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Cost-saving sustainability in sterile services at Princess Alexandra Hospital

Delegates at the IDSc Conference appreciated learning how ‘one of their own’ had argued the case for sustainability and shown how this reduced costs.

Anthony Heard, sterile services manager, Princess Alexandra Hospital NHS Trust, Harlow, explained that with the need to combat rising costs he considered going back to reusable as at his previous hospital, and presented a case study on the decision, cost implications and benefits.

The sterile services department was already under pressure to reduce costs, when the supplier of single-use plastics advised impending price increases. Anthony explained: “I considered moving to an alternative supplier, which might save a few hundred pounds, or whether I could turn to reusables, as I had done 15-years previously when at Plymouth.

At Princess Alexandra Hospital, the department’s plastic usage comprised: 27,000 receivers, 36,000 galipots and 6,000 compartmented trays. Almost 65,000 single pieces of plastic – equivalent to 3,300kg of plastic, which was incinerated after use.

When told that the departments change to single-use items had been due to washer capacity. Anthony, who does not take what people say at face value, decided to investigate. “I worked out that roughly three extra wash loads a day would be needed – one extra load per machine,” explained Anthony. “While the department is open for 16 hours per day, the machines do ten cycles a day, and each cycle takes 45-minutes. Rounding that up to one hour to allow for unloading, there are potentially six hours a day when the department is open, and the machines are not being used. So, the capacity was available.”

Told that plastic was also cheaper, Anthony next investigated the annual cost of single-use: products approximately £10,000; disposable incineration of 3,300kg of plastic £2,100; 500kg disposable cardboard £60. A total of £12,160 a year.

Both plastic and metal were considered as reusable alternatives. The concern, whether justified or not, was that metal would be heavier and would increase the weight of the trays, plus feedback from theatres was that plastic is quieter to use. There were also concerns that the metal would reflect under the theatre lights. From Anthony’s point of view, plastic was also more cost-effective.

Moving to reusable would require: 750 extra wash loads per year; 105 litres of detergent; 10,800 litres of water. A total ongoing cost of £1,800.

While the change to reusable would incur various one-off costs: £4,000 for racks and around £1,800 for the various reusable plastic items. A total one-off cost of approximately £6,000.

“I presented the idea to my divisional management team,” said Anthony. “Who said it could form part of our Net Zero plan. That’s when I discovered that the NHS has a plan to be net zero by 2045.

“We did have some issues, such as the labour ward returning full kidney dishes, storage in the washroom and issues in the autoclave. We used Datix*, put the products on the racks as we went along, and slightly changed the way we pack the trays.”

The results are impressive: 4,000kg less waste per year; 65,000 single-use items no longer being used or going for incineration; and an impressive £10,000 per year annual saving.

In appreciation for his work, Anthony was shortlisted for the trust’s Amazing People Award in 2022. This led to Anthony’s wry, closing comment: “Strangely enough, I was nominated for an award for going back to doing something I was doing 15 years ago.”

https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2021/06/B0507-how-to-produce-a-green-plan-three-year-strategy-towards-net-zero-june-2021.pdf

In this joint presentation, Janine Farmer, commercial manager Warwick SASCo, supplier of Anthony’s reusable plastic products said: “There is a need to dispel the myths about the use of plastics in hospitals. Plastic is often cited as the number one polluter.” Yet, as Janine pointed out, this is largely down to people’s lack of care for the environment.

A bi-product derived from processing oil and gas, coal, minerals and even plants, plastic was discovered in 1838, when French chemist Paven used simple plant matter to create a synthetic material – cellulose. Within years it was being used to stop the demise of the natural world and was celebrated at the time as an alternative to ivory, coral and tortoiseshell. Plastic is now helping to reduce deforestation.

“Plastic is a natural product which offers durability and reliability,” explained Janine. “Plastic products are easy to clean, reduces cost and processing time.

“Yes, we all need to make changes, but we must accept limits of what we can do in our workplace at present. Plastic in hospital use is a complex issue but fundamentally, plastic does help save lives. From a syringe to a ventilator – the parts are made of plastic. Plastic has a place in healthcare and is better for the environment than alternative materials.”

The environmental cost of using alternative material is approximately four times that of plastic. At some point, all products need to be updated or replaced, leading to disposal. The disposal of 1kg of plastic can replace three or more kilograms of other materials. New technology can also allow for efficient incineration of plastic waste to power heating plants, whilst dramatically reducing carbon emissions.

There is an industry alliance to end plastic waste, with product circularity at the forefront. Today, 70 per cent of used plastic is recoverable and plastic has advanced SSD processes. Health sectors globally are determined to reduce reliance on disposable plastics and are looking at ways to recover all used products.

Are alternative materials any better or even suitable for surgery and decontamination reprocessing? “It’s not that simple,” explained Janine. “The first thing I said to Anthony when he called me was: ‘Only consider reusable items where it’s appropriate and achievable.’

“Anthony and Princess Alexandra Hospital are pioneers, including their sterile services initiative in reducing plastic disposables. At Warwick SASCo is in discussion with other trusts who are following in their footsteps. Theatres and sterile services are prime areas for review.”

Janine said: “If you haven’t already been asked to look at your department’s use of plastic and disposable, you soon will be. We think co-operation will emerge between manufacturers, hospitals and recyclers on materials management and future sustainability.

“But we also feel it’s a tremendous burden for you to make individual assessments, product choices and costing reviews as part of the trust’s sustainability plan and commitment to Carbon Zero. We think as a minimum a framework needs drawing up for common use. Maybe there is the need for a national audit, for common use by sterile services and theatres, that is unbiased by commercial suppliers.”

Janine added: “We think the IDSc is the perfect collective to work with the NHS, NHSSC and individual trusts to effect a common pathway. At Warwick SASCo we believe that plastic is the answer to the environmental issues, rather than the cause. Over the last two years we have prepared an analysis of plastic used in healthcare, particularly for decontamination.” More at www.sasco.co.uk

*Datix is a risk management information system to collect and manage data on adverse events, as well as data on complaints, claims and risk. The purpose of collecting such data is to identify learning and implement improvement

The cost-saving reusable plastic products from Warwick SASco now used by the sterile service department at Princess Alexandra Hospital:

warwick-kd250-product-profile

LB150 – Sep 2021 APPROVED

warwick-lct2215-product-profile

See the NHS Green Plans here:

https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2021/06/B0507-how-to-produce-a-green-plan-three-year-strategy-towards-net-zero-june-2021.pdf