Sustainable Diathermy Use

Reusable diathermy return electrodes (pads). 

Project completed as part of Wrightington, Wigan and Leigh (WWL) Green Team Competition 2025.  

Team members:  

• Miss Naomi Mackenzie, Consultant Surgeon, Royal Albert Edward Infirmary, Wigan 
• Miss Kerry Foley, Surgical Registrar 

Setting / Patient Group:

Elective and day-case theatres across Wrightington, Wigan and Leigh (WWL) NHS Trust, covering 23 theatres across three hospital sites. 

Issue 

Single-use diathermy pads are widely used across WWL theatres, contributing significantly to clinical waste and lifecycle carbon emissions. These pads require skin preparation, cannot be reused, and are sensitive to moisture. Patients with tattoos, metal implants, or fragile skin require additional consideration. Despite low baseline risk of harm, reusable alternatives offer potential to further reduce risk to patients while minimising environmental impact and clinical inefficiencies of single-use pads.

Intervention 

The team aimed to evaluate and plan a trust-wide switch to reusable diathermy return electrodes compatible with existing equipment. A previous trial in 2022 provided valuable data on compatibility, staff feedback, and clinical performance. The intervention involved modelling environmental and financial impacts, gathering procurement data, and preparing for stakeholder presentations to secure approval. Staff from multiple specialties trialled the reusable mats, and feedback was collected on usability, safety, and integration into current workflows. Procurement has confirmed compatibility and pricing, and the team is now seeking executive approval to implement the change. 

Outcomes 

The team have modelled impact based on replacing approximately 8,300 single-use diathermy pads per year with 24 reusable alternatives with a 2 year lifespan. 

Clinical:  

• Reusable pads unaffected by moisture, reducing burn or electrical risks.
• Avoid repeated pad application mid-surgery, preserving the sterile field.
• Safer for patients with tattoos, metal implants, or fragile skin.
• Overall improvement in reliability and reduction in clinical risk. 

Environmental:  

• Estimated annual savings of 1,505.4 kgCO₂e, equivalent to driving 4,429 miles in an average car. This includes a 20% loss/damage assumption. 

Financial:  

• Projected annual cost increase of £7,333.  The main financial barrier is the fixed 2 year lifespan rather than a use-based lifespan. Targeting high-volume theatres could improve cost-effectiveness as each diathermy would be used more within the two-year window. 

Social: 

• Strong staff support and engagement from 2022 trial.
• Easy to use, no extra training, seamless integration, and boosted morale through greener practice.

Key Learning Point 

Carbon savings are clear and compelling. Success hinges on procurement and senior leadership approval in light of cost increases, though this may be avoidable with strategic rollout in high-use areas. Strong staff engagement and alignment with organisational sustainability goals were critical enablers. Previous trial data and compatibility with existing equipment significantly supported the case for change.