Journal of Sustainable Dermatology in Practice

Editorial

Simon Tso — 2024-02-27

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A Multi-Centre Interview-Based Study to Explore Environmentally Sustainable Skin Surgery Practices in the UK

Andrew Zhao — 2024-02-27

Skin surgery is a significant contributor to carbon emissions in dermatology. In this interview-based study, we explored clinicians’ experience of environmentally sustainable skin surgery practices. Seven of 12 invited site leads in the UK took part in semi-structured 1:1 online synchronous or online asynchronous interviews. Field notes from online synchronous interviews and texts from online asynchronous interviews were analysed using descriptive thematic analysis. Three broad themes emerged from the data: (1) preparedness for environmentally sustainable skin surgery, (2) barriers and (3) facilitators to engage with environmentally sustainable skin surgery. Our study findings have provided contexts and potential explanations for our related study’s findings on why some sites lacked access to reusable skin surgery instruments and recycling bins. Developing sustainability leadership and culture will promote engagement with sustainable skin surgery practices.

Environmental Sustainability in Curette and Cautery Skin Surgery: A Quality Improvement Project on Single-Centre Transformation to Sustainable Practices

Simon Tso — 2024-02-27

In this sustainability quality improvement project, we proposed a new lean pathway for performing curette and cautery minor skin surgery and evaluated our project’s social, patient, economic, environmental and population outcomes. If the new lean pathway is embedded into routine clinical practice, this could potentially lead to £4.08 (excluding VAT) and 1.24 kgCO2e per procedure of costs and carbon emissions savings, respectively. Surgical site infection rates for procedures performed with sterile gloves (n = 12) and non-sterile nitrile gloves (n = 8) were both at 0%. Our small single-centre study demonstrated that transforming to sustainable practices for curette and cautery procedures can lead to significant triple-bottom-line benefits with no obvious adverse postoperative infection risks. We encourage dermatology staff from the public and private sectors, as well as staff from other specialties, to consider adopting the recommendations from the British Society of Dermatological Surgery sustainability guidance when performing curette and cautery procedures.

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

Mi Joo Choi — 2024-02-27

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.

Delivering a Sustainable Dermatology Service

Simon Tso — 2024-02-27

Healthcare accounts for approximately 4.4% of global net carbon dioxide emissions in the world. In this paper, we discussed the NHS carbon footprint and the practical strategies to deliver a greener dermatology service at the individual, practitioner, service and corporate levels.

Sustainability of Pharmaceutical and Cosmeceutical Products within Dermatology

Vidya Madhwapathi — 2024-02-27

The extent of packaging materials used in topical dermatological products and the sustainability of these are not well known. It is a known fact, however, that individual dermatology departments prescribe or recommend these dermatological products to patients. This study aims to evaluate current practice in terms of how many dermatological products distributed to patients are recyclable, by assessing whether the topical treatments available within a dermatology department display a Mobius loop or equivalent – thus indicating that a product and its packaging may be recycled. Our results show that a low proportion of the assessed items displays any indication of their recycling potential, therefore adding to unnecessary waste. Raising awareness, promoting sustainability from grassroots levels within dermatology departments and empowering patients to adopt recycling practices enable dermatology as a specialty to encourage pharmaceutical and cosmeceutical companies supplying these products to support ethical recycling values in all medical fields.

Skin-Deep Sustainability: It is Time for Dermatology Education to Focus on the Environment

Rachel Blyth — 2024-02-27