Sustainable theatres
can significantly cut emissions. A structured shut-down checklist is a practical tool teams can adopt.
l Adopting reusables: Switching to reusable gowns, instruments, and trays reduces emissions and waste dramatically. Studies show reusable gowns alone reduce carbon emissions by 200-300% and water usage by up to 330%. Departments that have moved from disposable to reusable surgical hats, gowns, and trays have seen both environmental and financial benefits.
l Smarter stock management: Auditing sets and removing unused items has led to reductions of up to 70% in some departments. This not only prevents waste but improves efficiency and reduces the time and set up/counting before case required for sterilisation and storage.
l Waste reduction: Theatres generate 50-70% of all hospital waste, meaning recycling and mindful disposal of items can have a huge effect. As Nicola noted, even small changes such as only opening what is needed for surgery and segregating waste correctly can deliver significant carbon savings.
“We are not powerless in the face of climate change,” Nicola stressed. “Every small change, from what we open in a tray, not opening something ‘just in case’, to choosing reusable over disposable, all adds up to a big difference when done collectively.”
The Green Theatre Checklist Launched in 2022 and updated in 2025, the Green Theatre Checklist provides a structured, evidence-based approach to sustainable surgery. Developed by the Surgical Royal Colleges of England, Edinburgh, Glasgow, and Ireland, the checklist has since been strengthened with the backing of AfPP, the
Association of Anaesthetists, and the Royal College of Anaesthetists. The checklist is divided into four domains:
1. Anaesthetic care - encouraging low-emission anaesthetic choices, reducing nitrous oxide reliance, and promoting regional or local anaesthesia where appropriate.
2. Preparation for surgery - auditing instruments, rationalising packs, and avoiding
unnecessary opening of consumables.
3. Intra-operative practice - maximising reusable equipment, reducing energy consumption, and efficient waste management.
4. Post-operative measures - focusing on recovery, recycling, and ensuring sustainability is built into the patient pathway.
Its latest update goes further, recommending the decommissioning of centralised nitrous oxide and highlighting the potential of new reusable technologies. Importantly, the checklist is not prescriptive but adaptable, giving multidisciplinary teams practical entry points to integrate sustainability into their own practice. AfPP’s support has helped ensure that
perioperative nurses, ODPs, and the wider surgical team are fully represented in this collective professional commitment.
AfPP’s leadership and the role of practitioners For Nicola, the key lies in professional responsibility: “As people and professionals, we all have a
responsibility to take action. Sustainability isn’t just an environmental issue - it’s a patient safety and public health issue. By making our operating theatres greener, we are not only protecting the planet but improving health outcomes for generations to come.” AfPP’s leadership has been critical in ensuring sustainability remains a top priority for perioperative practice. Through conferences, webinars, and educational resources, AfPP provides perioperative practitioners with the tools, confidence, and community support needed to implement meaningful change. Its Sustainability Special Interest Group gives members a platform to share knowledge,
December 2025 I
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