Refurbishing Anaesthetic Rooms to make them Greener!

Jason Gandhi's picture

Hello, 

We're currently about to embark on refurbishing/changing the layout of several anaesthetic theatres in our trust. This is something I haven't been able to find much literature on but I was wondering if anyone had any experience or thoughts with how to create a greener anaesthetic room that improves both safety and sustainability of our practise!

Any comments/suggestions will be most welcome!

Cheers,

Jason

 

Comments

Reduce, Reuse, recycle.

Dan Connor's picture

At our hospital (Portsmouth) we haven't used anaesthetic rooms for about two decades. The older theatres still have the physical space, but the new bits don't. I would be uncomfortable using them now to be honest. Great savings in costs and resource, so on the 'reduce' principle automatically greener. 
We have been through all the usual objections (turnover, crowd control, patient acceptance etc) and none of them are a real problem once managed. 

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Thanks for this Dan

Jason Gandhi's picture

Thanks for this Dan

I completely agree with you and I am also in the field of not wanting an anaesthetic room but it'll be a difficult sell. Therefore I'm curious as to what the options are if we still had to have an anaesthetic room and how it could be economised financially, ergonomically and sustainably...

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Interested in the idea of not using trad anaesthetic rooms

Paul Rich's picture

Like everyone we got used to inducing patients in theatres during the worst of COVID. Apart from not requiring duplicate anaesthesia workstations and monitors, are there any other savings to be made? What uses have the rooms been put to other than anaesthesia storgage. Do you still use anaesthesia rooms for kids and orthopaedics - thinking of keeping things clean and doing blocks ?

Paul (RCHT)

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Streamline disposal points

Guy Wing's picture

Have you considered using re-usable sharps/ pharmacy disposal containers in your anaesthetic area and eliminating single-use plastic?

Through my work I have seen a spectrum of wasteful practices e.g. 2x yellow lidded single use sharps & 1 blue lidded pharma bin in the anaesthetic area alone.
However, this can be replaced by a single re-usable medicinal sharps container, reducing the carbon footprint by 86%.

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Steamlining disposal Points - eco sharps and medicine waste bins

Lynn Sproat's picture

Hello,

Several boards in Scotland have evaluates eco sharps and medicine waste bins and are looking to implement these including NHS Highland and Lanarkshire.

Our board is also investigating this.

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Hi Jason,

William Udall's picture

Hi Jason,

Is it the whole theatre or just the anaesthetic rooms that are being changed? Will there be the option of moving gas outlets/pendents in theatre?

Although there is currently resistance to inducing in theatre, I think this will change over the next few years. Whatever is implemented, it should probably have a degree of flexibility involved with the option of undoing it easily if plans change.

For instance, if new instalations such as cupboards/worktops are able to be easily relocated, whether on wheels or put together with screws/bolts rather than nails/glue, this would help with any changes going forward.

Large installations again reduce flexibilty and storage for different waste segregation bins.

Regarding gas/power outlets, can they be located in a position that allows the anaesthetic machine to be in multiple locations without additional pendents/empty leaking gas outlets.

Some thoughts, if I think of anyone who's been through similar I'll get in touch.

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Anaesthetic rooms/waste bins

Jason Gandhi's picture

Thanks all for the ongoing input. It's great to have such a positive response around this question. 

Paul - I feel that there are savings from many different angles. Without knowing the finer details each square metre of hospital floor space requires heating and electricity. Removing the anaesthetic room or merging the anaesthetic room into theatres would reduce the overall floor plan whilst also maintaining its function. You've also mentioned the lack of need to duplicate equipment such computers. We wouldn't need additional piping in the walls, no more outlets in two rooms in such close proximity. Less sockets, less cables -I wonder how much copper could be saved by getting rid of unnecessary plug sockets. Getting rid of a ventilator. Reducing the numbers of non kink tubing with NIST connections etc. How many consumables are associated with ventilators? Anaesthetising a patient on the operating table to reduce needless transfers once anaesthetised. No need to move an anaesthetised patient without any monitoring connected whilst moving from one room to the next - better safety. Improved and smoother daily workflows. Anaesthetising a patient in the operating room would give a greater impotus for surgeons to be ready to go instead of waiting for patients to be wheeled into the theatres once anaesthetised. Dare I say it, but maybe with out an anaesthetic room and improved workflow, there could be one extra patient added to each theatre list? This may utilise the theatres more efficiently and provide us with a better economy of use. Instead of patients being blocked in anaesthetic rooms, could they be blocked by a dedicated regional anaesthetist in a recovery area and then transferred to theatres once theatre is ready - creating a conveyor belt so to speak. Recovery could then have more than one purpose and not be empty for most of the morning. Sterility could be maintained for regional in many environments. 

Guy - Thanks for the advice. Completely agree and its something we have already adopted. The question is I guess from a waste point of view, how can you set up an anaesthetic room to get the waste put into the appropriate bins/segregated without too much thought for the less conscious folks? 

Will - We will be removing nitrous outlets in the anaesthetic room. The mobile worktops are a great suggestion and will make the rooms versatile. 

Enough of me rambling, any additional suggestions will be more than welcome! Thanks in advance

Jason

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My advice on sustainable waste: keep it simple

Guy Wing's picture

Sorry for the delayed reply Jason, great to hear you are using the Sharpsmart re-usable containers. A couple of things that aren't always common knowledge about waste in the anaesthetic areas:

1. Sharpsmart Yellow lid containers are dual-coded to compliantly collect both potentially infectious & Medicinally Contaminated waste. However, a blue lidded container cannot be used for the disposal of sharps or bodily-fluid contaminated items. Therefore, in areas where segregation is not always followed carefully, having both container types will likely lead to waste non-compliance.

2. Waste Collected in a yellow lid Sharpsmart container is treated with a less CO2 intensive process than blue-lid pharmacuetical waste. Sharpsmart have a patented non-burn technology which treats medicinally contaminated sharps using approximately 600kg CO2e/ tonne compared to High Temperature Incineration (legally required for Pharmacuetical Waste) which has a footprint of 1060kg CO2e/tonne.

Let us know if this is useful or something you have considered before, Guy

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Were having a trial!

Paul Rich's picture

Although we already have our anaesthetic rooms we have decided to trial anaesthetising in theatre in one of our elective theatre suites (as we did in early COVID days) for two weeks, to see how it feels in the absence of (AGP Pressure) and to see if throughput is faster or slower. We will also be looking at potential resource savings - AR machines and monitors could be relocated to a new build rather than buying new ones for instance. I'll let you all know how we get on.

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How did you get on with the

Jason Gandhi's picture

How did you get on with the trial @Paul Rich?

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Greener Anaesthetic Rooms & THEATRES - BIG ROOM?

Jasmine Winter Beatty's picture

This is a fantastic thread!

Probably obvious but VCT and n2o destroyers should probably be included? (if n20 used at all).

PS Jason can we set up an other virtual meeting? maybe a "BIG ROOM" for all OR practitioners? this could be a very interesting topic to start with! maybe we could talk about re-greening the OR too?

Also is there a surgical/AHP/OT manager counterpart to yourself that we could get involved?

As a sustainability champion for RCSEd it would be great to link up and share ideas and this might be a great platform to for a multidisciplinary meeting?

Thank you very much!

j

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Estates and facilities + BIG ROOM

manraj phull's picture

Hi Jason. This seems like a great opportunity to link in with your estates and facilities team re refurbishment. I am working nationally in the Greener NHS team and the Estates and Facilities workstream has recently published the 'Estates 'net zero' carbon delivery plan' Estates Net Zero Carbon Delivery Plan.Final - Greener NHS Knowledge Hub [BETA] - FutureNHS Collaboration Platform - this can be accessed through the Greener FutureNHS platform / I can send you a copy if you can't access it. It might be a good lever to help you drive change and start those conversations with the estates team but also give you some tips. Hope it's helpful. Also completely agree that a MDT approach to all things sustainability is the way to go. The idea of getting everyone involved in a BIG virutal ROOM would be great. Happy to help. Thanks, Manraj 

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Refurbishment

Jasmine Winter Beatty's picture

I thought Ventilation, temperature control and AGSS should probably also be reviewed and have just heard from fellow Green Surgery enthusiast Pete Labib (also on this network) that his trust have introduced smart sensor controlled "Air handling units". He also shared with me this NHS england document that states that they should all be switched off overnight, here is link in case this is useful to take back to your trust: https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM0301-PartB-accessible-F6.pdf

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Hi Jasmine, 

Jason Gandhi's picture

Hi Jasmine, 

Thanks for your wonderful comments - it is refreshing to get that non Anaesthetic perspective!

I've recently heard about the sensor based AGSS and will be doing some more digging. 

I'll have a look at this document but I do wonder if something like this is going into being incorporated into new build theatres as a directive rather than being left to individual trusts to decide.

With reference to your previous comment about nitrous cracking and volatile capture, they are all great ideas, but not solutions that are ready to be implemented nationwide without the evidence that will come from places like Newcastle, Manchester etc showing they are working and the cost benefits...

I've just set up some sharing hour discussion themed on anaesthetic gases for next week, but the following one in January will be on themed 'beyond anaesthetic gases'. This is certainly something you could discuss to gauge the opinion of others!

It'll be on the 17th January and all are welcome! Details will soon follow...

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