Reusable sterile operating theatre light handles

During surgery, theatre lights are used to assist surgical staff, allowing for greater visibility. The lights have fixed handles with coverings, so that staff can easily adjust them. At John Hunter Hospital (JHH) and Belmont District Hospital (BDH) in Hunter New England Local Health District (HNELHD), two disposable (single-use) sterile plastic covers are used per operation within all operating theatres.

Both hospitals use theatre lights from different companies, with each single-use item is wrapped in non-recyclable packaging. Used covers and packaging are disposed of as clinical waste, costing approximately $1.25 per kg. This project aimed to reduce the carbon footprint of surgical care by transitioning from disposable sterile operating theatre light handle covers to reusable sterile light handles. The intervention introduced reusable sterile light handles as alternatives to disposable covers, and analysed the cost and carbon footprint, particularly considering the reprocessing of reusable handles.

Sourcing reusable alternatives

At JHH, which maintains ten operating theatres, 80 reusable light handles were purchased and introduced as standard practice, with single-use covers still available as an alternative option. The mount for single-use covers was disconnected from each light, and simple, screw-on re-sterilisable aluminium handles were attached instead. At BDH, which maintains four operating theatres, eight adaptors (to fit the new handles) and 50 click-on re-sterilisable handles were purchased, and the purchasing of disposable covers was ceased altogether.

The reusable handles were reprocessed by onsite Central Sterilising Department (CSD) at both JHH and BDH. JHH autoclaves use steam generation powered by natural gas, while BDH autoclaves use electricity-powered steam generation. Purchased electric power in both hospitals is supplemented by roof-top solar panels (JHH 10%, BDH 15.5%). The project was delivered in partnership with the operating theatre equipment officers and CSD.

At JHH, the impact of introducing reusable handles was assessed by the ongoing monthly ordering of single-use covers, cost differential, amount and cost of clinical waste management, cost of reprocessing, and comparative carbon footprint. Data from the 12 months prior to project implementation was compared with the 12 months after implementation. At BDH, impact was assessed on cost differential, amount and cost of waste management, cost of reprocessing, and comparative carbon footprint.

Cost outweighs reduction in plastic waste

John Hunter Hospital

• During the first year, ordering of disposable covers decreased by 92%, reducing clinical waste by 92% (586kg to 44kg).
• The cost of handles, reprocessing and disposable covers was $52,432, compared with $70,818 for disposable covers the previous year (26% reduction).
• Cost neutrality was achieved after one month and ~$18,000 saving after one year.
• Usage of both covers and handles decreased by 26% after intervention.
• During the first 12 months, the annual carbon footprint increased from 3.24 to 3.40 tonnesCO₂e, which included full embodied carbon of the new handles.
• At current energy profile, per use carbon footprint is higher for reusable handles (0.205 kgCO2e compared with 0.146 kgCO₂e for single-use covers).
• Sterilising handles as part of a larger tray or set, instead of individually, would reduce footprint to 0.172 kgCO₂e per item.

Belmont District Hospital

• Apart from purchase cost of adaptors and click-on reusable light handles, per use cost of reusable handles is 11% higher than that of disposable covers. The latter was an inexpensive lightweight sheath while the reusable system is heavy and more complex.
• Per use carbon footprint is higher for reusable handles (247g CO₂e compared with 41 gCO₂e), due to the emissions from sterilization in the autoclaves and the energy mix (largely fossil fuels) of the grid.

While significantly reducing plastic waste, changing from disposable light handle covers to reusable handles is only cheaper when the cost of disposables is higher than the cost of reprocessing the reusable handles. The current cost re-processing reusables is too high to create cost neutrality/savings. Although the carbon footprint of using reusable handles is higher, this could be reduced by sterilising as part of an existing set or tray and converting the hospital’s power source to renewable energy.

The use of both handles and covers appears to decrease after the intervention. It’s not clear why this occurred, perhaps change of attitude and behaviour. Any planned change from disposable to reusable equipment requires careful analysis of the relative complexity of each item, ease of installation and reprocessing of reusable items and relative cradle-to-grave carbon footprints.

This project has recently been featured in the ANZ Journal of Surgery – Switching to reusable operating theatre equipment: lessons learnt from sterile light handle projects in two Australian hospitals.

For more information, access the net zero surgery resources site: www.health.nsw.gov.au/netzero/Pages/surgery-resources.aspx