OP E R ATING THEATR E S
from recyclable materials. However, some progress is being made with recycling of clean plastics and cardboard. Pioneers – such as Tom Pierce and Nick Enzor (2013) at University Hospital Southampton – have been making progress by recycling steel from single-use laryngoscopes blades and Magill forceps. Even taking into consideration the cost of decontamination, they are now making a net profit. Dade went on to discuss the issue of anaesthetic gases, which are responsible for over 2% of all NHS emissions. Desflurane is one of the most common anaesthetic gases used in theatres, but is also one of the most harmful to the environment. Using a bottle has the same global warming effect as burning 440 kg of coal. Recognising the impact climate change is having on the environment and the health of its people, Mat Molyneux and colleagues at University Hospitals Bristol have stepped up activity. The Trust has been encouraging the use of alternative surgical anaesthesia options to decrease the use of desflurane, including switching to lower carbon alternative sevoflurane.
In just two years, staff at the Trust have reduced use of carbon intensive desflurane significantly, saving the equivalent to 30,000kg CO2
per month. Chris Allen, sustainable anaesthesia
fellow, at Newcastle Hospitals, has also been pioneering the use of technology across the
hospital’s maternity unit to support women to use gas and air during labour, while making it as environmentally friendly as possible. The hospital is using a Mobile Destruction Unit (MDU), which “cracks” exhaled nitrous oxide into harmless nitrogen and oxygen. “In Newcastle, there seems to be a will from the executive team at the Trust to work together with clinicians to help produce a greener operating room and across the whole of the hospital,” Dade observed. He asserted that such actions need to be supported with “guidance and empowerment” at executive level.
Dade added that theatres also need to look at the volumes of unused single- use items in surgery, to streamline their instrument trays, and to consider moving to reusable instruments and products. The ‘Green Surgery Challenge’ (launched in February 2021), is organised through the Centre for Sustainable Healthcare and is aiming to tackle some of these key issues. Five teams have been selected to receive mentoring from sustainable healthcare specialists at the Centre for Sustainable Healthcare over a ten-week period, to hone a specific question, design a project, implement the project, and measure the outcomes: l Peter Labib, Bryony Ford and colleagues at Derriford Hospital Trust are looking at maximising reusable surgical instrument use, including laparoscopic ports, for a sustainable appendicectomy
About the Operating Theatres Show
The Institute of Government & Public Policy hosted The Operating Theatres Show at Hilton Metropole Hotel in London in October 2021. Chaired by Jane Perry, dean of Health, Sport and Bioscience, University of East London, the event looked at key strategies for reducing wait- ing times in operating theatres, improving safety and outcomes of surgical services and achieving greater productivity and capacity. Other presentations included: l Stryker Neptune – The real story: Sarah Baker, head of nursing perioperative and critical care medicine; Julie Clark, senior operating department practitioner, The Friarage (South Tees NHS Foundations Trust)
l The role of technology in managing the post-COVID elective surgical backlog: Piyush Mahapatra, innovation director, Open Medical
l Using robotic surgery to enable greater precision in surgery and improve recovery time: Dr. Shahnawaz Rasheed, consultant surgeon, Royal Marsden NHS Foundation Trust
l Integrated theatres: designing smart
spaces: Andrew Frost, technical director, MTS Health
l Supporting awareness and basic ed- ucation of multi-disciplinary teams in human factors: Nicola Stroud, operating department practitioner, Addenbrooke’s Hospital, Cambridge University Hospi- tals NHS Foundation Trust
l Unlocking the power of digital clinical information with the Ascom Healthcare Platform: Ian Binks, business develop- ment manager, Global Clinical Solutions and Sophie Evans, clinical sales consult- ant, Ascom
l Surgical prehabilitation – enhancing general health and wellbeing prior to major surgery: Dr. Tarannum Rampal, consultant anaesthetist, Princess Royal and clinical and strategy lead, Kent and Medway
Sponsors of the event included GE, Pentland Medical, Intersurgical Complete Respiratory Systems, Stryker, Glanso UK, Cardiac Services, and Medicare Products, to name just a few. For further information on future events, visit:
https://igpp.org.uk
24 l
WWW.CLINICALSERVICESJOURNAL.COM
pathway at the Trust.
l Aaron Quyn, Adam Peckham-Cooper and colleagues, at Leeds Teaching Hospital Trust are looking at an innovative, gasless appendicectomy procedure, lean instrument trays, and reducing pre-operative urinary catheterisation for a sustainable laparoscopic appendicectomy pathway.
l Alyss Robinson, Shameen Jaunoo, Mansoor Khan and colleagues at the University Hospitals Sussex NHS Foundation Trust are seeking to reduce blood testing in the pre-operative work-up for laparoscopic cholecystectomy.
l Preetham Kodumuri, Prash Jesudason and colleagues, at Wrexham Maelor and Ysbyty Gwynedd are looking at reducing energy use by moving out of the operating theatre, streamlining surgical sets, and reducing single-use instruments for a sustainable carpal tunnel release pathway.
l Jasmine Winter Beatty, Jonathan Gan and colleagues at Imperial College Healthcare NHS Trust are substituting local in place of general anaesthesia for inguinal hernia repair and introducing reusable surgical gowns.
Other focus areas for attention, in theatres, include the design of carbon efficient ventilation and sustainable theatre design in general. The University of Cambridge’s department of architecture are currently looking at modelling the optimum sustainable theatre.
In his closing comments, Dade highlighted the continued need for dialogue around sustainability in theatres and reminded delegates of the challenging targets ahead for the NHS.
AfPP is proposing to partner with industry to drive more carbon efficient manufacturing and is already partnering a variety of key stakeholders and organisations including: the Centre for Sustainable Healthcare, The Association of Anaesthetists, the James Lind Alliance and The University of Cambridge. Vickie Hain is leading the AfPP ‘Sutainable Theatres Special Interest Group’ (
sustainability@afpp.org.uk) and theatre staff are encouraged to get in touch and become part of the dialogue.
He pointed out that most of the pioneers,
so far, have been clinicians, and called for greater involvement of all staff working in theatres – adding that they need to be empowered and given the time to do this. Dade urged delegates to contribute to global efforts to tackle climate change and reflected on his own impact and role in delivering change.
“When my son was young, he often asked his grandfather: ‘what did you do in the war, grandad?’ Now, I wonder whether my son’s children will one day ask me: ‘what did you do in the war on climate change?’” he concluded.
CSJ JANUARY 2022
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