Reusable versus disposable drapes
14 April 2025
Hannah James explains how BSAVA PetSavers funding is helping to determine if the use of reusable drapes affects post-operative wound complication rates in routine surgeries
The environmental impact of veterinary care is increasingly seen as an essential concern. In a 2019 BVA survey, 89% of vets stated they wanted to play a more active role in the UK’s sustainability agenda, and the same year also saw the founding of Vet Sustain, a community interest company which educates and supports veterinary professionals to drive sustainability in the profession. Many practices are considering ways in which they can reduce their environmental impact, and reusable drapes are one possible contribution to their efforts (Figure 1). Lifecycle analyses from human hospitals demonstrate that, in the majority of cases, reusable surgical drapes have substantially lower environmental impacts compared with their single-use equivalents.
FIGURE 1: The use of reusable drapes in routine surgery.
The use of reusable versus single-use drapes varies between practices and individual surgeons and depends on the procedure being undertaken. Alongside the need to launder and sterilize reusable drapes, a presumed reduction in infection risk is a commonly cited reason by those preferring single-use. However, there is in fact limited empirical evidence to conclude whether a higher risk of wound complications may be expected with reusable drapes or not. Anecdotal evidence from practices suggests that reusable drapes are not associated with increased infection rates, and a 2019 knowledge review published in Veterinary Evidence concluded that there was insufficient evidence to make the statement that single-use drapes and gowns reduced the risk of surgical site infections.
In 2022, veterinary surgeon Nicole Dyer approached clinical research colleagues at VetPartners to suggest conducting a large-scale study: project DRAPES (Drapes in Routine Aseptic Procedures for Environmental Sustainability). This plans to investigate the question ‘does using reusable versus disposable surgical drapes lead to higher rates of post-operative wound complications?’ Nicole is a keen champion for sustainability in veterinary practice and wanted to know whether recommendations to use reusable surgical drapes could be backed up with data on patient safety.
A team was formed to bring together colleagues with experience in clinical practice, clinical research and sustainability, to design a study which involved all three areas. A randomized controlled trial is being run to look at post-operative wound outcomes when either single-use or reusable drapes are used. If reusable drapes provide at least equivalent patient outcomes, this would allow practitioners to choose reusable drapes where appropriate, knowing that they are reducing the environmental impacts of surgery without compromising patient care. Conversely, identifying a causal relationship between drape type and risk of wound complication would facilitate better patient care, by providing evidence for the use of one type of drape over the other to reduce complication risk. This would lead to a reduction in morbidity and mortality for patients undergoing routine neutering surgery and may also reduce antimicrobial use, which benefits both humans and animals by slowing the development of antibiotic-resistant bacteria.
Study design
The study will be carried out on healthy (ASA <2) cats and dogs undergoing routine neutering. Recruited patients will be randomized to having their procedure using either single-use or reusable drapes. The calculated required sample size is 4750 patients, allowing for attrition throughout the study.
Given the level of recruitment required, we designed the study as a pragmatic, multi-centre randomized controlled trial. This meant that we could recruit patients from multiple practices without requiring them to alter any of their existing protocols, aside from the randomized choice of drape. Information collected includes patient age and sex, ASA status, surgical approach, surgery time, perioperative treatments, pre-medication including anaesthesia, suture pattern and materials, and post-operative treatments. There is no requirement for participating practices to standardize any of these factors for the study, but we collect the data to check that there aren’t other factors which could be influencing our findings. Likewise, we don’t specify the use of a particular brand of drape and leave the choice of fenestrated drape or field draping to the surgeon. This choice means we can minimize disruption in our participating practices, and also ensure our results are applicable to the real-world environment in which we want to apply them.
To be included in the study, a patient must have at least one post-operative check: in person, via telemedicine, or by the owner sending a photo of the surgical site. Data for each included patient is retrieved from the practice management software for 30 days post-surgery to extract post-operative wound check codes, any antimicrobial prescriptions, and clinical notes available for where ambiguity exists in a record.
The study design has been approved by the RCVS ERP and the plan is freely available on the Open Science Framework at https://osf.io/72hma.
Findings so far
At the time of writing, we have recruited 848 patients from nine practices. Interim data analysis showed no emerging difference between the two study groups, and the overall post-operative wound complication rate for all patients in the study is comparable with the rate seen in a recent clinical audit of 55 sites. We will continue to carry out interim analyses every 3 months or 500 animals recruited (whichever is sooner) to ensure patient safety is not compromised.
We hypothesize that there will be no significant difference in the rate of wound complications between reusable and single-use drapes when used for dogs and cats undergoing routine surgical neutering procedures.
Practices have reported that the study protocol has been simple to follow, and that client consent to the study has been easy to obtain using the client information sheets and posters provided by the research team. Despite the challenges of time and workload, recruitment has been steadily increasing in the majority of participating practices. We have begun to provide practices with bespoke monthly updates on their rates of recruitment, which practice teams have told us is a helpful reminder to enrol eligible patients into the study.
Thinking about applying for BSAVA PetSavers funding?
The BSAVA Petsavers grant helped us to provide each participating practice with a portable tablet linking to the data collection form, making it easy for teams to capture information about pre-, peri- and post-operative care at a time and place convenient for them. The low-cost nature of the study combined with the grant has allowed us recently to enrol two further practices into the study to increase the rate of data collection.
Participation in this study has been enormously rewarding. Having conducted research on renewable energy systems during my PhD, I have welcomed the opportunity to revisit research in a different discipline, in the company of colleagues who are hugely knowledgeable and passionate about evidence-based veterinary medicine. The practice teams involved have also enjoyed participating. At a recent update meeting at The Minster Veterinary Practice in York, where the team has recruited over 100 patients to the study thus far, veterinary surgeon Elise Purdy commented that it was rewarding to be contributing to green research and thinking about the bigger picture of One Health. SVN Hannah Hook agreed and said that participating in the interdisciplinary research made her feel that the practice was “moving with the times”.
About the author
About the research team
Nicole Dyer BVetMed CertAVP MRCVS, Veterinary Surgeon, Ash Tree Vets; Hannah Doit BVSc MSc MRCVS, Patient Data Manager, VetPartners; Natalie Robinson BVetMed BSc PhD MRCVS, Clinical Data Manager, VetPartners; Jenny Stavisky BVM&S PhD PGCHE FHEA MRCVS, Clinical Research Manager, VetPartners; Kathryn Wareham BVetMed PhD MRCVS, Evidence-Based Veterinary Medicine Manager, VetPartners.
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