Sustainable theatres
date. Digitising them and leaving many of the items ‘on the side’ for ‘just in case’ is already practised in many theatres as a cost saving, but nonetheless gets a mention in the compendium – leaving an item until it is actually required is good sustainable practice.8
The suggestion
to reduce or avoid all unnecessary single use equipment is also mentioned. There are many single use items in trays,
which could be replaced by serviceable re-usable gallipots, kidney dishes, quivers, light handles, etc. Individual hospitals will know their own inventory and can make substitutions, which reduce cost and waste. There are many re-usable equivalents that might be exchanged for the current single use items showing considerable environmental savings, as was found by a systematic review of theatre equipment.10 Disposable packs of instruments and swabs used for non-complex surgery could readily be substituted for small packs of instruments and a few swabs. These were brought in to reduce time taken for set-up – but, in reality, saved very little; often the contents of the packs were wasted and had to be binned. The Compendium speaks of disposable instruments but, to the authors knowledge, most theatres looking out for their budget have abandoned single use instruments long ago. However, there may be pockets where
they have continued, although they are environmentally unhelpful and should not be continued. There are the instances of single use ports for laparoscopic surgery in common use still, which could be swapped for modern reusables that are far more reliable than in earlier times.
Post-operative Waste management is the top of the list for post-operative care. Recycling waste streams for a great deal of wrapping material could be used if it was bagged as domestic waste, before the patient entered the theatre. This merely needs a champion and adoption of slightly different practices. It would save the hospital a great deal of money and the planet more, as the clinical waste is incinerated or goes to landfill and costs far more to dispose. Systems for appropriate recycling need to be planned and the change take place. However, it also requires some effort and supervision to ensure it is done effectively and efficiently. Energy efficiency can be included in the
changes to make the theatres more sustainable. This would include using the ‘set-back’ function which is built into the ventilation systems in the theatres. This includes heating and ventilation and is unnecessary in an unused space. Recovery departments were not included in
the Compendium although they are often in use 24 hours per day. They are a large space, which is heated, lit and ventilated for all that time. Perhaps alternatives can be found? In many other ways, recovery is a less energy intense area and has a lower carbon footprint than theatres.
Conclusion Surgery is a significant contributor to global and UK-wide carbon emissions. The concept of sustainability is massive with complex systems, such as healthcare, unable perhaps to consider all the elements. These need to be untangled and made easier. It is up to each of us to read the information, find ideas which are relevant to our own team practice, and suggest ways to reduce the impact. To coin a phrase, ‘every little helps’ and, while we may not be able to see the impact, we will be contributing to mitigate a desperate situation. Health and climate change are inextricably linked, and we need to take action to help to heal our planet. The scale of the challenge is not inconsiderable, but we must take action and now. There is already a wealth of information out
there and many champions already at work. In among all the other imperatives which are on the agenda at the moment, not least the recovery from COVID-19 and the surgical backlog, we need to ensure that sustainable surgery with a low carbon footprint is on the mind of every practitioner as they go about their daily work.
References 1. Climate change and health (
who.int), https://
www.who.int/news-room/fact-sheets/detail/ climate-change-and-health,
2. Greener NHS, Delivering a net zero NHS,
https://www.england.nhs.uk/greenernhs/ a-net-zero-nhs/
3. Green Theatre Checklist, RCSEd, https://
www.rcsed.ac.uk/professional-support- development-resources/environmental- sustainability-and-surgery/green-theatre- checklist
4.
https://news.sky.com/story/its-nice-to- make-a-bit-of-history-mother-becomes- first-in-uk-to-use-greener-pain-relief-gas-in- labour-12407848
5. Environment and sustainability, The Royal College of Anaesthetists, https://www.rcoa.
ac.uk/about-us/strategy-vision/environment- sustainability
6. Ibid 7. Surgical site infections: prevention and treatment, NICE,
https://www.nice.org.uk/ guidance/NG125
8. Green Surgery Challenge,Centre for Sustainable Healthcare, https://
sustainablehealthcare.org.uk/what-we-do/ green-surgery-challenge
CSJ
9. Ibid 10. Operating in a Climate Crisis: A State-of-the- Science Review of Life Cycle Assessment within Surgical and Anesthetic Care, https://
ehp.niehs.nih.gov/doi/epdf/10.1289/EHP8666
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