Intercollegiate Green Theatre Checklist

According to the World Health Organization, humanity faces its greatest ever threat: the climate and ecological crisis. Health care services globally have a large carbon footprint, accounting for 4-5% of total carbon emissions. Surgery is particularly carbon intensive, with a typical single operation estimated to generate between 150-170kgCO2e, equivalent to driving 450 miles in an average petrol car.

The UK and Ireland Surgical Colleges, The Association of Anaesthetists, The Royal College of Anaesthetists and the Association for Perioperative Practice have all recognised that it is imperative for us to act collectively and urgently to address this issue. Here we present a compendium of peer-reviewed evidence, guidelines and policies that inform the interventions included in the Intercollegiate Green Theatre Checklist. This compendium should support members of the surgical team to introduce changes in their own operating departments. Our recommendations apply the principles of sustainable quality improvement in healthcare, which aim to achieve the “triple bottom line” of environmental, social and economic impacts. This is an emerging field, and therefore this is an iterative document that will evolve with new evidence. 

How to use the Green Theatre Checklist

The checklist is divided into four sections, the first dedicated to anaesthetic care, and the subsequent three looking at preparation for surgery, intra-operative practice and post-operative measures.

We suggest the checklist is initially used at the daily brief at the start of an operating list, as an aidememoire for the team of the modifications that could be applied there and then. Once these practices become embedded into practice, then the checklist may be used less frequently. At present, some theatres will lack the infrastructure required to enact all the suggested interventions and so the checklist can serve as a roadmap for discussion with management, or at departmental meetings, to guide required changes. Finally, if completed regularly, the checklist could also be used as a scorecard to monitor progress.

However you choose to use the checklist, we hope that it will be a valuable tool for staff to identify and understand interventions and considerations to decrease the environmental impact of their work.

We are grateful for feedback and any information on new research and developments, so please do contact us at sustainability@rcsed.ac.uk.

Download the A3 or A4 Green Theatre Checklist Poster below.

Green Theatre Checklist Compendium of Evidence

eQIP Toolkit - Rub Don't Scrub

Traditional hand washing has been estimated to use approximately 18-21 litres of water per scrub, per staff member! Alcohol based hand rub (ABHR) is a waterless method of hand decontamination with the same, if not better, antiseptic capabilities. Some hospitals benefit from intermittent flowing water systems, which can also save significant water use if programmed appropriately. The carbon footprint of 41-degree water from a gas-heated system is approximately 8.4kgCO2e per m3. Therefore, switching to ABHR where appropriate could lead to significant water, energy and carbon savings. Read more here.

Download the Information Leaflet, Poster, Presentation and Data Collection below.