Sustainability
Implementing lean surgical trays across NHS Scotland
Lydia Robb and Steven Chawk, from the National Green Theatre Programme, at the Centre for Sustainable Delivery, in NHS Scotland, provide an insight into a sustainability project to reduce the total number of surgical trays in circulation across NHS Scotland by 20% by March 2026. If achieved, SSDs could see a potential reduction in carbon emissions of over 400 tonnes.
Sterile Services Departments (SSDs) play a vital role in delivering safe surgical care to NHS Scotland. Each year, they support over 274,873 planned surgeries, processing over 38 million surgical instruments. However, this energy- intensive process is estimated to emit over 2,000 tonnes of carbon emissions annually. The services across NHS Scotland are
stretched, operating at near full capacity, particularly in densely populated areas in the central belt. SSDs process surgical tray sets, which group instruments for specific specialties or procedures. We know from the literature, that in some instances, up to 75% of instruments on surgical trays are routinely not used in theatre. This results in unnecessary processing, waste,
and a reduced lifespan for the instruments. Additionally, from a clinical perspective, the time associated with counting unused instruments pre- and post-operatively decreases the efficiency of the surgical pathway. Recognising the inefficiencies and detrimental effects on the environment, the National Green Theatre Programme (NGTP) at the Centre for Sustainable Delivery (CfSD) in NHS Scotland has established a project team to develop an implementation strategy. This strategy will allow clinical teams across
Scotland to audit, review and streamline surgical tray sets within their surgical specialty. The project team gathered qualitative data from SSD managers and quantitative data from Public Health Scotland to identify surgical specialties that are likely to have the greatest impact on SSD’s capacity and the environment. To support local departments, the project
team have designed a simple, easy-to-use toolkit for local departments to adapt to their specialty. This clinically led implementation strategy will be presented at future clinical delivery groups with the long-term goal of
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operating theatres, contributing to 274,873 planned surgeries in 2023-24.2
This is achieved by
processing over 38 million surgical instruments, packs, and supplementary items. Unfortunately, SSDs are operating at near full capacity, particularly in densely populated areas in the central belt of Scotland. Surgical instruments undergo a
comprehensive process of cleaning, disinfection, packaging, and sterilisation after each use. This process is labour and energy-intensive, contributing significantly to the overall carbon footprint associated with operating theatres. A study published in the British Journal of
making these resources available to all clinical teams in NHS Scotland.
Situation The National Green Theatres Programme (NGTP) is a key element of the Scottish Governments Climate Emergency and Sustainability Strategy, which aims for NHS Scotland to reach Net Zero by 2040.1
The NGTP aims to reduce the carbon
footprint of operating theatres across NHS Scotland and enable more environmentally sustainable care by: lWorking with clinicians, professionals and subject matter experts to develop actions that reduce carbon emissions.
l Supporting health boards to measure, implement, and report improvements.
A crucial service supporting our theatres is the SSDs, also known as Central Decontamination Units (CDUs). This service plays a vital role in delivering safe healthcare throughout NHS Scotland. There are 15 decontamination units across Scotland, with 14 managed by NHS Health Boards. These units provide essential services to ensure surgical instruments and devices are clean, safe, and ready for use in
Surgery found that each surgical instrument has an associated carbon footprint of 0.052kg of CO2 equivalent (CO2e).3
Given the current demand
within NHS Scotland, decontamination services are responsible for an estimated carbon footprint of 2,010 tonnes annually. Regarding costs, data from Health Facilities Scotland reveals that the cost to process a single instrument is, on average, £1.23, accounting for both staffing and non-pay expenses.4
While
these services are essential, it is imperative to identify opportunities to reduce unnecessary carbon emissions and develop strategies to improve efficiencies across the system. This is of particular importance as the health service attempts to reach pre-pandemic waiting list targets. Surgical services in many boards are addressing their larger waiting lists by increasing operational capacity through expanded workforce, theatre access and waiting list initiatives. These efforts to reduce patient waiting lists will put further strain on decontamination services.
Vision The ambition of the project is to reduce the total number of surgical trays in circulation across NHS
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