Gaby Judah

Objectives To identify factors influencing unnecessary non-sterile glove use in operating theatres and to estimate how common these factors are across the UK. Design Mixed-methods study using interviews and a cross-sectional survey. Setting Imperial College Healthcare Trust for interviews and nationally across the UK for the survey. Participants 19 interviewees and 329 survey respondents, all clinical staff working in UK operating theatres. Outcome measures Barriers and facilitators to unnecessary non-sterile glove use in operating theatres. Results The findings highlight a combination of key drivers leading to the unnecessary use of non-sterile gloves: (1) lack of prioritisation of sustainability, (2) fears around negative patient outcomes, (3) strong social influences such as norms to use gloves, (4) the absence of clear guidelines and limited training on glove use, (5) availability of alternatives and quality of gloves and (6) beliefs about personal safety and habitual glove use. Respondents also suggested potential intervention strategies. Conclusions 67% of participants reported using gloves unnecessarily. Our findings highlight the role of habitual behaviour, social influences and unclear guidelines in driving this practice. Interventions should address these factors, for example, by clearly communicating when gloves should and should not be worn, encouraging changes to local social norms towards waste reduction, improving access to hand gel and supporting habit change to reduce unnecessary glove use and associated environmental impact.

Objectives Poor quality handover instructions prepared by hospital staff have been identified as a key threat to safe discharges. To optimise patient safety, it is important to identify and understand the influences on how discharge documentation is prepared by hospital staff. The aim of this study was to systematically identify and explore important barriers and enablers to the preparation of high-quality discharge documentation by healthcare professionals (HCPs) for primary care teams at patient discharge. Setting and participants HCPs from different staff groups (doctors, nurses, pharmacists, occupational and physiotherapists) participated in online interviews. Design Semistructured interviews informed by the theoretical domains framework (TDF), to identify key influences on the preparation of discharge documentation. Anonymised transcripts were analysed thematically using a combined inductive-deductive approach. Themes were framed as influences on the preparation of discharge documentation. The likely importance of influences was decided through iterative team discussions structured on predetermined criteria. Criteria included whether the influence was an existing enabler, whether beliefs about the influences were expressed voluntarily and how often they were mentioned. Results 12 HCPs were interviewed (5 junior doctors, 1 advanced nurse practitioner, 2 nurses, 1 occupational therapist, 1 physiotherapist and 2 pharmacists). Of 44 influences identified, 10 were deemed most important in the preparation of discharge documentation, spread across five TDF domains: knowledge (eg, lack of awareness of guidelines), skills (experience of hospital staff), social and professional role and identity (effective team communication), environmental context and resources (eg, software limitations) and social influences (eg, lack of feedback). Conclusions This study identified 10 important influences on how discharge documentation is prepared by hospital staff. These influences are potential targets for subsequent interventions to improve the quality of discharge documentation and patient safety during discharge.

Background: In the UK, breast cancer affects 1 in 8 women, accounting for 31% of cancers and 15% of cancer-related deaths in women. In 2023, London’s breast screening coverage was 56%, falling below the NHS target of 70%. This survey assesses psychological and behavioural factors impacting screening attendance. Methods: Using the Theoretical Domains Framework, an online survey including 15 behavioural factors was distributed through a market research company to women eligible for breast screening (aged 47–73) across London and Southeast and West England. Logistic regression was used to predict the impact of behavioural variables on history of attendance and intention to attend future screening opportunities. Results: Of the 922 respondents who returned the full survey, 88.6% intended to attend future screenings, and 88.1% reported previously attending screenings regularly. ‘Behavioural regulation’ had the strongest influence on past attendance (OR = 1.92, p < 0.001) and future intent (OR = 1.56, p = 0.003). Not intending to attend was linked to emotional consequences (OR = 0.68, p = 0.003) and environmental barriers (OR = 0.66, p < 0.001), where OR—Odds Ratio. Conclusions: This survey identifies behavioural factors influencing breast screening participation and screening intention, providing insights that may help design interventions to increase attendance rates.

Introduction: The healthcare sector is a major contributor to the climate crisis, and operating theatres (OTs) are one of the highest sources of emissions. To inform emissions reduction, this study aimed to (i) compare the outcomes of interventions targeting sustainable behaviours in OTs using the Triple Bottom Line framework, (ii) categorise the intervention strategies using the 5Rs (reduce, recycle, reuse, refuse, and renew) of circular economy, and (iii) examine Intervention Functions (IFs) using the Behaviour Change Wheel (BCW). Methods: Medline, Embase, PsychInfo, Scopus, and Web of Science databases were searched until June 2023 using the concepts: sustainability and surgery. The review was conducted in line with the Cochrane and Joanna Briggs Institution’s recommendations and was registered on PROSPERO. The results were reported in line with PRISMA, Supplemental Digital Content 1, https://links.lww.com/JS9/D210 (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Results: Sixteen reviews encompassing 43 life-cycle analyses, 30 interventions, 5 IFs, and 9 BCW policy categories were included. 28/30 (93%) interventions successfully led to sustainability improvements; however, the environmental outcomes were not suitable for meaningful comparisons due to their using different metrics and dependence on local factors. The ‘reduce’ strategy was the most prolific and commonly achieved through ‘education’ and/or ‘environmental restructuring’. However, single-session educational interventions were ineffective. Improving recycling relied on ‘environmental restructuring’. More intensive strategies such as ‘reuse’ require multiple intervention functions to achieve, either through a sustainability committee or through an intervention package. Conclusion: Policymakers must examine interventions within the local context. Comparing the outcomes of different interventions is difficult and could potentially be misleading, highlighting the need for a tool integrating diverse outcomes and contextual factors. ‘Reduce’ strategy guarantees environmental and financial savings, and can be achieved through ‘Education’ and/or ‘environmental restructuring’.