Reducing operating theatre bluey use.

Abstract

Disposable absorbent pads (“blueys”) are water, chemical and energy intensive to produce, and take more than 100 years to break down in landfill. They are cheap, readily available, and widely used in healthcare, particularly in operating theatres. However, it would often be appropriate to use a reusable alternative or repurpose another item (e.g. packaging) instead. This study aimed to measure the effect of a range of targeted interventions to reduce bluey use. Methods: Interventions to reduce bluey use in operating theatres were implemented at three hospital sites within Western Health, Melbourne in 2021 and 2022. In 2021, the sites took part in the TRA2SH “Operation Clean-Up” initiative,1 which included informational posters placed around the operating theatres and an educational presentation to theatre nursing staff. In 2022, the posters remained in place and anaesthetic trainees were encouraged to discuss bluey use with their team each day. The issue was discussed with the technician and nursing leadership at each site, blueys were removed from recovery bedspaces, and daily opportunistic discussions were held with staff. Reusable huck towels were stocked as an alternative in anaesthetic rooms, technician storerooms, and recovery bedspaces. Procurement data for blueys using the operating theatre cost centres were sought for the calendar years 2019, 2020, 2021, and 2022. The number of surgical encounters were obtained, and average blueys per case calculated. Ethics approval was not required. Results: Total operating theatre bluey procurement for all three sites was 70,350 in 2020, 67,350 in 2020, 64,150 in 2021, and 45,050 in 2022. Theatre encounters numbered 15,151 in 2019, 12,868 in 2020, 19,206 in 2021, and 19,052 in 2022. This corresponded to blueys per theatre encounter of 4.6 in 2019, 5.2 in 2020, 3.3 in 2021, and 2.4 in 2022. Discussion: Over the two years in which the interventions were implemented, total bluey procurement reduced by 35% from pre-intervention levels, and blueys per theatre encounter by 45%. There was a small reduction in bluey procurement prior to the interventions, however, this primarily reflected reduced theatre activity related to COVID-19, as there was a higher bluey per encounter figure. This study demonstrates that a substantial reduction in bluey use can be achieved with an awareness and educational campaign, including active engagement of doctors, nurses and technicians, together with replacing blueys at the point of care with suitable alternatives. Ongoing daily conversations with a range of staff were required to achieve observable changes in behaviour, with support from senior leadership of each group at each site appearing to increase the effectiveness of the intervention. A reusable alternative to blueys could avoid their use and waste altogether, however, a true like-for-like alternative does not currently exist. Western Health has engaged their linen supplier to develop one, though this is an ongoing process.