BACKGROUND
Tonsillectomies account for 17% of the UK’s elective workload, costing the NHS £68 million and generating 41kg CO2e per operation, equivalent to the monthly electricity consumption for a three-bedroom house.1,2 At Cambridge University Hospitals, usage of sterile personal protective equipment (PPE) in selected ENT operations cost £6,176 annually. The rationale for gowning requires interrogation. Sterile consumables significantly drive this financial and environmental burden. The surgery is clean-contaminated with no part of the surgeon touching the operation site. The surgical site is rapidly contaminated by the patient’s oro-pharyngeal flora during and immediately after surgery, hence theoretical risk of surgeon to patient contamination is very low. What is less clear is the degree of contamination risk from patient to surgeon. There variability with gowning in tonsillectomy with 25% of surveyed surgeons not using sterile gowns for tonsillectomy.3
METHODOLOGY
This prospective, observational study aims to quantify the extent and distribution of bodily fluid splashback during elective adenotonsillectomies. The £1,500 grant will fund essential resources – primarily water-sensitive paper sheets (as used in agriculture) to assess volume and degree of splashback during the operation, which will be analysed using image processing software to quantify and map fluid distribution.
ANTICIPATED IMPACT
The findings will provide objective data to understand risk exposure and provide an evidence base to optimise surgical drape and gown use from both a safety and sustainability perspective. If, as anticipated, splashback is negligible, our findings will support surgeons to safely minimise PPE waste, reduce financial costs and carbon emissions across the NHS.
References
1. Cannon, Joseph et al. “Carbon footprint of tonsillectomy.” The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland vol. 22,4 (2024): 242-247. doi:10.1016/j.surge.2024.06.001
2. Rizan, Chantelle et al. “The carbon footprint of products used in five common surgical operations: identifying contributing products and processes.” Journal of the Royal Society of Medicine vol. 116,6 (2023): 199-213. doi:10.1177/01410768231166135
3. Thakrar, Jai et al. “UK national survey on surgical gowning for tonsillectomy.” The Journal of laryngology and otology vol. 138,8 (2024): 845-848. doi:10.1017/S0022215124000331