Streamlining birth and suture packs in maternity care

Project completed as part of the 2024 Hampshire Hospitals NHS Foundation Trust Green Team Competition.

Team members:

• Victoria Cusick – Clinical Midwifery Matron
• Rachel Stoodley – Midwife
• Jessica Lorrain – Labour Ward Coordinator

Setting / patent group:  

Hampshire Hospitals NHS Foundation Trust (HHFT) Maternity Care

Issue:

Maternity care currently uses a high volume of single-use instruments. Such instruments are the largest contributor to carbon emissions for the NHS, with a large carbon footprint across their lifecycle. Single-use instruments were initially preferred due to infection prevention and cost factors.

While the initial upfront cost of reusable instruments appears greater than single use, in the long-term reusable options also bring significant savings. Single-use instruments have also been reported to be inferior to reusables, with items sometimes missing or of poor quality. This provides challenges to staff experiences and can negatively impact patient outcomes, particularly where such kits are required to facilitate emergency births.

Intervention:

The team conducted a staff survey of all registrants involved in the facilitation of vaginal births and suturing, including maternity support workers and theatre nurses. The survey aimed to gather perceptions of single use tools, assess staff opinion on a switch to reusable items, and identify the single-use tools that are used the least often. The survey reported consistent issues with a number of single-use instruments, including Episiotomy scissors and Spencer Wells forceps. The Episiotomy scissors were also the least commonly used item in the kit.

Following a meeting with an external supplier, the team consulted the Theatre Sterile Supply Unit (TSSU). Meeting with the TSSU was important to confirm that they could meet the demand of sterilising instruments within a 4-hour window. Once this was confirmed, the team decided to move forward with a business case to support the purchase of new reusable item packs for suture packs, birth packs, and two individual items (Episiotomy scissors and sponge holding forceps).

Outcomes:

• Environmental
  • Reduced reliance on single-use instruments reduces emissions of 2869 kgCO2e each year, the equivalent to driving 8453 miles
• Social
  • Addresses the staff concerns around single use equipment quality
  • Meets staff preferences to use more reusable instruments, as 80% of staff are worried about the environmental impact of their work
• Clinical
  • Can improve care outcomes as staff are using better quality instruments
• Financial
  • Per year this change will save the service £27,692, which can be used to purchase further reusable equipment or hire more staff
  • A further £372 will be saved from reduced disposal costs

Key learning point:

Moving toward more sustainable equipment in maternity has significant benefits both for environmental impact and staff satisfaction. Implementing the change relied on strong staff engagement, as was ensuring that equipment can be effectively and efficiently sterilised by the TSSU.