Theatre sustainability: our journey to reach net zero

Abstract

Background: In 2021, University College London Hospitals declared a climate and health emergency and committed to reach net zero CO2 emissions by 2031. Our theatre sustainability team has so far focused on (a) reducing our use of inhalation agents, (b) improving our waste streaming, and (c) education. Here we summarise some of our projects. Methods: (a) In February 2021, desflurane was removed from our anaesthetic machines after departmental consensus. Our department purchased 138 TIVA pumps so that availability of pumps was not a barrier to using TIVA. (b) We introduced tiger-stripe bags to dispose of our non-infectious clinical waste. Previously only orange bags were being used for clinical waste in theatre, which have a higher cost and carbon footprint than tiger-stripe bags.1 We surveyed staff on waste management then introduced tiger-stripe bags to one theatre during a pilot week. We carried out daily staff education and weighed all the bin bags. (c) Education initiatives to increase awareness and engagement of staff and patients include audit day presentations, updates at theatre multidisciplinary teaching, a sustainability journal club, and an ongoing patient and staff survey on environmental sustainability and healthcare. Results: (a) There has been a downtrend in use of desflurane to almost zero (Fig. 15). There has been an overall upward trend in use of TIVA (as shown by number of 50- and 100-ml propofol vials used) and downwards trend in sevoflurane use (Fig. 15). A survey conducted in November 2021 showed 50% of those surveyed used TIVA for more than 75% of general anaesthetics. There has also been a downward trend in total volume of nitrous oxide used. (b) The use of tiger-stripe bags during the pilot week resulted in a 32% reduction in waste disposal cost and 59% reduction in CO2 emissions. Tiger-stripe bags have now been introduced to all 27 elective theatres across three separate sites. Conclusions: With appropriate education, engagement, and provision of the required equipment, we have reduced our use of inhalation agents (desflurane in particular), increased our use of TIVA, and made significant carbon and cost savings through optimising our waste streaming. We are now working on reducing our use of single-use items, minimising energy wastage and conducting life cycle assessments of common operations. 1.Rizan C, Bhutta MF, Reed M, Lilywhite R. J Clean Prod 2021; 286: 125446