Ditch the drapes: Non-sterile substitution in proctology, a population-based cost and carbon life cycle analysis with early implementation audit.

Abstract

To quantify cost, waste, carbon emissions and early feasibility of source reduction in proctology. Population-based cost and carbon analysis of common proctology procedures in New South Wales public hospitals. Targeted recycling was compared with source reduction through drape avoidance, clean non-sterile protective equipment, and selective opening of suction and diathermy. A focused audit assessed state-level inputs against routine practice. Implementation outcomes followed adoption at one tertiary hospital. Annual procedures totalled 6753 in New South Wales. The Australian denominator was 22,084 procedures. Suction and diathermy were unused in 54% and 46% of audited procedures respectively. Targeted recycling was projected to save AUD 0.84 (GBP 0.44, EUR 0.52) and 0.47 kg waste per procedure. Source reduction was projected to save AUD 40 (GBP 21.06, EUR 24.80), 1.36 kg waste and 7.9 kg CO₂e per procedure. For conservative national modelling using 20,000 cases, projected annual savings were AUD 776,857 (GBP 408,938, EUR 481,651), 27 tonnes waste and 158 tonnes CO₂e. During early implementation, no infective complications were recorded in 100 procedures. Drape omission avoided a median 3 min of set-up time. Selective device opening introduced a 30-s delay when required. Four of five surgeons adopted the practice, and 11 of 12 nurses strongly supported the source-reduction initiative. Source reduction was feasible in early proctology implementation and projected to reduce cost, waste and carbon emissions. These proof-of-concept findings support multicentre evaluation but do not establish clinical equivalence.