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But we now have Miss Saha, a breast surgeon here. Um That comes to talk about sustainable surgery. So following on perfectly. Um I think I've got your slides here. Yes, I think I've got them here. Thank you for working out. II kind of gave up on, you know, II should be able to, there we go. Auntie. I just need to show them here. Hello, you can see my face. I can turn off if you like. That's ok. I don't, wasn't kind enough to myself to do that. Um I can and where is the slide? The, you know, the notes are they on there? Um So yeah, if I go there I can. Ok, perfect. Let's double check. They moving fine. Ok, lovely. Is that your? No, no, that's not mine, I think. Is it K you might be ok. Um Thank you, Becca. Um My name is Anita, so a consultant breast surgeon here at Colchester and I have a bit of an interest in um improving the sustainability in our theaters. So thank you for inviting me. So I'm sure a lot of my first few slides have been covered earlier on today. Sorry. I didn't make it for the morning. But why do we need to have more sustainability? Well, we know that global warming is a huge issue. There is um an increasing in the temperature of the earth's atmosphere. The slides from bite size that my Children showed me um demonstrate that the carbon dioxide in the atmosphere is in increasing. And so is the temperature in a very simplistic view. We are seeing on the news all the time that there are significant global changes. There is um there are extremes of weather, droughts, there are flood, there is flooding um and tropical storms, all of these contribute to part are, are features of climate change. What we do know that it is the greatest threat to human health in the 21st century. And why do we need to change it? We need to change it for our future um generations to come. So what triggered me to think about sustainability um in the midst of COVID where we have a lot of time to think I was putting out my rubbish and I was carefully separating the various eight different types of rubbish into its various components to put them out to recycle and like everything every little bit helps. I'm sure many of you are careful in separating away so that you have the appropriate um waste. So it's recycled. And then I thought back to um our practice in theater and we had huge bags of waste and actually so much is thrown away and we need to apply the care that we apply at home also to our working environment. So I thought, ok, I thought what about our food waste? There is so much that goes into those yellow bags. There is gloves, Kate's already talked about the non sterile glove issue gowns, hats, drapes, masks, inco sheets, va Go Kates, um the sliding sheet, the bare hugger devices in breast. We also have radioactive waste, but there's packaging for each and every one of these items as well as also some single use instruments. And this has become a huge thing in surgery. We, when I grew up, when I started training, we used a lot of er reusable instruments and actually we, you have migrated to single use instruments somehow overnight and actually we could re some of that back Galip pots, kidney dishes. Again, these are now single use er Gainer would know that this is a huge bug bear of mine um that these are actually can be um reusable options and obviously the sharps. So I thought what components within my domain are reusable options where we can change, we can make some changes that um can impact sustainability. We know that gowns and hats have a good er reusable alternative ino sheets, drapes, the Bare Hugger device. So some of those things in red have got a good um reusable alternative. So as I said, this all struck me during the midst of COVID and actually COVID was really bad from an NHS perspective. We've all lived through it, but it was also particularly bad from a sustainable perspective. This diagram from the Department of Health and Social Care Policy paper looked at the massive increases in PPE that we used in COVID. As you can see, there's a frightening 17,000% increase in the amount of eye protection we use. And the same goes for ma 4700% increase. This is just within health and social care services, let alone outside um in the er wider world, gowns are particularly energy intensive um products and they were, they increased by 6 1600% during the COVID pandemic. And that made me think at that time, there was even more waste than normal and it certainly had increased after COVID and we haven't quite gone back to the pre COVID levels. I would say anecdotally, I've got references if anyone wants them later. So we know that um the Health and Care Act of 2022 aim for a net zero NHS by 2045. This is quite an ambitious um project and we know that NHS accounts for a large proportion of the U K's total carbon footprint, not just from direct producers such as the fossil fuels and the NHS facilities, but there is also the indirect um uses from our medicines and our products that are manufactured and transported across the U UK as well as the energy consumption in our health care facilities. We know that the NHS produces 5.4% of the U K's greenhouse gasses. Kate's already talked about some of those including our anesthetic gasses. Um But this also accounts for sum of the inadvertent production via CO2 production. This is not just a UK problem, this is a global problem. There are a number of industries that um contribute to the global gas emissions, but actually healthcare accounts for 4.4% worldwide of carbon emissions. So that is quite a significant amount. It is the fifth biggest producer of carbon emissions in, in, in terms of industry. So it's not something to be taken lightly. You've already seen this diagram from Kate's talk which shows some of the um various aspects of NHS uses which um NHS products which produce high carbon emissions. A big proportion is medicines and medical equipment. But also we have our carbon from, from, from the anesthetic gasses that, that we've talked about and also the waste and water that we use in theater, one area which is particularly energy intense is theaters. We u we contribute in theaters to about a quarter of the environmental impact within the hospital. So this is somewhere where we can make some big changes with small things that we can do, can have a big impact. Uh Where are we? Ok. So as I said, um theaters and surgery is a particularly energy intense, um, and environmentally challenging. Um, part of the NHS theaters use up to six times as much energy as the rest of the hospital theaters also contribute to 70% of the hospital waste, which is really quite significant. And much of those I will talk about in a moment. So there are some components where the common footprint of operating theater can be reduced. So, anesthetic gasses we've talked about already reusable and er versus single use products and managing our energy use and our waste. Um er our waste management is also really important to improve our sustainability going forward. So I'm sure you will have already gone through this um earlier today. But what does the carbon footprint mean in a nutshell? It is the cost to the environment of a product or process and it's often given a measure of carbon er in terms of kilograms per carbon dioxide equivalent. So how much carbon dioxide is produced? Carbon dioxide is used as a reference gas because it accounts for three quarters of the global gas emissions from human activity and that, but there are other global um uh uh other uh what they called er glo greenhouse gasses that um are contributory and they're given an equivalent to the carbon dioxide and they, they're given a global warming potential. Um It is used to give us an estimate measure of the direct or indirect production of greenhouse gasses for a given product or process. So when we're thinking about changing from a single use product to a reusable product, we need to think of the whole life cycle from when it's produced by the manufacturer, the packaging cost, the transport cost to the um er place point of delivery and all. So the waste management afterwards, but also we need to consider if it is reasonable, laundry maintenance repair costs in order to figure the whole life cycle analysis. But on the whole reasonable um items are more sustainable than single use. So um Chantal re did a really er, did a really nice study looking at the carbon footprint of five major common surgical um operations that are performed not just in er, in um the UK, but throughout the world, um they looked at three trusts and they looked at all of the operations within these five domains and calculated the carbon footprint. So we go from our sort of relatively low carbon footprint procedures such as tonsillectomy right up to the knee arthroplasty, which is another common procedure and you can see there's quite a considerable difference in the carbon footprint. So I