Sustainability
single use instrument during the reprocessing mechanism.
Infection prevention and decontamination One of the reasons cited for using single use items is that they carry no possibility of being the cause of infections. In surgery, where surgical site infections can cause serious harm to patients, increased length of stay and pain and suffering, surgical teams do not want to be the originator of potential harm. They want to be certain of the ethical and moral certainty of not causing any harm to the patient, as far as is possible. In the UK, there are strict decontamination
and sterilisation quality standards, which are vigorously protected and verified at many different stages of a product being reprocessed through sterile services. Teams and patients can trust that an item or tray of instruments, which has been to sterile services, is fit for purpose and meets the required standard. Critical medical devices require sterilisation, semi- critical devices need high-level disinfection or sterilisation, and non-critical devices should have low- to intermediate-level disinfection. Healthcare-associated infections linked to reusable medical devices are related to a failure to comply with the reprocessing guidelines.3
Waste management Segregation of waste occurs within hospital practice but could be a great deal better, particularly in operating theatres, where it is said that 80% of the waste is collected before the patient arrives in theatre. This indicates that there could be a recycling project which could prevent much of the clean paper waste being disposed of into bags, which are incinerated at considerable financial cost. This also demands that the waste management companies enable clean domestic waste to be recycled, which is not always available. There is a new 2023 NHS clinical waste strategy,4
which sets out to
reform the system by eliminating unnecessary waste and calling for innovative ways to reuse and ensure waste is processed in the most cost effective, efficient and sustainable way.
Use of energy One of the more abstract areas of buildings management is the heavy demand for the use of electricity 24 hours each day. Protocols to switch these systems off when they are not in use would save the planet a great deal of energy. The anaesthetic gas scavenging system, which removes gas from the local area during delivery of a gas-based anaesthetic to protect staff from the gases, could be switched off when the room is not in use. This is estimated to save the equivalent of taking 51.6 cars off the road for one year.
In the future, these systems may be motion sensor automated, detecting the room occupancy and automatically switching them off. The system for heating, lighting and air conditioning could similarly be part of the ‘shut down’ of an operating room, with great savings made on energy use, or the room could be retrofitted with motion sensors. It is estimated that we could save 66% of the energy consumption used by these systems.
Reviewing the instrument trays A good deal of work on the contents of each instrument tray could be done to enable smaller trays to be used with fewer costs to re-processing and sterilisation. This review should be undertaken on a regular basis, in any case, and should involve the surgical lead for each speciality, the Theatre Manager, and the manager of the Sterile Services Unit. The first chapter of this review needs scrutiny and the preference card relating to the instruments updated and, if possible, digitised so it can be easily updated in the future. However, the backlog additional surgery is the cause of time pressures in surgery and few of the ‘extra’ tasks
are being accomplished at present. They are on the ‘to do’ list.
Conclusion There is a great deal of extra work already being undertaken with reports and strategies for action, so that we, as professionals, have some guidance on the tasks we need to undertake to contribute to the NHS Net Zero target. It could not be a more important task and it could be that the first undertaking within the hospital is to find some enthusiastic champions who are willing to take a lead on local actions, to help to deliver reductions in the carbon footprint of the hospital. They could be a link to the Trust lead who will motivate and oversee the progress being made. Without doubt it will be down to each individual to contribute to the overall effort, creating a safer service for themselves and for their patients. The greater benefactor will be planet health.
CSJ
References 1. NHS England Delivering a Net Zero National Health Service 2022 Accessed at https://www.
england.nhs.uk/greenernhs/publication/ delivering-a-net-zero-national-health-service/
2. ABHI. HealthTech and Sustainability : the opportunities and challenges for the sector. Accessed at
https://www.abhi.org.uk/ resource-hub/file/17549
3. Robertson P, Smith A, Mead A, Smith I, et al. Risk assessment- based approach to patients exposed to endoscopes contaminated with Pseudomonas spp. J Hosp Infect 2015,90, 66-69 cited in Garvey M 2024 Medical device – associated healthcare infections: sterilisation and the potential of novel biological approaches to ensure patient safety. Accessed at https://
www.mdpi.com/1422-0067/25/1/201
4. NHS Clinical Waste Framework agreement 2023 Accessed at
https://www.sbs.nhs.uk/ services/framework-agreements/sustainable- healthcare-recycling/
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