Sustainable waste management in anaesthesia and critical care

Abstract

Collaborators: Yorkshire Green Anaesthesia Society, Anaesthetic Audit and Research Matrix of Yorkshire, South Yorkshire Hospitals Audit and Research Collaboration Background: The NHS is responsible for 4% of the UK carbon footprint; waste and water are together responsible for 5% of this. The NHS has set targets to have net zero emissions by 2045.1 Anaesthetists report discarding single-use items from pre-made device insertion packs without having used them, thus identifying a potential waste hotspot that could be tackled to reduce environmental and financial costs. Our aim was to identify whether items are wasted from commonly used pre-made packs in anaesthesia and critical care, and if so, quantify the carbon footprint and financial costs of this waste. Method: All acute hospital Trusts in Yorkshire and Humber were invited to participate. Data were collected for a period of 2 weeks on the items discarded unused from the following premade packs in anaesthesia and critical care: spinal, arterial line, central line, and cannula. Waste hotspots were identified as items most commonly discarded unused across all pack types. One of each of these items was broken down, and the constituent materials were identified and weighed. The weight for each item was multiplied by a conversion factor from the ICE database to calculate their materials’ carbon footprint.2 Results: During the study period, data from 319 pre-made packs were reported across 10 Trusts. All the reported packs included single-use items that were thrown away unused. There was variation in the constituents of each pack, however overall, the following items were most commonly wasted when they were present in a pack; 100% of cannula pack drapes, 90% of disposal bags, 74% of sharps safety disposal mats, 56% of green needles, 56% of 2 ml syringes, 51% of non-woven (white) gauze, 43% of gallipots, 38% of orange needles, 35% of 5 ml syringes, and 16% of woven (green) gauze. The total carbon equivalent of the top nine items thrown away, for which material information was available, was 8.94 kg CO2 equivalent (CO2e). Extrapolated over 1 yr this equates to a CO2e of 232 kg. The total weight of these items was >2 kg, equating to 56 kg unnecessary waste per year. Disposal of these would equate to a carbon cost of a further 20 kg CO2e over a year.3 Conclusion: Device insertion packs are a waste hotspot. The waste identified has environmental, financial, and social impacts. A multidisciplinary approach including healthcare staff, procurement teams, and suppliers is necessary to reduce waste from single-use device insertion packs. This might include exploring reusable options and removing unnecessary items from pre-made packs. 1.NHS. 2020. Delivering a ‘net zero’ national health service. Available from https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf (accessed 20/03/23)2.Circular Ecology. 2019. Embodied Carbon – The ICE database. Available from https://circularecology.com/embodied-carbon-footprint-database.html (accessed 20/03/23)3.Rizan C, Bhutta MF, Reed M, Lilywhite R. J Clean Prod 2021; 286: 125446