Simple Maths, Reducing Waste, Improving Care – Surgical Skin Prep
The Problem
The use of Product B is expensive, generates a lot of plastic waste, and I did’t like it!
The Solution
An appropriate alternative proposed with multiple stakeholder engagement episode demonstrating the broad benefit
Surgical Skin Preparation
Once upon a time even washing hands before surgery was seen as an innovation in the field of asepsis. It was with Joseph Listers work that antiseptic solutions started being used to reduce infection risks and subsequent morbidity and mortality during surgery. Even during recent pandemics we’ve seen many different strategies being employed to manage and minimise the transmission of infection.
Surgical skin preparation is a often an antimicrobial solution that is utilised to create a sterile field at the surface of the skin to facilitate surgery. From the early uses of carbolic acid, through to modern day utilisation of iodine or alcohol based no surgery starts without the liberal usage of this saturated fluid to clean the the surgical field.
In this project, Product B appeared to have significant advantages in being a single use, single dose item. However, as a surgeon, I didn’t like it so I pushed for change. I found a viable alternative (Product A), demonstrated multiple advantages and followed it through the process to final sign off by the finance team.
Now it is used Trust-wide as a product of choice, but with recognition that each product has a role to play.
The Surgical Team
At first the orthopaedic team was consulted to determine their views on skin prep. When Product A was pitched as a potential replacement for Product B, there was 100% uptake.
Infection Prevention Team
Any change in product has to be assessed to ensure infection risk doesn’t increase. Product A and B were of similar chemical composition which was a recognised and approved composition (as per national guidance). With that acknowledgement the infection prevention team approved
Operating Theatre Department
The size of the product and safety data sheet was evaluated to determine if any specific storage conditions were needed. The team was reassured that this product could be safely acquired and stored with exisiting protocols.
The second concern was the operating procedure to use Product A. This was drafted and found to have no additional safety concerns for any of the team who were using it.
Green Committee
The Green Agenda Committee, recognised that the amount of waste generated by Product B was significantly greater than Product A. Considering the same chemical composition they were happy to approve the change.
Finance
The cost of Product A was found to be 45% less than Product B.
Current Position
Product A – is the prep of choice for the Trust being more economical, generating less waste and giving the surgical teams greater confidence.
This doesn’t mean that Product B doesn’t have its place but does force procurement teams making changes across organisations to consider the individual needs to specific practitioners.
Green Surgery
Going green in Surgery – Small steps