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Yeah, we're live now. We're live now. Ok. Hello. Right. Hi, everybody. Uh welcome to the breakout session. This is theater emergency and intensive care breakout session. Uh My name is Helen Wilkins. I'm um an E consultant in Coventry and work with Green and I've got Olivia with me who is a medical student. Sorry, not a medical student. Sorry. F two. So we'll, we'll be co chairing the session this afternoon. Um We've got uh we think five presentations, um possib de depending on our links, but we, we'll see, we're gonna see how we go, but we're gonna, we'll start now with uh Jonathan who is going to talk about an MDT approach to the Rub Don't Scrub campaign. Thank you. Lovely, thanks. Um um Just give me a second to get that up. So, um I'm Johnny. Uh I'm a surgical trainee at South Mead Hospital in Bristol in the UK. Um It's been amazing actually to hear all the talk so far today in people from all over the world. So this is a little bit smaller than that. Think of it more as a, as kind of like a pragmatic example of how to implement some of the things that we have evidence for. Um So we've been looking at implementing something called the Rub Don't Scrub campaign. Um And we've been trying to use an MDT approach to, to implement that. So we'll go through all the bits of, of how we did it. So for those of you not familiar, the Royal College of Surgeons in the UK, there's a few of them, um they've put together a document on how we can try to improve the sustainability of surgery. Um In the UK, it's really useful to read if you've not come across it before. Um So that's just here, green surgery. Within that, they have another document called the Green Theater checklist, which is based on something called the wh check wh O checklist, which you may or may not be familiar with, which is just something that we do at the beginning of surgery. Um to check that we've got everything in place. It's sort of a safety procedure. What they've done with this is they've tried to implement the different aspects of sustainability for surgery and try to get us to review that almost on a daily basis and to look if we're doing those in our cases. Um I don't think it's necessarily that useful um when it comes to each individual case, like it is for the normal checklist, but as a framework, it's, it's really useful. So within that, um we chose uh objective number the seven, which is reducing water and energy consumption through something called the Rub Don't Scrub campaign, which is basically after the first water based scrub of the day. So using water and water based wash, we then suggest and this is nice guidance too that you can use an alcohol based rub for the rest of those cases, as long as your hands are clean. So it's appropriate for most of the cases for the day. Um So NHS Scotland put together and this is the only data I could find on this specifically, they put together a bit of a bit of data looking at what this might be able to achieve. If everyone in Scotland did this in the theater, in theater cases, they might be able to reduce water consumption by something like 60 million L of water, 100 and 35 tons of CO2 and a bit of um money saving there as well. So what we tried to achieve which is slightly different, we did an audit. Um We looked at our standards which would be 100% use of the alcohol based hand wash um in appropriate cases. Uh But as a sort of secondary measure, we were trying to also introduce this idea of the green theater checklist and sustainability within theaters to our wider our wider staff group. And we were trying to target within the all of the members of staff that are found in theaters So scrub team, surgical Senior leadership and surgical assistant, resident doctors as well. We did all the classic audit stuff. We did a um data collection, stakeholder mapping and, and intervened and then close that up. But I'll go through what we actually found out. So we did quite a few meetings with the members of the scrub team as well as the um surgical team. And we found out a few barriers to the use of this uh framework, the rub don't scrub. So one of the key things is most people just weren't aware of the fact that you can use alcohol based hand wash and that that's perfectly fine to do. And in fact, it's recommended by nice guidance. There was one specific issue that the scrub team had, which is that the dispensers we normally have for other washes were not available for the alcohol wash. So you had to basically just pick up the bottle and put it on your arms and then scrub, which in a way is actually fine. But most people found that they didn't feel comfortable doing that. They didn't think it was sterile and it didn't fit in with the particular way they normally scrub for a case. Um We also found that leadership was a big issue. So if a consultant, um particular consultant in that theater didn't want to use it or a scrub lead didn't want to use it, then often the rest of the team would not be using it as well. And there was a bit of a misunderstanding that it's worse for your skin. And actually the evidence suggests it's better for your skin. Although I think that's more on an individual basis. If somebody finds it's not working for them and it causes problems, then obviously they, they shouldn't be using it. Um, so what did we actually do? Well, we made greener surgery group which hadn't been set up in the hospital yet. We went and spoke at the scrub team meetings and we also spoke at the surgical department meetings and we identified a leader in both of those. And this is just for two theaters in the whole hospital. But we wanted to start small. Uh and then we actually installed those pump dispensers as well. So this is one of those dispensers which um interestingly became probably the biggest thing we ended up doing within the whole um, audit. Uh And you can just see it there next to the sink, which means it's right in front of you where you normally do your scrub. So what did we find? Well, um, we kind of messed up in, in the audit sense in that we actually intervened before we gathered the baseline data, which is a bit stupid on our part, but we were just sort of keen to get this going. Um We did a few of the interventions already. So the baseline was something like 70% of people were doing it within theater. And we think probably anecdotally and from working in those theaters before this before, we did anything, actually, it was probably quite a lot less lower than that. And in the urological theaters, which we're introducing this into next, it's basically 0%. Um almost. So we had a bit of an increase. Um What we also noticed is that we had an increase in days where everybody did this for every case that it was appropriate, which when we looked into more detail and spoke to those particular teams on that day, we actually found that it was often because either they'd been at those departmental meetings that we'd spoken at or they'd actually had the leader in that group, um in that particular day. So it tended to disseminate down through the team. Um Now this is quite a small study and what we were really using it for was basically just to try and use it as a case study to see if we were able to implement these ideas in theater and use this MDT approach. The idea going forward is actually that we use the whole of the green surgical checklist, but we sort of wanted to develop that network ahead of time by using something fairly simple. Basically the simplest thing on that list to try and see if it's actually possible and what we found is it is possible. Um But it is quite difficult and the M BT approach, although hard is actually, I mean, it's probably obvious but is the most is the best way of achieving this. Um And it really requires quite a lot of networking and chatting and going back and forth and, and in particular finding out what the barriers are for individuals and for the groups that are involved. So the biggest thing that just kept being mentioned, especially by the scrub team was the pump dispensers, as I've mentioned, um something that I don't think had really come up before until we actually just asked them directly. What is stopping you doing this? Once we brought that in, people were much more comfortable using it. And the uptake was, was, was really good. So it's a small lesson, but the MDT approach is really useful on a local pragmatic level. Um And actually logistical things can often be the biggest barriers that exist. Uh And actually getting hold of those dispensers was, was really hard and it did happen and it, it did work. So, um we're rolling this out across the rest of our theaters. Uh And that's pretty much it. So if you have any questions, let me know at the end. Thank you. Thanks so much, Jonathan. That was uh pretty well kept the time um moving on to our next week because I think we've got Sam and Rana uh speaking about Green Ed uh taking it away. Yup. Thank you. No. Right. So Hello everyone. I'm Sweet Kumar. Hello, I am Rana. We are clinical fellows in the Emergency Medicine at Northampton General Hospital and we are part of the green team. And this project about the present is a green initiative. So a bit of a background. So almost all the patients who walk into A&E are being cannulated just to take blood from the patient rather than a clinical indication. And to look at numbers, almost 50% of the cannulas every single day are unused in our department. So we asked the staff the same questions to find out where the problem is. And 82% of our staff thinks that yes, we are cannulated unnecessarily without an indication and the reasons for cannulation. 60% of them think they can the patient because of the clinical judgment and 40% think just in case the patient deteriorates or just in case the patient needs it later for a scan. So,