Green Theatres Programme

NHS Tayside has worked hard to reduce greenhouse gas emissions
Clinical teams within NHS Tayside have been working with colleagues in medical physics, pharmacy and estates to deliver a reduction in emissions across all acute hospital settings.

As part of this, all Nitrous Oxide (N2O) and Desflurane cylinders have been decommissioned and the pipelines shut down to prevent gas wastage in Stracathro, Perth Royal Infirmary, Ninewells.

N2O and Desflurane are just two of several anaesthetic gases used by NHS Tayside. Rather than making these gases unavailable, they can still be accessed in smaller, portable cylinders when required for essential clinical use.

Public dental services in Perth & Kinross have also decommissioned their N2O cylinders with the services in Dundee and Angus progressing towards this and shutting down their pipelines. This will result in a future reduction in emissions.

Dr Pavan Bangalore, consultant anaesthetist and clinical lead for sustainability and climate change, said, "This is a great step forward in reducing the carbon footprint of NHS Tayside. This is another great example of collaborative working across services to deliver projects which have a really positive impact on the environment and for our colleagues."

  
The 4 steps of surgical hand disinfection

To ensure that all germs are effectively inactivated, the procedure for surgical hand disinfection is precisely prescribed. Surgeons, doctors, and assisting staff must adhere to the following steps.

Wash hands: 10 minutes before the first hand disinfection procedure on operation day, thoroughly and carefully wash and dry the hands and forearms (if several operations are performed in a day, this step must only be done once as long as the hands do not get dirty).
Wet hands and forearms with disinfectant: Operate the dispenser lever with the elbow and wet both hands and forearms with sufficient hand disinfectant.
Rub hands and forearms with disinfectant: Then rub the hands and forearms and keep them moist for the entire exposure time of 1.5 minutes. If necessary, add more hand disinfectant.
Drying: Allow the hands and forearms to air dry before putting on the surgical gloves.
Illustration of the four steps of surgical hand disinfection.
The individual steps of surgical hand disinfection are precisely prescribed.

“Rub” vs. “Scrub”

Better skin tolerance, more efficient inactivation of germs and time saving: The advantages of "Rub" over "Scrub" are obvious.
Better skin tolerance, more efficient inactivation of germs and time saving: The advantages of "Rub" over "Scrub" are obvious.
Steps two and three of the instructions described above have only become common in recent years and reflect the transition from "scrub" to "rub". In the past, people did not use disinfectants to prepare for surgery, but washed their hands with water and antimicrobial soap ("surgical scrub"), mainly with chlorhexidine or iodine. Special sponges were used for this purpose, with which surgeons and their team scrubbed their hands for several minutes under running water.

The disadvantage of this technique is that frequent washing with soap and water, combined with intensive scrubbing for several minutes, can cause skin irritation and even inflammation. Frequent washing with soap and water also makes the hands brittle and cracked, making viruses and bacteria harder to inactivate. In recent years, more and more hospitals have introduced alcohol-based hand disinfectants ("rub"), which irritate the skin less. The refatting substances in products such as Sterillium®* help the skin maintain or even rebuild its natural protective film.

But it is not only the better skin tolerance that speaks in favour of "rub" instead of "scrub" – various studies have shown that alcohol-based hand disinfectants also inactivate the viruses and bacteria found on the skin more effectively than traditional antimicrobial soap. Especially when it comes to the long-term reduction of pathogens on the skin, disinfectants show a greater effect. Another important point is that the modern "rub" technique takes much less time than scrubbing hands with soap and water for minutes on end.

This is an area which is not just unique to Theatres but can be looked at across all services.

Can we replace any of our single use items with reusable items?
Do we need the item in the trays we receive?  If not let Procurement know to seek an alternative
Can we wipe and reuse trays? rather than using disposable kidney dishes?
There are lots of areas where we can reduce waste and plastics used  

NHS Tayside is working in line with Estates teams to minimise energy use and switch off ventilation systems in theatres where this is currently possible and looking at amendments needed to enact in those which cant be switched off currently