Stephanie Rees and Kenneth Igwe
Betsi Cadwaladr University Health Board
The environmental impact of surgery and theatre wastewater management is significant, with untoward effects on the environment. Traditional hand scrubs are chlorhexidine-based, which persists through water treatment. It is toxic to aquatic life, particularly primary producers, and is harsh on human skin. This scrubbing method uses a significant amount of clean water, which, when extrapolated across all sterile procedures within our hospital, is upwards of 1 million litres per year. Our project seeks to change the scrubbing practices for sterile procedures in Ysbyty Glan Clwyd, changing chlorhexidine-based hand washing to Alcohol-based Hand Rubs (ABHRs) over the next 12 months.
Hand rubbing with ABHRs has been shown to outperform traditional hand scrubbing, and The World Health Organisation, the Royal College of Physicians of London, and the Royal College of Surgeons of England recommend ABHRs for surgical hand asepsis. There is evidence of prolonged antimicrobial action within sterile gloves for up to six hours after use, compared to the chlorhexidine-based scrubs, where microbial numbers steadily increase. There is also an ergonomic aspect, as traditional scrubbing facilities in certain areas of the hospital, e.g., the Intensive Care and the Emergency Department, are less than ideal. ABHRs will improve adherence to asepsis in these areas, thereby reducing the chances of post-procedural infections.
Our project aims to improve the sustainability of healthcare provision in North Wales. It represents a potential cost savings, a significant reduction in the hospital’s ecological footprint, and an improvement in the quality of the care we deliver to patients. This change will involve evaluating the effectiveness and feasibility of using ABHRs for sterile hand asepsis, staff training, and performance monitoring to ensure compliance with the relevant protocols.
