NHS Forth Valley has been at the forefront of the National Green Theatres Programme, an initiative which was launched in May 2023 to reduce the carbon footprint of NHS Scotland and enable more environmentally sustainable care.
This was born out of the early work by anaesthetists around the country to reduce the usage and carbon footprint of a particularly polluting volatile anaesthetic agent called desflurane, which has a global warming potential 2,500 times greater than carbon dioxide. Scotland became the first country in the world to ban the use of this drug in early 2023 (bar a very few exceptional cases), saving in the region of 6,400 tonnes of carbon dioxide equivalent (tCO2e) with zero detriment for patients and realised an almost £850,000 financial saving nationally. Many similar ‘triple’ bottom line – carbon, financial and staff/patient experience – projects have been initiated and brought to various stages of fruition since.
NHS Forth Valley has delivered a number of successful measures to reduce its carbon footprint within theatres, namely;
Decommissioning of nitrous oxide pipeline
Nitrous oxide is an anaesthetic gas which has fallen out of favour amongst the anaesthetic community due to superior techniques, but NHS Forth Valley became aware that keeping the built systems for delivering this gas to over 60 outlets around the hospital board’s theatre suites resulted in some 90% of the gas being vented to the environment without any clinical use (through leaks, checks and stock rotation). Establishing a more local cylinder-supplied system allowed NHS Forth Valley to decommission its entire manifold and pipeline system, saving over 500 tonnes of carbon dioxide equivalents, while realising further financial savings. Reducing the maintained requirements for an obsolete system has also allowed the redeployment of valuable experienced staff elsewhere to alleviate clinical pressures. Nationally, NHS Scotland has seen 44 out of 68 manifolds decommissioned already with a realised carbon saving of over 4000 tCO2e.
Waste segregation
Clinical waste (or orange stream) costs around £600 per tonne to dispose of, with significant amounts of energy used in its transfer and heat treatment. Numerous audits repeatedly show that a large proportion – up to 75% – of included items are not clinical but could be safely treated in domestic waste streams at a vastly reduced disposal cost of £150 per tonne or alternatively streamed to recycling opportunities. With theatres producing the largest amount of waste within the healthcare setting, NHS Forth Valley has now established an excellent streaming of cardboard to recycling and non-clinical waste to domestic waste, resulting in an approximate 20% reduction in its orange clinical waste.
Oral vs intravenous medication
NHS Forth Valley has changed its approach to several medications promoting the oral route rather than intravenous, which has seen a 30% reduction in the use of IV paracetamol.
Surgical suction system
Many surgical procedures require large volumes of fluid for irrigation. Traditionally, the waste fluid was treated as clinical waste, solidified and added to the orange clinical waste stream. NHS Forth Valley has invested in a certified system of filtering this waste fluid and disposing of the remaining ‘dirty’ fluid into the sewage system as authorised by Scottish Water and SEPA. This has saved in the region of 1000 tonnes of ‘clinical’ waste and has improved the staff experience by reducing the manual handling from floor level of multiple 5kg recepticles
Reduction in energy consumption
Each theatre has dedicated heating, ventilation and air conditioning (HVAC) units which use expensive electricity 24 hours a day, seven days a week, even though the theatre may only be in use for some 50 hours of the week. Theatre staff are working with Infection Control and Facilities Management colleagues to reduce the speed of fans and therefore energy consumption, with a possible move to complete switch-off in certain theatres. Each theatre also has an anaesthetic gas scavenging system (AGSS) which has high electricity consumption, and again is often only required for relatively few hours per week but is currently required to run 24/7. NHS Forth Valley is supporting research into the effectiveness of these AGSS units with modern ways of working in providing anaesthesia, which may result in these becoming obsolete.
Other initiatives that have been rolled out across NHS Forth Valley include a Gloves off campaign, procurement of washable identifying theatre hats, installation of automatic electrical equipment switch-off, moving from paper to digital recording, reduced drug stock to minimise wastage, ‘lean’ theatre trays and procurement of reusable gowns and drapes.
NHS Forth Valley continues to work with all colleagues from across the organisation to make the throughput of patients within its theatre suite as safe, efficient and carbon neutral as possible, while encouraging other across the health and social care sector to join in on the ‘Green Theatre’ journey.
You can find out more about our Climate Change and Sustainability work on the NHS Forth Valley intranet.
