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Trying to reduce the ecological footprint of an operating theatre is a tough challenge.

鈥淪o much is disposable, with a lot of water and energy being used,鈥� says senior theatres nurse and practice educator, Harriet Dean-Orange, who works at Brighton and Sussex University Hospitals NHS Trust. 鈥淭here鈥檚 also a perception that it鈥檚 a different world, so you can鈥檛 integrate sustainability because everything must be done in a particular way. But it鈥檚 a misunderstanding.鈥�

For Harriet, awareness grew when she first started working in theatres about four years ago. 鈥淚t was seeing all the bags of waste,鈥� she recalls. 鈥淟iterally everything was being put into clinical waste, even sterile packaging. It felt so wrong, when I knew some of this could be recycled.鈥�

Now she is on a personal mission to make theatres greener, reducing waste, lowering the use of vital resources and boosting recycling. 鈥淚 think the biggest thing I鈥檝e done is not stop talking about sustainability,鈥� says Harriet. 鈥淚鈥檝e continually brought new ideas for people to think about and explore. I鈥檝e also asked questions, for example, why can鈥檛 you have easily recyclable materials in theatres?鈥�

Key to her approach is encouraging staff to think about what things are made from, whether plastic, paper, fabric or something else. 鈥淚t鈥檚 important for people to understand what it has taken to get these materials to us,鈥� explains Harriet, who has taken on a voluntary role as an NHS England Sustainability and Health Ambassador. 鈥淚f staff appreciate that disposable gloves cost X, their carbon footprint is Y and they must also be disposed of in a particular way, it makes them think each time about whether they definitely need to wear them.鈥�

Gloves too can also be counter-productive in terms of infection control, argues Harriet. 鈥淏acteria need heat, time and moisture to grow, so wearing gloves for hours on end provides the perfect environment,鈥� she says. 鈥淭here鈥檚 a misconception that once you have your gloves on, you鈥檙e safe and protecting yourself and the patient. A lot of my work is about challenging these behaviours.鈥�

A popular initiative has been to stop using polystyrene cups and disposable cutlery. 鈥淔or me, this was a real gateway,鈥� says Harriet. 鈥淚t helped people to connect with what we were trying to do. You wouldn鈥檛 dream of using these things at home, so why use them at work? For our department alone, the NHS was paying 拢7,000 a year for throwaway cups. Now we have a really good culture of people bringing in their own mugs and showing them off.鈥�

Other initiatives include segregating waste into four streams, including recyclables, replacing plastic waste containers with cheaper biodegradable alternatives, and reducing the use of plastic bags, including recycling where possible. 鈥淚 can鈥檛 emphasise enough the value of having a really well-structured waste management programme in theatres,鈥� says Harriet.

She has also focused on water usage. 鈥淗and scrub preparation takes about five or six minutes, with the hot water tap running throughout,鈥� says Harriet. Now staff are educated about alcohol-based solutions, which have the added benefit of helping to eradicate skin problems, alongside dramatically reducing the volume of water used.

Among the challenges is trying to identify the precise amounts of energy and money they are saving. 鈥淚t鈥檚 hard to say to staff, we know you are making a difference, but I can鈥檛 give you the numbers,鈥� says Harriet. 鈥淲e would love to be able to give something concrete back for the efforts that people are making.鈥�

Another has been challenging the negative attitudes of those staff members who believe it鈥檚 too difficult, too big to tackle or just not worth it. 鈥榊ou have to be willing to be unpopular sometimes,鈥� she says. 鈥淎nd try to be light-hearted. Doom and gloom never work, so I try and keep a positive and educational stance, shaping the message to the particular audience.鈥�

For Harriet, it鈥檚 the small wins that add up. 鈥淪ustainability isn鈥檛 about a top down approach - it鈥檚 a collaborative movement,鈥� she says. 鈥淓ven though what we鈥檝e done so far is small, it鈥檚 growing and we鈥檙e becoming known for it. I take a great pride when someone says, 鈥業 can鈥檛 believe we used to throw these away鈥�, and they鈥檙e re-using it.鈥�