Background: Reuse of sterile textiles could potentially reduce the carbon footprint of operating theatres. The aim of this mixed-methods study is to gain a deeper understanding of the implementation of reusable drapes and gowns across different contexts through applying the Consolidated Framework for Implementation Research (CFIR).

Methods: A mixed-methods analysis was performed of cross-sectional data from a survey distributed by snowball sampling across a global research network. A five-point Likert scale assessed perspectives on safety and feasibility of implementation of reusable textiles. An open-ended question asked about the implementation of reusables. Inductive and deductive coding was used, informed by the CFIR.

Results: A total of 5734 responses were collected, of which 5230 were eligible for inclusion. Most respondents believed that the intervention was unlikely or very unlikely to affect safety (3266/5230, 62.4%) or have detrimental consequences on environment or patient care (2990/5230, 57.2%), and that its introduction was likely or very likely to be successful (2888/5230, 55.2%). From a total of 1514 free-text entries, nine unique implementation factors were identified. Financial constraints were important across all settings. Whilst sterilisation-related issues were commonly reported in low and middle-income countries, institutional challenges were prominent in high-income countries. Mapping these factors to CFIR, the 'setting' of the intervention was the most relevant for effective implementation, along with the 'individuals' within the setting, rather than the intervention itself or the implementation process. A strategy identification tool and programme theory were developed, providing a starting point for institutions considering implementation of reusables and basis for future research.

Conclusion: Implementation of this carbon-reducing intervention varied across resource settings. Recognising the unique implementation context, and developing tailored strategies, could aid implementation of this innovation through both research and wider scale rollout.