17th February 2025
It is widely accepted that the climate crisis is an increasingly significant problem on a world-wide scale. Healthcare systems globally contribute significantly to emissions of greenhouse gases (GHGs), and the perioperative environment is a substantial contributor to this due to the high utilisation of disposable resources, production of non-recyclable waste and the use of medications with a high carbon footprint such as volatile anaesthetic agents.
Whilst the nature and scale of this problem is largely accepted; the question of how to make healthcare practice more sustainable without compromising patient care does not have as much consensus.
The issue of climate change is global; however, we suggest that in-depth assessment of the regional practices allows for meaningful changes to be made in order to move towards more sustainable practice.
This project provides a useful framework that can be replicated in other regions with an aim to improving sustainable practice in the perioperative setting.
Our study consisted of 4 main phases.
Firstly, we reviewed 11 ICS Green Plans from systems across the Midlands (United Kingdom), to identify key broad areas of potential improvement that are not currently being meaningfully addressed by current plans.
Secondly, we performed a thematic literature analysis, to identify and consolidate potential interventions to address the areas previously identified in the green plans, and key barriers in doing so.
Thirdly, we performed a stakeholder survey to gauge an initial response to potential interventions suggested.
Finally, we made some recommendations of interventions that can improve sustainability in the perioperative environment.
Our review of the ICS Green plans highlighted significant variation in the quality of plans across systems in the region. One area which was consistently poorly addressed in plans was the supply chain and procurement, which is a key priority area given it accounts for 63% of emissions, in addition to waste management and recycling. Our thematic analysis focused on these, exploring methods of improving sustainability as well as the key barriers in achieving this.
The analysis highlighted concerns about infection control, cost implications, instrument damage and safety, and inadequate waste management practices as key barriers in making these changes.
Our stakeholder survey highlighted that the barriers resisting change largely consisted of attitudes across the multi-disciplinary team and lack of awareness.
To summarise, there needs to be an increased drive towards more sustainable practice in the perioperative setting if the NHS is to achieve its “net zero” carbon target by 2045. Our study highlighted that across systems in the Midlands of the UK, there were key areas for improvement in the current ICS Green plans pertaining particularly to procurement and supply chain, as well as waste management and recycling.
Our thematic analysis and stakeholder survey suggest that the key potential barriers to this may be addressed by investing in comprehensive training programmes and implementing rigorous quality control measures with input from infection prevention, procurement teams, clinical leaders and clinicians.
Green Surgery report
Click here to be taken to the UKHACC Green Surgery report on reducing the environmental impact of surgical care.