Abstract
As I write this, the COP26 Summit is underway in Glasgow as we hope for a better environmental future. And, as you read this, you will be working towards Christmas and hoping for a better one than last year.
In October, at the London Operating Theatre Show, I had the privilege of speaking during a day exploring ways of increasing our surgical productivity. My presentation focused on the ecological impact of those initiatives. NHS England published ‘Delivering a “Net Zero” National Health Service’ in October 2020. It’s a document that states that the NHS is responsible for around 4% of the nation’s carbon emissions. When I asked the audience who had read this document, a show of hands suggested that awareness and readership of this publication was, well – net zero. Have we really bought into it in theatres? Were we really sold it?
I accept there are challenges and issues. For example, a barrier to recycling items is the cost of the pre-recycle decontamination process for clinically used items. My counter argument to this is the cost of clinical incineration which is huge. One other issue is that many single use anaesthetic items such as some supraglottic airway devices are mainly non-recyclable. Fortunately, there are some glimmers of hope lead by groups around the country. These include:
The recycling of clean outer packaging from surgical items, anaesthetic laryngoscope blades and Magill forceps once decontaminated.
Reducing the use of environmentally harmful anaesthetic gases such as nitrous oxide and desflurane.
Promotion of low-carbon alternative products and processes in surgery, including reusable instruments, maintenance and repair.
Using Rigid Sterilisation containers negating the need for so much paper wrapping.
Re-imagining Operating Theatre Architecture, to include carbon-efficient ventilation. The ‘Green Surgery Challenge,’ which AfPP is a partner of and organised through the Centre for Sustainable Healthcare, aims to tackle some of these key issues and the winners of the challenge will be known by the time you read this.
The Scottish Environmental Anaesthetic Group are doing some great work. See their video in the link. It is 25 minutes long but worth a watch.
There are some questions that require further enquiry. What is on your instrument tray? Is every single-use item needed for most procedures? What is the environmental impact of certain single-use surgical trays versus the steam sterilisation process of autoclaving? The answer isn’t always as straightforward as we would think.
What can we do? In preparing the presentation, I discovered that most of the initiatives have come from clinicians. Where are the environmentalists among the theatre staff? Before you respond loudly ‘when do we have time?’ I met some of these theatre champions. Many AfPP members approached me during the conference assuring me they would like to help the cause but need direction. This needs to be lead at executive level so theatre staff can be empowered in their efforts to make a difference. I would also suggest that you have a voice and can raise the issue up to executive level. It would be difficult for them to ignore you.
At AfPP, we have good relationships with our industry colleagues, many of whom were in the audience. I stated that we need to have conversations with them about the environmental impact of their products. During my tour of their exhibition stands several made a point of offering to start those conversations.
For our part, we have created an AfPP Sustainable Theatres Special Interest Group led by Vicky Hain.
I know that during the holiday season many of you will be on duty and some will be at home with family.
To all of you I wish you a Happy Christmas and an environmentally friendly New Year.