A recent article in the Journal of Climate Change and Health by Asfaw et al from the Cleavland Clinic has given us some ideas which we’ve synthesised into the below table for easy digestion! What ideas do you have to add? Tell us on twitter
| SUMMARY POINT | PRIMARY DRIVER | CHANGE IDEAS |
| HVAC ‘setback’ | Reduce energy consumption | Minimise air exchange in unoccupied areas |
| LED lighting review | Reduce energy consumption Reduce radiant heat | Existing type of lights? Consider replacement |
| Power down checklists | Reduce energy consumption Reduce radiant heat | List appropriate equipment that can be switched off or set to standby mode Scavenging standby |
| Choose reusable supplies where possible | Reduce waste Reduce carbon footprint | Review disposable items Review life cycle analyses Research reusable alternatives Review sterilisation options. Many clinical devices can be reused if cleaned in accordance with accepted guidelines Resources: 2024 MJA article on reducing waste in Operating Theatres CASCADES Resuable First Playbook Video – Reusable anaesthetic circuits – NY |
| Recycle where possible | Reduce waste to landfill | Identify recyclable materials in regular use Integrate recycling into existing workflows Maximise usage of existing recycling programs Visual references Review bin locations |
| Single-use device recycling/reprocessing | Reduce waste to landfill | Investigate with suppliers regarding reprocessing of specific items |
| Waste segregation – medical waste | Minimise usage of energy and cost intense waste streams | Educate on waste segregation Audit waste streams Review with IP&M Engage staff Visual references Review bin locations |
| Anaesthetic inhalational agents | Reduce greenhouse effect of these gases | Low-flows, Regional techniques, TIVA. Cease desflurane use. Nitrous oxide – move to cylinders rather than pipes |
| Reduce or avoid medication waste | Minimise medication leaching into groundwater | Pre-filled syringes for seldom-used drugs Drugs available but not opened Medication disposal units Give oral paracetamol (not IV paracetamol) |
| Water and chemical waste | Minimise unnecessary usage of water and chemicals | Sensors to turn off taps Chemical recycling e.g. formalin and xylene |
| Procurement | Look beyond point of use to minimise waste | Sustainable procurement Sustainable packaging alternatives Product alternatives – biodegradable or compostable |
| Chemicals of concern | Minimise disposal of chemicals | Avoid purchasing items of concern to environment |
| Surgical kits and sterilisation | Minimise unnecessary items in pre-made kits Minimise energy usage from sterilisation | Optimise kits to minimise waste Reusable rigid sterilisation containers Recycle blue wrap |
| Pre-operative evaluation | Minimise unnecessary tests | Choosing Wisely campaign – review relevant points |
| Measurable metrics | Enable review of processes and improvements Improve staff engagement | Engage key stakeholders at health-service and government level to provide data |
The UK Royal Colleges of Surgeons also have a checklist for Green Theatres