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Making operating theatres more environmentally friendly and reducing energy costs for the NHS 

3 January 2024 | Dr Anne Symons and Dr Jonny Groome
Hear from Dr Anne Symons and Dr Jonny Groome about their project which aims to assess ventilation in operating theatres which could save £90m per year and up to 108,000 tonnes of CO2 across the NHS.

UCLPartners’ Connecting for Change programme, part of our climate collaborative, is funding four new research projects we believe can accelerate progress towards reducing the carbon footprint of NHS estates.  

These proposal ideas were facilitated through an innovative ‘sandpit’ methodology. This methodology involved bringing together doctors, nurses, estates staff, and IT teams to work collectively together to reduce CO2 emissions.  

Hear from Dr Anne Symons (Health Care Architect, Senior Research Fellow, The Bartlett School of Sustainable Construction, University College London) and Dr Jonny Groome (Consultant Anaesthetists and Greener Theatres Lead at Barts Health NHS Trust) about their project which aims to assess ventilation in operating theatres which could save £90m per year and up to 108,000 tonnes of CO2 across the NHS.

Cutting energy waste in operating theatres to help the NHS reach net-zero by 2040

Around 10% of the NHS’ carbon footprint comes from energy consumption, with operating theatres being among the installations that require the most energy. Approximately half of the energy is used by IT, medical equipment and lighting and the other half comes from the anaesthetic gas scavenging system (AGSS) and ventilation systems. A lot of this equipment is left running when the theatre is not in use. Considering that operating theatres are used for less than half of the time per week, there is lots of potential to reduce the NHS’s CO2 emissions whilst simultaneously saving money. Some of these issues can be addressed by changing people’s behaviour, but if we want to reduce the amount of energy used by ventilation systems, we need to change operating systems and look at whether placing them from ‘low powered set back mode’ to an ‘off mode’ can be done without having any negative impact on patients.  

The considerations we need to take into account are twofold: first, we need to look at risks from a patient safety perspective. Second, we need to assess risks from an operational perspective.  

From a patient safety perspective, robust evidence can be found in the microbiological data available. The data shows that there is no risk to patient safety if the ventilation is switched off when the theatre is not in use and is then switched on again 30 minutes before use. We will be looking at surgical site infections, and air flow within theatre, amongst other things, to further assess the safety aspects of turning ventilation off.  

From an operational perspective, we also need to look at whether the building management systems can be adjusted to save energy, especially as different hospitals use different systems. For example, timers and trigger points would need to be set to start up the ventilation when needed. Moreover, management systems for operating theatres need to be updated so that individual theatres can be maintained independently of each other. In line with these changes, maintenance protocols would need to be updated as well. When these changes are in place, it is important that staff are provided with clear instructions on which pieces of equipment need to be turned off, how to turn them off and what needs to remain on charge.  

The first step of our project is to look at a wide range of operating theatres across the UK used for different kind of operations. That is important for us to develop a useful dataset. The number of staff, the kind of and quantity of equipment, the activities that take part in the theatre, the ventilation system as well as the floor space all need to be considered when changing procedures. There is also an opportunity for us to learn from hospitals abroad which use systems that are not used in the UK.  

Protecting the climate and reducing the bills 

Our models predicts that the NHS could save around 36 tonnes of CO2 and – based on 2022 energy prices – £30,000 per year per theatre.

Across the NHS that would save up to 108,000 tonnes of CO2 and £90m per year. 

That is the equivalent of taking 76,000 cars off UK roads and would not only be a significant contribution to the NHS’s pledge to reach net-zero by 2040, but it would also save lots of money that could be spent elsewhere in the NHS. Our project is not about spending money on new equipment, it is about optimising the equipment hospitals already have to not only reduce CO2 emissions, but also to reduce energy bills. 

Getting everyone on board 

As academics, clinicians and architects we bring very different skill sets to the table that complement each other.

Academics are experienced in formulating and conducting research. Clinicians can offer their experience from working in theatres and can provide access to relevant contacts that manage the hospital estate as well as relevant manufacturers. Architects can discuss layouts with clinicians and then translate that information for the people who install the equipment at the hospital sites. It is about bringing it all together to drive our joint objectives forward.

Early successes and long-term goals 

One of the real positives for us was the enthusiasm at the board level in Trusts we are working with. We selected two NHS sites initially – Barts Health NHS Trust and University College London Hospitals NHS Foundation Trust.

The engagement by the whole team from junior to senior roles was incredibly positive.

We were also contacted by a third London NHS trust which would like to get involved, so there is clearly interest in and support for our work. Moreover, we are liaising with colleagues in other European countries to exchange our knowledge and we are working with mechanical engineering students who support our project. It is widening out and the more research we do, the deeper we dig, the more information we find about how to reduce emissions and costs. 

We would like to demonstrate significant cost and carbon reduction across the NHS estate and our hope is that our project will set the standard for how we manage energy consumption in operating theatres. But we would like to go even further and look at how we can create theatres that are more energy efficient in future. We can make changes to current theatres now, but future theatres need to be energy efficient from the start. That requires us to update building guidance which needs to place more emphasis on the evidence we generate and the recommendations we make. 

The role of UCLPartners 

Collaboration is not always easy and it is not always easy to get funding to conduct research into energy efficient estates, but UCLPartners have struck gold here and this shows what kind of collaboration is possible. This is not silo based research. This is fast action, collaborative research that provides us with vital links. This is going to make a difference and we could not have done it without UCLPartners. 

UCLPartners have struck gold here. This is fast action, collaborative research that provides us with vital links. 

How can anyone who is interested in your work get in touch if they’d like to hear more? 

We would be very happy to speak to anyone who is interested in our work. You can contact us at Anne.symons.14@ucl.ac.uk or jonathan.groome@nhs.net 

This work is part of the UCLPartners’ Connecting for Change programme which is funding four new research projects we believe can accelerate progress towards reducing the carbon footprint of NHS estates.