A reusable stitch in time saves nine? U.K. hospital sterilizing suture kits to reduce waste

It's almost second nature for doctors to toss aside a suture kit once they've patched up a patient. But as those instruments join a pile of medical waste in an industry already heavy with single-use items, one U.K. centre is pivoting to reusing them.

The Royal Sussex County Hospital in Brighton is one of the first emergency departments in the U.K. to pilot using reusable suture instruments to better the service's carbon footprint.

"We cannot talk about planetary health without embedding certain principles into everything that we do — and health care is no exception," said Dr. Mahmood Bhutta, the clinical green lead at University Hospitals Sussex who instigated the project.

The pilot program, which started in January, removes from rotation single-use suture kits designed for stitching wounds. These kits — comprised of scissors, needle holds and forceps — are usually put into a sharps bin immediately after use and incinerated.

The instruments in the reusable kits are instead now sterilized on site and stored in specialized boxes to protect their 15-year lifespan.

The hospital estimates that switching to reusable suture instruments will save at least 2,240 kits from incineration every year and eliminate one kilogram of carbon per use.

"We absolutely have to reuse what we can — it's part of future health care," said Bhutta.

The health-care industry has been long reliant on plastic and single-use materials, like masks, gloves, gowns, tubing, medication packaging and more. But with growing concerns over the environmental impact and climbing health-care costs, a shift to reusable instruments can address some of these pressing challenges.

According to a 2019 report by Health Care Without Harm, the sector is responsible for an estimated 4.4 per cent of global greenhouse gas emissions, with an overall climate footprint equivalent to the annual GHGs of 514 coal-fired power plants.

If the health sector were a country, the report said, it would be the fifth-largest emitter on the planet.

Net-zero pledge from the U.K. NHS

For the U.K.'s National Health Service (NHS), its providers produce approximately 156,000 tonnes of clinical waste every year that is either sent for incineration or alternative treatment — the equivalent to more than 400 jumbo jets loaded with waste.

In 2020, the NHS laid out a roadmap to become the first net-zero health service in the world by 2045.

Reusing equipment that is safe to do so, such as suture kits or some personal protective equipment (PPE), can significantly lessen the sector's overall impact on climate change, says Bhutta.

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The health-care industry in North America has a pollution problem. One study showed it generates more than eight per cent of greenhouse gas emissions in the U.S. But a few changes in the operating room could go a long way in helping the planet.

On average, switching from single-use to reusable health-care products can reduce the global warming potential by between 38 to 50 per cent, according to a 2023 study published in the European Journal of Public Health.

While the thought may make some patients uneasy, all instruments reused in the program meet stringent sterilization requirements, said Dr. Chantelle Rizan, a clinical lecturer and researcher in sustainable health care.

That means there is no increased risk of infection for patients when it comes to recycling the medical equipment.

"We wouldn't do it if it wasn't safe for our patients," she said.

There are also some instruments that hospitals will likely never be able to reuse — needles, for example.

What's the process like?

At the Royal Sussex, once a pair of surgical scissors from a kit are used, they are returned to the sterile services department within the hospital, Rizan explained. The scissors are then washed and any physical debris or contaminants removed, typically using water and detergent.

Then they are repackaged in sterile housing material — special packaging that is tightly sealed, allowing the rest of the sterilization process to safely take place.

The next step is steam sterilization, followed by final tests to ensure the assurance standards are met.

Although the process is lengthy and requires some more resources, Bhutta says reusing instruments will end up saving money in the long run.

"I think what's really going to drive it, if I'm honest, is the financial savings we're seeing," he said.

After one department of the Sussex hospital started using reusable tourniquets, the hospital has saved around 80,000 pounds — about $136,000 Cdn — every year, he said.

"So if nothing else, [with single-use instruments], we throw away money, as well as materials, as well as [create] carbon."

Another program at the Royal Surrey County Hospital in Guildford, England, has been reusing other medical equipment in their emergency department, such as gowns, drapes and scrub caps.

Siya Lodhia, a clinical research fellow, organized the nine-month program there in April to see how hospital staff would react to a push to green the department.

"The whole attitude around it is positive so far," she said. "They had questions about the safety of it; so just all the little things that they were worried about, the timing of having to do everything and the change. But I mean, people are jumping on board."

'Throwaway culture'

As the program reaches its halfway point next month, Lodhia said she will check in to see how the staff are continuing to fare with the change. She predicts that some staff might be having a hard time adjusting after having a long-established way of working.

The potential for a rocky transition from single-use to reusable equipment for staff could be a reason why hospitals might not be eager to make the switch, said Bhutta.

"We've become so used to a throwaway culture," he said. "We even found in our department, the mentality is we just throw everything away.

"That's completely normal practice, absolute madness."

Another obstacle is a lack of infrastructure to support the sterilization process, he said, as it can be considered "inconvenient" in often-busy emergency rooms.

The regulations for new, reusable instruments to be used in the health-care system can also be hard to meet, noted Bhutta.

"If they want to change even one small piece of packaging around a product to make it smaller, they have to go through an entire regulatory process," he said. "I'm afraid it just seems to be paperwork for the sake of paperwork."

A trend around the world

While industrialized countries like Canada and the U.K. are often at the forefront of reusing medical instruments in hospitals, the real front-runners are the countries that are doing so out of necessity, Bhutta said.

"We should be looking to lower-resource countries, such as India and Cambodia and parts of Africa, where they reuse all the equipment naturally. They do complex surgical operations safely, with much lower carbon and financial costs, out of necessity," he said. "But also because that's actually the right thing to do."

In one study looking at more than two million cataract operations performed in India, predominantly using reusable equipment, the rates of infectious endophthalmitis, a common infection after the procedure, were significantly lower than those reported in the U.K., where single-use products are routinely used.

While it might take some time for hospitals to adapt to reusable equipment, Bhatta says he's hopeful for change.

"I'm still optimistic. I think we need a real investment in both physical and human resources to enable these sorts of changes. But, of course, it can be done."