Hi, I am a consultant Orthopaedic upper limb surgeon in the West Midlands. I am involved as a clinical advisor in the project to refurbish what is currently a ward to provide 4 new Laminar flow Orthopaedic Operating theatres. I am interested to find out if there are any ideas to incorporate sustainable features in the design and commissioning process for new theatres.
I have seen the royal college of Surgeons document which advises on the use of foot operated taps, and the CSH network advice not to run the AGSS 24/7 , especially since we are a cold elective orthopaedic site, so theatres will not be in use at night or weekends (currently).
Does anyone have any more ideas that we should look to incorporate at the design stage?
Hi Mr Simons,
A number of our customers are considering our waste anaesthetic gas capture and recycling solution as part of new theatre design and builds, to prevent the associated release of significant CO2e emissions. I can be contacted at luke.rawlinson@sagetechmedical.com and our website is SageTech Medical | Leading Sustainable Anaesthesia
Hi Adrian,
A necessary question asked previously but really important to get right first time round as there wont be another opportunity for decades. This can be answered by looking at the biggest contributors of the theatre carbon footprint. Firstly it is Desflurane. When this is eliminated then it is energy use from HVAC.
Like with anything I'd suggest developing close ties to those with an interest in sustainability in the Anaesthetics and Estates department. Estates are heavily influenced by what we want.
Are most of your operations done via regional or GA methods, or maybe a combination?
Will the Anaesthetist need an Anaesthetic room? If not, this will save duplication of all the equipment, saving hundreds of thousands of pounds.
If GA; then is nitrous oxide used? If not, then the theatres will not need to be connected to the nitrous oxide manifold (95% Nitrous oxide is lost through waste). This can prevent the installation of nitrous oxide piping.
If not using volatile, is TIVA the predominant means of delivering anaesthesia - invest in infusion pumps and depth of anaesthesia monitoring.
I'm glad you've thought about AGSS and HVAC. Sensor based activation of theatres i.e. passive infrared sensory (PIR) activation is a common means used in theatres.
(If you want to look at the carbon and economic burden of AGSS use currently in the theatre complex then please use this tool - https://sustainablehealthcare.org.uk/what-we-do/sustainable-specialties… )
These sensors can be linked to lighting, HVAC and AGSS. This will result in theatres only being activated when people are present. Utilise the capacity of 'double knock' sensor activation - your estates team will understand what this means. This will prevent inadvertant activation when someone walks in just the once in the middle of the night i.e. cleaners.
Discuss with the ventilation safety group what would be a safe parameter to turn the theatre setback HVAC motors to. A lot of setbacks when theatres are not occupied still run at over necessary rates i.e. >50%. As long as theatre humidity is <70% as per HTM02-01 then there should be any reason for the HVAC system to turn on in the middle of the night.
Hope this helps.
Jason
Good afternoon
I echo all of Jason's advice and so I will not repeat it.
Refreshing to see the subject of sustainability so interwoven with theatre design. I have just enjoyed a conference hosted by Health Care Without Harm (useful resources on their web site) in which the Scottish strategy was presented https://www.gov.scot/publications/nhs-scotland-climate-emergency-sustai…
I know there are theatre specific strategies included.
Ideas I have also heard described include
Design the operating space to make separation of waste at source easy. Perhaps much as we do in our own kitchens.
Map clinical processes. An interesting presentation from Denmark this afternoon examined waste for the same THR in 5 different institutions. Range 6 to 13 kg per case. Explore unnecessary packaging/inserts/products.
Similarly for patients within the healtcare system and passing through your new development, map that process and look for efficiency (human resource) savings and areas of process replication.
Building on Jason's points. If the move is to TIVA and or regional anaesthesia, ensure the design and layout is conducive to the preparation and performance of LA blocks efficiently so reducing patient turn around time. I'd advocate an LA block room or anaesthetic room in the design.
Engage with the staff. This does not mean just your anaesthetic colleagues, but the nursing staff and ancillary theatre staff. All will have ideas to improve sustainability. If their ideas are included then they have buy-in and they will adopted.
Tom Pierce
Retiring Environmental Advisor, Royal College of Anaesthetists
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