to implement a switch from disposable surgical hats to reusable cloth theatre hats in our Ophthalmology theatres. We trialled this initiative in one of our three surgical, Ophthalmology hubs which consisted of two day theatres, 13 scrub nurses and 22 doctors. 

In order to implement this change, we identified key stakeholders, and created a cost-benefit plan, to demonstrate the savings with switching to reusable hats. We also liaised with local infection control teams to reduce barriers to implementation. We offered individual trial fittings of both tie-back and bouffant-style hats, to ensure comfort and compliance amongst staff. We created a survey which we are in the process of sending to AECOS members to gather data on the type of hats used, including reusable versus single use, and to identify any potential barriers to implementing this initiate nationwide and potentially globally.

On average, there are 8 members of staff across our two theatres each day. At a minimum, each staff member changes their disposable hat at least twice a day. Comparing this to the cost of each staff member having four reusable hats, there would be a saving of £1,632.47 across a 3 year period. This change would equate to a 77.66% saving in carbon dioxide production, and a reduction of 1,093.71Kg of carbon dioxide emissions across the same 3 year period.

Ophthalmologists, alongside other surgical staff, have a responsibility to advocate and support more sustainable practice in theatres. The Royal College of Surgeons Green Report also advocates for moving towards reusable textiles, including hats. Our future work would involve plans to move towards adopting other reusable textiles including drapes and gowns too. Given the overall positive impact on reducing greenhouse gas emissions, reducing carbon footprint and reducing costs, we recommend this simple yet effective initiative be implemented on a national scale in Ophthalmology theatres.