Delivering vital interventions, medicines, and all other healthcare services are responsible for a major part of the NHS’s carbon emissions. We need to redesign our services to reduce their environmental impact, whilst maintaining the highest standards of care delivery.
To achieve this, we will:
• Continue reducing our use of the most harmful anaesthetic gases
• Minimise the use of metred dose inhalers (MDIs)
• Ensure our models of care are environmentally and financially sustainable
• Reduce the environmental impact of pharmaceuticals we prescribe.
A new initiative to reduce the usage of nitrous oxide for trauma patients in UCLH’s emergency department is being implemented.
The project, led by Dipak Mistry, involves the introduction of a recyclable single-use anaesthetic dispenser called Penthrox; an innovative solution that bridges the gap between polluting nitrous oxide and resource-heavy anaesthetic usage.
“When patients come to the ED and need strong pain relief for, for example, a shoulder dislocation, they have historically either been offered nitrous oxide from a portable cylinder, or, if their pain is severe, procedural sedation which requires space in a resus bay and the support of additional staff,” said Dipak.
“The problem is that Entonox cylinders contribute to nitrous emissions, which are polluting. And if they are in a lot of pain, nitrous sometimes doesn’t touch the sides, and they then need strong IV opioids and or to be sedated, which means a longer stay in the ED.”
Penthrox is a single-patient use vial containing an anaesthetic agent that vaporises. It includes a charcoal scavenger for unused gas, is recyclable, and, as it is not a controlled drug, it can be easily prescribed. Importantly, Penthrox can be administered in any location, meaning that a specialist bay does not need to be available for the patient. This can reduce the length of stay in the ED by at least two hours and also frees up staff who would otherwise be called in to support procedural sedation.
While Penthrox has been widely used in the NHS for some time, this is the first time it has been implemented in the emergency department at UCLH.
“Moving towards using Penthrox in the ED represents a significant step forward in sustainable healthcare,” said Dipak. “By reducing reliance on nitrous oxide and minimising resource usage, our emergency department can provide better care for patients while also protecting the environment.”
The anaesthetics team at University College Hospital has taken another step forward in sustainable practice with the introduction of Coolsticks, an environmentally friendly alternative to ethyl chloride spray for testing anaesthetic nerve blocks.
Ethyl chloride—a volatile gas—has been widely used in maternity anaesthesia to confirm the effectiveness of spinal nerve blocks during caesarean deliveries. However, the production, transportation, and disposal of ethyl chloride spray cans pose environmental concerns, prompting the search for a greener alternative.
Coolsticks, reusable devices consisting of a metal head and plastic handle, offer a simple yet impactful solution. Stored in the fridge, they provide the same cold sensation needed for nerve block testing without the environmental drawbacks of ethyl chloride. Unlike the traditional spray, which is both a pollutant and a single-use item, Coolsticks can be reused for thousands of patients.
“We use around 500 cans of ethyl chloride a year at UCLH, mostly in maternity,” explains Dr Peter Odor, who led the initiative alongside Dr Hannah Biker and Dr Rob Craig. “By switching to Coolsticks, we estimate we could cut our use of ethyl chloride by 50 per cent in the first year, reducing carbon emissions by approximately 125 kg annually. Over the next decade, this shift will lead to a significant reduction in our environmental impact.”
A comprehensive evaluation confirmed that Coolsticks are just as effective as ethyl chloride, and patient feedback has been positive. “Patients don’t notice a difference—it works just as well,” says Dr. Odor.
This initiative is part of a broader push within the anaesthetic community to rethink practices with sustainability in mind. “A lot of what we do in anaesthesia is based on ritual rather than rationale,” Dr. Odor adds. “By re-evaluating our methods, we can make small but meaningful changes that add up over time.”
UCLH is among the early adopters of Coolsticks, joining approximately 15 other NHS trusts using them. The findings of the evaluation have been published in the International Journal of Obstetric Anaesthesia, providing a roadmap for other hospitals considering the switch.
Over half a million non-sterile blue gloves have been saved from landfill betweeen launching our Gloves Off initiative in May 2023 and March 24.
This reduction in glove use has saved around 15 tonnes of carbon from entering the atmosphere, roughly the same as driving 40,000 miles in an average petrol car. This is alongside delivering a cost saving to date of around £50,000.
As long as there is no risk from blood or bodily fluids, and the patient is not infectious, staff do not need to wear single use non-sterile nitrile gloves when:
- Taking patients’ vitals (e.g. blood pressure)
- Moving patients
- Assisting patients with food or drink
- Examining or touching a patient
- Giving vaccinations
- Administration tasks near patients (e.g. using the computer)
- Moving a patient’s belongings
Excellent hand hygiene remains expected in all situations, even when gloves are required.
The project has been well received by all areas, and the sustainability team have even been approached by The Royal Melbourne Hospital in Australia about implementing a similar project, after the team there learned about it online.
Jam Phil De La Pena, deputy charge nurse, said: "It was fun leading the gloves off campaign in T10 medical. There is a significant drop of glove use in the ward since we started the campaign and I hope that the team will continue this practice and keep in mind sustainability and infection control."
Lisa Worden, staff nurse, said: "Gloves Off has produced some interesting discussions and made us examine our practice. Putting on gloves to do anything for our patients had become a habit, we are now questioning whether gloves are really needed for a particular activity. It is exciting seeing our glove usage fall.”
Taking action: Greener operating theatres
