P041 The British Society for Dermatological Surgery’s national sustainable skin surgery audit standards and checklist: preliminary findings and recommendations from the first national audit
Authors: Forbat Emily , Barlow Richard , Wernham Aaron , Abbott Rachel , Tso Simon 
Published: June 2024

Abstract
The British Society for Dermatological Surgery (BSDS) 2022 sustainability guidance provided evidence-based recommendations on delivering sustainable skin surgery. Our 2022 national study involving 12 sites identified significant heterogeneity in the setup, resource consumption and waste management in skin surgery. We developed sustainable skin surgery standards and a checklist, based on evidence from the BSDS guidance followed by consultation with experts. We conducted the first UK-wide audit of dermatology departments against the audit standards and checklists. In total, 36 dermatology teams from 30 NHS trusts took part in the national audit and returned completed self-administered questionnaires. All participating teams formally registered the audit with their organization. The audit period was 1 June 2023 to 31 October 2023 (extended to 31 January 2024 due to the high level of interests). The audit standards and checklist consisted of five sections: section 1, general information (compulsory); section 2, audit standards (compulsory; scored out of 20; 10 audit standards covering governance, service, training, skin surgery room setting, surgical instruments, personal protective equipment and communication); section 3, desirable practices (compulsory; scored out of 6; nine items covering electrical, facilities, consumables, single-use instruments and energy); section 4 (optional; scored out of 4; skin surgery waste management and recycling rate) and section 5 (compulsory; calculation of total score out of 30). The results showed a mean score of 17.3 out of 30 [95% confidence interval (CI) 16.3–18.3; range 12–23]. The mean weight of waste generated per skin surgery procedure averaged 1.0 kg (95% CI 0.35–1.7; range 0.18–10.5). The mean recycling rate was 8.6% (95% CI 4.6–12.5; range 0–41). Overall, 17 of 30 trusts (57%) had recycling bins in their skin surgery rooms, while 19 of 30 (63%) had access to a mobile smoke evacuator when performing skin surgery. The study findings showed continuing wide variability in the setup and waste management of skin surgery since our 2022 study. The recycling rate of 8.6% in this study was less than the 16% reported from the 2022 study. There are significant differences in the audit and checklist scores and mean weight of waste generated per procedure between the top- and bottom-performing teams. Potential explanations for the differences could include prior learning, local infection control policies and site-specific factors that could impact on the setup and delivery of skin surgery services, including the acceptability and adoptability of the standards set out in this audit. Mohs micrographic surgery lists generated more waste than standard surgery. Trusts that recycle their single-use surgical instruments reported high recycling rates. Sharing good practices and experiences between the top- and bottom-performing teams could potentially help to narrow their performance gaps.