SP 5.10 10 Litres of Waste: A Systematic Review Quantifying the Impact of Sink Mechanics on Surgical Scrubbing
Abir Mamun, Yumna Saleem, Yahya El-TahlawyAbstract
Background
Operating theatres are resource-intensive, yet the precise volume of potable water consumed during surgical hand antisepsis remains poorly quantified. This systematic review aims to determine baseline water consumption of standard scrubbing techniques and explicitly quantify preventable waste generated by sink infrastructure and behavioural patterns.
Methods
PubMed, Embase, and Cochrane Library were searched from inception to January 2026 to identify studies quantifying water volume (Litres) or flow rates (L/min) during surgical scrubbing. Studies were stratified by sink mechanism. Descriptive statistical analysis calculated median usage and percentage reductions across intervention types.
Results
Eight studies met the inclusion criteria. Baseline water usage for standard continuous-flow scrubbing ranged from 15.5 L to 22.5 L per episode. Granular analysis of sink mechanics identified a median flow rate of 5.1 L/min. Timer-controlled sinks were significantly associated with preventable waste, generating a median of 10.2 L of unused water running post-procedure, compared to 0 L for knee-panel sinks (P=0.01). Infrastructural interventions demonstrated substantial efficiency gains: sensor-operated taps reduced consumption by 87% (22.5 L to 2.9 L). Behavioural modifications were similarly effective; a ‘taps on/off’ technique yielded a 71% reduction (15.5 L to 4.5 L), while revised scrubbing protocols demonstrated significant mean savings of 11.3 L per case (P<0.0001).
Conclusions
Traditional surgical scrubbing consumes significant volumes of water, with timer-controlled infrastructure identified as a primary driver of preventable waste (>10 L per scrub). Transitioning to knee-operated or sensor-based sinks, alongside behavioural modifications, can reduce water consumption by over 70% without altering scrub formulations.