Environmentally Sustainable Skin Surgery: Staff Perception, Attitude and Practices at a Dermatology Department in the United Kingdom

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Mi Joo Choi


Introduction: The National Health Service (NHS) has set the goal of reaching net zero emissions by 2040. Within dermatology, minor skin surgery is particularly energy- and resource-intensive. As we approach the 1-year mark since the publication of the British Society for Dermatological Surgery (BSDS) sustainability guidance 2022, there is a need to assess dermatology staff’s awareness, attitudes and practice towards environmentally sustainable minor skin surgery.
Methods: A single-centre service evaluation study was conducted at South Warwickshire University NHS Foundation Trust (SWFT). A 12-question structured questionnaire was distributed to all medical and nursing staff that undertake skin surgery (n  =   14 medical and n  = 5 nursing staff) between 10 and 21 July 2023, with a response rate of 11 out of 19 (58%). The skin surgery waste disposal practices were evaluated between 14 June and 11 July 2023 where the weights of waste generated from seven skin surgery lists (each lasting 4 h) involving a total of 29 procedures were evaluated using a digital scale accurate to the nearest 100 g.
Results: Out of 11 respondents, 9 (82%) stated that they were aware of the BSDS sustainability guidance 2022, but only 4 (36%) respondents had read the guidance. Seven (64%) stated that they used absorbable and non-absorbable sutures for surface wound closure, whereas 4 (36%) respondents stated that they exclusively used non-absorbable sutures for surface wound closure. Eight (73%) stated that they exclusively used sterile gloves for skin surgery, and 3 (27%) stated using a mixture of sterile and non-sterile nitrile gloves depending on the situation. In the free text responses, 8 (73%) respondents stated they exclusively used sterile gloves for all skin surgery procedures, and 3 (27%) stated using both sterile and non-sterile nitrile gloves depending on the situation. Waste generated per procedure averaged 0.54 kg (0.05 kg sharps waste, 0.36 kg clinical waste, and 0.13 kg recycling waste). The recycling rate averaged 24.0%.
Conclusions: Our study identified a high level of awareness of the BSDS sustainability guidance, but few had actually read the guidance itself. Staff is engaging with recycling of waste from minor skin surgery. Staff education on National Institute for Health and Care Excellence (NICE) guidance on hand disinfection in minor procedures and the BSDS sustainability guidance could further promote staff transition into more environmentally sustainable minor skin surgery practices.

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