Sustainability
insulation became an issue of patient safety. There are many fine suction tubes used
in many different specialties and these are very difficult to clean effectively and so have been replaced with single use items. Infection prevention has to take a prime position where these instruments are concerned. Further products, in use by many different specialties, are robotic instruments – which, by their very nature, are long and thin and difficult to clean. In general, an aseptic set-up on a trolley has
many different items which have become single use due to the capacity of autoclaves in sterile services. Items such as bowls and kidney dishes create considerable bulk for disposal after each surgery and it would be difficult to return to reusable items, although this would be an obvious change. The same applies to single use drapes, although there is more of an infection prevention argument here, but the capacity of hospital laundries to take on the vast volume of gowns and drapes which they coped with in the past is an unlikely change to occur. Teams must review all of their current
products and uses to see what might be possible to change. There is no doubt that procedure packs, with vast numbers of single use items included, need to be on regular observation to see if products can be removed. This also applies to instrument sets and, indeed, preference cards. These enquiries are just good management – but are often left undone, due to all the other stresses encountered by theatre teams.
Education and leadership Keeping busy teams up to speed with changes that are occurring around them is hard enough, but it is becoming more and more essential that each and every professional is ahead of the curve. The professional associations have
many opportunities to educate their members online and in the development of useful tools. The recommendations of the Intercollegiate Green Theatre Checklist13
are a case in point and
should be helpful to all surgical teams to reduce the environmental impact of surgical practice. Leadership from within the hospital is needed
at every level but particularly at Board Level. There will be one Director in each Trust or Integrated Care Board who will be assigned a leadership role in this area to help teams to make some difficult decisions.
Conclusion There are a number of key barriers to these changes coming into place. There is the issue of the backlog, which is causing many teams extra time in their working week; this has an impact on time available for other changes that need to be made. Many teams are motivated to improve sustainability but some lack awareness, lack information, feel disempowered, encounter financial constraints, have inadequate facilities or resources, and have a lack of guidance and leadership. We must not leave this to industry to take a lead; every health board needs to enable their teams (and in particular their operating theatre teams) to examine their practice, so they can reduce their carbon footprint. In the next article, in the August edition of TheClinical Services Journal, we will identify some of the activities going forward by looking into the future of greener surgery.
CSJ
References 1. UK Healthcare Alliance on Climate Change 2023, Green Surgery Report. Accessed at:
https://ukhealthalliance.org/resource/ green-surgery-report/#:~:text=The%20 Green%20Surgery%20Report%20is%20a%20 landmark%20report,patient%20care%20 and%20potentially%20saving%20the%20
NHS%20money.
2. Ibid 3. NHS England, Delivering a Net Zero NHS. Accessed at:
https://www.england.nhs.uk/ greenernhs/a-net-zero-nhs/
4. Lobo DN, Pavel SkoĊepa, Gomez D, Greenhaff PL. Prehabilitation: high-quality evidence is still required. Br J Anaesth. 2023 Jan;130(1):9-14. doi: 10.1016/
j.bja.2022.09.016. Epub 2022 Nov 1. PMID: 36328811.
5. ERAS 2024, Accessed at:
https://surgery.ed.ac. uk/clinical-specialties/colorectal-surgery/ for-patients-and-families/what-we-do-offer/ eras-enhance-recovery-after-surgery
6. NHS England, Putting anaesthetic-generated emissions to bed. Accessed at ttps://www.
england.nhs.uk/ greenernhs/whats-already- happening/putting- anaesthetic-generated- emissions-to-bed/
7. Green Surgery Report 8. Scotish Government, Making the NHS more environmentally friendly. Accessed at: https://
www.gov.scot/news/making-the-nhs-more- environmentally-friendly/
9. Association of Anaesthetists, Guide to green anaesthesia. Accessed at: https://
anaesthetists.org/Home/Resources- publications/Environment/Guide-to-green- anaesthesia
10. MacNeill A, Hopf H, Khanuja A, Alizamir S, et al, 2020, Transforming the medical device industry: map to a circular economy. Accessed at:
https://www.healthaffairs.org/doi/10.1377/ hlthaff.2020.0111811.
11. Hamish T. Reid, Arthur Fordham, Lara Rasha, Mark Buckwell, Daniel J.L. Brett, Rhodri Jervis, Paul R. Shearing. Up in smoke: Considerations for lithium-ion batteries in disposable e-cigarettes. Joule, 2023; DOI: 10.1016/j. joule.2023.11.008
12. Woodhead K. Greening the surgical process: key strategies, Clin Serv Jnl, June 24.
13. Intercollegiate Green Theatre Checklist, February 2023. Accessed at: https://publishing.
rcseng.ac.uk/doi/10.1308/rcsbull.2023.25
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www.clinicalservicesjournal.com I July 2024
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