Author: Dr Siobhan Clayton (Member of ESSPWP, RACSTA representative) 

Broome Hospital in Western Australia is setting a new benchmark for sustainable theatre practices, replacing disposable scrub caps with reusable alternatives. This change is already yielding environmental and cultural benefits and is now being carefully assessed for long-term cost savings.

Driven by growing concerns about clinical waste and the environmental cost of single-use items, theatre staff initiated the transition after reviewing the volume and cost of disposable headwear. In Broome Hospital theatre, a key regional hub, disposable scrub caps cost $3192 in the 2023–2024 financial year alone.

While data for disposable tie-back caps is still being gathered, preliminary analysis suggested a more sustainable approach was urgently needed. A 2024 systematic review and meta-analysis demonstrated the safety of using reusable hats with regards to surgical site infection (SSI) rates as well as reducing the carbon footprint.

Turning to reusables
The hospital has begun introducing fabric caps that meet ACORN (Australian College of Perioperative Nurses) standards. The cost of purchasing 60 reusable scrub caps was $1538. However, with the goal of fully replacing disposable caps, twice that number is expected to be needed. As a result, the first year is likely to be a break-even investment—one that is expected to deliver savings in subsequent years, particularly as replacement costs decrease and laundering becomes part of routine linen workflows.

Linen operations and logistics
Reusable caps are integrated into the hospital’s existing linen service, which operates Monday to Friday and the turnaround time is typically two to three days. Laundering is done at 60 – 80°C using industrial-grade chemicals, with drying temperatures up to 80°C— in line with Broome Hospital’s standards and national infection control guidelines.
On average, laundering costs about $2.50 per kilogram. While the hospital is still gathering data to calculate the wear-and-tear rate of reusable caps (using annual scrub uniform purchases as a benchmark), early indications suggest the caps will withstand dozens of wash cycles before needing replacement.

Culture, pride and regional impact
While the caps themselves aren’t personalised, the shift to reusable headwear has positively influenced workplace culture. Staff have expressed pride in contributing to a more sustainable health service and being part of a meaningful change. The initiative has also sparked interest beyond the hospital itself, with neighbouring health services in the Kimberley now beginning to explore or adopt reusable caps in their own theatres.

Added benefits in remote settings
For remote and regional hospitals like Broome, the benefits of reusables extend beyond environmental and cost advantages. Relying less on single-use supply chains means fewer disruptions from transport delays or stock shortage—challenges that are often magnified in remote areas. By embedding reusables into local linen services, hospitals can reduce dependence on external supply chains while building greater resilience into day-to-day operations.

Next steps
With thousands of disposable caps now on track to be eliminated from waste streams, the hospital is building a case study to share with other Western Australian regional and remote facilities. Once wear rates and replacement frequencies are better understood, the data will help quantify long-term financial savings.

The Environmentally Sustainable Surgery Working Party (ESSPWP) will be publishing a bi-monthly report highlighting real world practical examples of how our colleagues around Australia and Aotearoa New Zealand are adopting changes in their practice which reduce the environmental impact of surgery. We hope these reports inspire you to think about how positive changes can be implemented in your own practice or health service.