Making operating theatres greener

Trying to reduce the ecological footprint of an operating theatre is a tough challenge.

“So much is disposable, with a lot of water and energy being used,” says senior theatres nurse and practice educator, Harriet Dean-Orange, who works at Brighton and Sussex University Hospitals NHS Trust. “There’s also a perception that it’s a different world, so you can’t integrate sustainability because everything must be done in a particular way. But it’s a misunderstanding.”

For Harriet, awareness grew when she first started working in theatres about four years ago. “It was seeing all the bags of waste,” she recalls. “Literally everything was being put into clinical waste, even sterile packaging. It felt so wrong, when I knew some of this could be recycled.”

Now she is on a personal mission to make theatres greener, reducing waste, lowering the use of vital resources and boosting recycling. “I think the biggest thing I’ve done is not stop talking about sustainability,” says Harriet. “I’ve continually brought new ideas for people to think about and explore. I’ve also asked questions, for example, why can’t you have easily recyclable materials in theatres?”

Key to her approach is encouraging staff to think about what things are made from, whether plastic, paper, fabric or something else. “It’s important for people to understand what it has taken to get these materials to us,” explains Harriet, who has taken on a voluntary role as an NHS England Sustainability and Health Ambassador. “If staff appreciate that disposable gloves cost X, their carbon footprint is Y and they must also be disposed of in a particular way, it makes them think each time about whether they definitely need to wear them.”

Gloves too can also be counter-productive in terms of infection control, argues Harriet. “Bacteria need heat, time and moisture to grow, so wearing gloves for hours on end provides the perfect environment,” she says. “There’s a misconception that once you have your gloves on, you’re safe and protecting yourself and the patient. A lot of my work is about challenging these behaviours.”

A popular initiative has been to stop using polystyrene cups and disposable cutlery. “For me, this was a real gateway,” says Harriet. “It helped people to connect with what we were trying to do. You wouldn’t dream of using these things at home, so why use them at work? For our department alone, the NHS was paying £7,000 a year for throwaway cups. Now we have a really good culture of people bringing in their own mugs and showing them off.”

Other initiatives include segregating waste into four streams, including recyclables, replacing plastic waste containers with cheaper biodegradable alternatives, and reducing the use of plastic bags, including recycling where possible. “I can’t emphasise enough the value of having a really well-structured waste management programme in theatres,” says Harriet.

She has also focused on water usage. “Hand scrub preparation takes about five or six minutes, with the hot water tap running throughout,” says Harriet. Now staff are educated about alcohol-based solutions, which have the added benefit of helping to eradicate skin problems, alongside dramatically reducing the volume of water used.

Among the challenges is trying to identify the precise amounts of energy and money they are saving. “It’s hard to say to staff, we know you are making a difference, but I can’t give you the numbers,” says Harriet. “We would love to be able to give something concrete back for the efforts that people are making.”

Another has been challenging the negative attitudes of those staff members who believe it’s too difficult, too big to tackle or just not worth it. ‘You have to be willing to be unpopular sometimes,” she says. “And try to be light-hearted. Doom and gloom never work, so I try and keep a positive and educational stance, shaping the message to the particular audience.”

For Harriet, it’s the small wins that add up. “Sustainability isn’t about a top down approach - it’s a collaborative movement,” she says. “Even though what we’ve done so far is small, it’s growing and we’re becoming known for it. I take a great pride when someone says, ‘I can’t believe we used to throw these away’, and they’re re-using it.”