Abstract: Surgical hand scrub is essential in preventing surgical site infections The traditional water-based scrubbing method is costly both financially and environmentally. A six-minute scrub can consume up to 45 liters of water per person, per case. In a tertiary hospital, this translates to thousands of liters daily. Alcohol-based hand rub (ABHR) offers a safe, cost-effective, and sustainable alternative. Despite alcohol agents costing less per use ($0.36 vs $0.50–$0.71) and saving nearly 900,000L of water annually, barriers persist. We surveyed 64 operating theatre staff on their scrubbing preferences and perceptions at the Royal Melbourne Hospital. Most understand that ABHR is guideline-approved, yet traditional methods remain preferred. Key concerns included skin irritation, dispenser availability, and unfamiliarity with the technique. 36% of staff underestimated water usage from traditional methods. Multiple randomised trials and meta-analyses have shown no difference in surgical site infection rates when alcohol rub is used after an initial scrub or simple hand wash. ABHR reduces water consumption and may offer an environmental advantage over traditional surgical scrub by reducing chemical discharge into wastewater, and it is better tolerated by users. In conclusion, wider adoption of ABHR represents a pragmatic shift towards environmentally sustainable surgical practice. A culture shift supported by education and infrastructure addressing practical concerns is key to bridging the gap between awareness and practice. Reference: 1. Kara A, Yasar C, Birinci M, Gulenc B, Sener B. Don't let our operating theatre to be desert. Acta Chir Orthop Traumatol Cech. 2021 Jan 1;88(3):229-32. 2. South Australia Infection Control Service. Hand Hygiene Clinical Guideline [Internet]. 2020 May 5; Version 1. Clinical Guideline Number: CG165. Canberra: AIHW. 3. Widmer AF. Surgical hand hygiene: scrub or rub?. Journal of Hospital Infection. 2013 Feb 1;83:S35-9.

Purpose: Operating room (OR) shoe covers are widely used as part of surgical attire, despite uncertain evidence of benefit in preventing surgical site infections (SSIs). This scoping review aimed to evaluate whether OR shoe covers reduce environmental contamination or SSIs and to consider their clinical and environmental implications. Methodology: MEDLINE, Embase, Emcare and Scopus were searched for primary studies evaluating OR shoe covers in relation to bacterial contamination or SSIs. Eligible studies included quantitative or qualitative primary research conducted in operating room settings. Data was narratively synthesized. Results: Six studies met inclusion criteria, all from high-income countries. Five studies assessed environmental bacterial contamination and reported conflicting findings: two demonstrated lower colony-forming units with shoe covers, two showed no difference, and one reported higher contamination associated with shoe cover use. Only one study assessed clinical outcomes, reporting a reduction in SSI rates following reduced use of disposable perioperative attire, including shoe covers. No study demonstrated a direct reduction in SSIs attributable to shoe covers alone. Conclusion: Current evidence and international guidelines does not support the routine use of OR shoe covers for the prevention of SSIs. Given the lack of demonstrated clinical benefit, conflicting contamination data and the environmental burden associated with single-use OR shoe covers, routine shoe cover use should be strongly reconsidered. Further high-quality studies are required to inform evidence-based and sustainable perioperative infection prevention practices.

Purpose: To evaluate the net-zero commitments of surgical device companies operating in Australia and their alignment with global sustainability targets. Methodology: 29 major surgical device companies operating in Australia were selected based on a large tertiary hospital’s expenditure in Victoria and an expert panel from the Royal Australasian College of Surgeons. A scorecard was developed using the PricewaterhouseCoopers Building Blocks for net zero transformation framework, the Carbon Disclosure Project grading, and the SBTi approval system. The companies’ Environmental, Social, and Governance reports were reviewed to assess their monitoring and disclosure of GHGE, their scopes 1, 2, and 3 targets, and their strategies for GHGE reduction. Results: Companies were classified into three groups: industry leaders with SBTi-approved targets across all three scopes (Abbott Laboratories, Bard Australia, Boston Scientific, Edwards Lifesciences, Johnson & Johnson, Olympus, Teleflex, Terumo, and Zimmer Biomet); companies with SBTi-approved targets missing scope 3, or with specific targets without SBTi approval (3M, B Braun, Baxter Healthcare, Cardinal Health, Livanova, Medtronic, Molnlycke Health Care, Smith & Nephew, and W L Gore & Associates); and companies without adequate targets (Applied Industrial Technologies, Bausch & Lomb, Conmed Corporation, Cook Medical, Da Vinci Intuitive Surgical, Defries industries, Integra Neurosciences, Karl Storz Endoscopy, Medline Industries, Multigate Medical Products, and Stryker). Common gaps included suboptimal scope 3 commitments, limited sustainability strategy disclosure, and most importantly, an effort to move away from a linear business model towards a circular one. Conclusion: Surgical device companies in Australia show growing commitments towards net zero, but with important gaps remaining in carbon reporting and reduction strategies that need to be addressed to move towards a circular business model.

Purpose: Waikato Hospital has been applying the Graf method in the diagnosis and management of babies with DDH since 2022. With increasing numbers of babies being referred to our clinic as have experienced decreasing capacity to perform diagnostic ultrasound scans (USS) in a timely fashion. Therefore, our aim was to determine whether the routine 2-week ultrasound following Pavlik harness application in infants with Graf IIb hips at Waikato Hospital offers a meaningful advantage in guiding clinical management or improving outcomes. Methods: A retrospective analysis was conducted of all babies diagnosed with Graf 2b hips and treated in a Pavlik Harness at Waikato Hospital since establishing the Graf method from January 2022 – September 2025. After identifying these children manually, the 2-week check USS was examined for any disadvantageous clinical change. Results: A total of 2156 ultrasound scans were done from January 2022 – September 2025. There were 48 patients in total that were diagnosed with Graf 2b hips and 45% of patients (n=28) were diagnosed with bilateral Graf 2b hips, therefore the sample size was 62 hips. 77% of the patients were female (n= 37) and 23% were male (n=11). The average age where patients were diagnosed with Graf 2b hips was at 113 days old. The mean alpha angle at diagnosis was 56.2 and beta angle of 88.1. 14% of hips (n=9) did not receive the 2-week post-Pavlik harness application ultrasound scan and at their next follow-up there was no significant change. Of the 53 hips that received the 2-week scan, none of them demonstrated that the hips were dislocated or other clinically significant change. Conclusion: The 2-week post-Pavlik harness USS can be safely omitted. A clinical check at the 2-week mark to check the fit of the Pavlik Harness and femoral nerve function should still be done along with a follow-up USS at 4-6 weeks after harness application. This has change been implemented at our DDH clinic at Waikato Hospital.

Purpose: Proctology is performed in a non-sterile field, yet sterile drapes, gowns and personal protective equipment (PPE), plus adjuncts (diathermy, smoke evacuation and suction), are commonly opened by default. We quantified the avoidable cost and environmental burden and modelled pragmatic de-implementation strategies. Methodology: A prospective utilisation audit with cost analysis and life cycle assessment (LCA) was undertaken for the estimated 6,000 annual proctology cases in New South Wales. Billing records, procurement contracts, manufacturer specifications and emissions factors were integrated to calculate per-case and annual cost, landfill mass and carbon dioxide equivalents (CO2e). Current practice was compared with (i) targeted recycling of sterile consumables and (ii) a low-waste set-up: open-on-demand adjuncts and substitution of sterile drapes/gowns/PPE with non-sterile alternatives. Results: Diathermy, smoke evacuation and suction were opened but unused in 50% of cases. Targeted recycling reduced cost by AUD 0.86 and landfill by 0.47 kg per case (AUD 17,000 and 9.3 tonnes landfill annually in Australia). The low-waste set-up reduced cost by AUD 40, landfill by 1.13 kg and emissions by 7.6 kg CO2e per case, equating to AUD 798,000, 23 tonnes landfill and 153 tonnes CO2e annually across Australia’s ~20,000 proctology cases. Extrapolated internationally, annual savings were GBP 1.0 million (UK), USD 6.6 million (USA) and EUR 12.6 million (Europe), with 1,081 tonnes landfill and 6,759 tonnes CO2e avoided. Conclusion: In high-volume proctology, default sterile draping and routine opening of adjunct devices represent measurable low-value care. Sterile drape use should be avoided, and open-on-demand set-ups implemented to deliver immediate and scalable reductions in cost, waste and carbon emissions.

Purpose: Routine use of disposable suction/irrigation devices (SIDs) in elective laparoscopic cholecystectomy (LC) is widespread to maintain operative field clarity. Substituting fabric swabs within Morrison’s pouch may offer a cost‑effective and sustainable alternative without adversely affecting outcomes. This study aimed to assess the feasibility of omitting routine SID use by utilising fabric swabs. Secondary objectives were to describe patient demographics, intraoperative and postoperative complications, and surgeon satisfaction with swab usage. Methodology: Twenty consecutive adult patients undergoing elective LC for biliary colic at Broadmeadows Hospital (Northern Health) were prospectively identified after applying exclusion criteria. After establishing pneumoperitoneum, a fabric swab was placed in Morrison’s pouch. Surgeons could deploy a SID at any point if clinically indicated. The primary outcome was the proportion of cases completed without SID use. Secondary data included operative duration, complications, and surgeon satisfaction with swab use measured via Likert scale. Results: A significant proportion of cases (42.1%) were completed without the need for a SID, demonstrating that SID use was not universally required. SID devices were opened in 57.9% of cases, most commonly for bile or blood spillage. Only 47.4% of SID use occurred after swab inspection, suggesting predominantly reactive rather than pre‑emptive use. Postoperative complications were infrequent and comparable across operator experience levels. High satisfaction was reported for field clarity, patient safety, and feasibility without SID, although perceived operative efficiency was moderate. Conclusion: Elective LC can be safely and effectively performed without routine SID use when fabric swabs are employed. Surgeon satisfaction remained high and complication rates were low. Selective rather than routine SID deployment may therefore be appropriate, offering potential cost and environmental benefits without compromising outcomes.