With Great Western Hospitals NHS Foundation Trust recently receiving recognition from NHS England as an exemplar site for sustainability in infection prevention and control, Katherine Price finds out what initiatives they implemented, how clinical staff got involved and how other hospitals and Trusts can take inspiration to achieve their own sustainability goals.
From floods in Spain to wildfires in Los Angeles, healthcare professionals globally are continuing to see the devastating impacts of climate change first hand, and the UK is no exception.
While many individuals are identifying ways to reduce the environmental impact of their clinical practice and driving change, the NHS in England recognised the need for formal, integrated processes to meet its net zero by 2045 target.
Following discussions with NHS England, Great Western Hospitals (GWH) NHS Foundation Trust in Swindon became the pilot site for an exemplar sustainability project. It received around £2,000 towards a four-month programme of initiatives and to create a replicable model, including governance and reporting structures, for sustainability quality improvement.
A clinical sustainability group – chaired by Graham Pike, associate director of nursing and infection prevention and control and clinical sustainability lead – was established in January 2024 to oversee progress. The group included representatives from infection prevention and control (IPC), sustainability, quality improvement, facilities management, pharmacy and procurement.
Following the successful pilot, GWH became the first organisation recognised by NHS England as an exemplar site for sustainability in IPC practices.
Implementing sustainability measures
As IPC touches all areas of practice, it is ‘crucial to optimise sustainable practice’ in this area, says Rachel McLean, sustainable quality improvement programme lead at the Centre for Sustainable Healthcare.
Many practices in hospitals are driven by fear or risk of infection, and Graham says this includes ‘the products we use, the procedures we do, the way we do them and how we dispose of things’. And while sometimes those risks are real, if the rationale and evidence are lacking, there may be opportunities to identify and adopt more sustainable practices without compromising patient care.
As part of its efforts in the pilot project, GWH implemented a series of 11 initiatives that other hospitals around the UK and beyond can take inspiration from to make strides towards their own sustainability goals, of which three had a particularly big impact.
Changing sheets
Many UK hospitals change patient bedsheets daily. Although regular linen changes are important for IPC, evidence supporting the daily changing of unsoiled sheets is lacking. ‘This is a really good example of “we do it this way because we’ve always done it this way”, and how we need to review everything we do – can we do it less, can we do it differently?’ says Graham.
A proposal to move to twice-weekly linen changes – excepting specified circumstances – was approved by the Trust’s infection control group, received positive feedback from the public and now is being trialled.
Gloves off
Reducing glove use was a priority, which saw GWH adopt the Intensive Care Society’s Gloves Off in Critical Care campaign.
‘There’s plenty of evidence out there that the unnecessary use of gloves, as well as being a waste and costing money, increases the risk of infection,’ says Graham. Posters showing when and when not to wear gloves were displayed by patient bedspaces and emails, articles and a webinar on glove use were shared among to team members.
Subsequently, the percentage of staff observed performing a procedure where inappropriate use of gloves risked cross-contamination fell from 63% to 20%. Hand washing observed before glove application improved from 15% to 70% of cases, and hand washing after glove removal increased from 20% to 90%.
Procurement data showed a 22% reduction in glove use over three months that, if sustained, would lead to a £1,382 annual saving for the hospital and prevent 1.6 tonnes of CO2e emissions.
Reducing cannulation
GWH’s emergency department (ED) also set about working towards the Royal College of Emergency Medicine’s GreenED sustainability accreditation. ‘There were challenges on that – how do you release the staff to do the project and how do you fund [it]?’ says Graham. Pilot funding helped pay for the registration fee and staff time – and GWH became one of the first five GreenED accredited sites in the UK, and one of just two to achieve silver.
This scheme specifically encourages reduced cannulation and, after developing and displaying clear cannulation criteria, GWH saw a 29% reduction over three months. Since the pilot, this has continued to a 40% reduction – approximately the same amount of CO2e as nine flights between London and New York.
Achieving team buy-in
There can be a perceived conflict between IPC and sustainability, and Graham says existing case studies were a valuable resource to allay anxiety, for example when shifting to use reusable theatre caps.
‘Data demonstrating the potential or actual impact of improvement is important,’ explains Rachel. ‘If you don’t fully understand the problem beforehand and have baseline data, you won’t be able to show you have improved care later. Utilising existing case studies which demonstrate tangible benefits – for example, carbon and cost savings – can build trust that similar initiatives will be successful in another setting.’
She also suggests tailored messaging highlighting the range of benefits, including time savings, and, of course, improvement in patient outcomes.
Generally, it was straightforward to achieve buy-in for the project from colleagues across all departments and seniority, Graham recalls, partly because there is increasing concern about the effects of climate change.
‘There are a lot of staff out there who are worried,’ he says. ‘They see the waste that’s generated by healthcare every day and people are increasingly aware of climate change.’
Graham recommends working with managers to identify team members keen to drive sustainability projects within their departments. Two intensive care nurses at GWH led the Gloves Off project, for example. Already frustrated by glove waste in their unit, the project empowered them to implement and drive change, and Graham says they ‘did a cracking job of engaging the rest of the team’.
Rachel adds that collaboration ensures staff ‘feel ownership over an improvement and that changes are made in a way that best embeds them into the existing workflow and everyday systems’.
The future of IPC sustainability
Following completion of the pilot at GWH, trials continue, initiatives are being rolled out, more sustainability groups have been established across the hospital. Sights are also set on GreenED gold accreditation.
Every project created a ripple of discussion and action, says Graham, and funding staff time to focus on sustainability identified significant cost savings as well as opportunities to reduce environmental impact, highlighting an important return on investment.
Formalising the relationship between IPC and sustainability also ensured projects progressed more quickly and consistently, resulting in an exemplar site project report that can be adapted to service, resource and patient need.
