Implementing Pre-Filled Syringes (PFSs) to Improve the NHS’ Carbon Footprint, Procurement Expenditure, and Operational Efficiency

NAME OF ORGANISATION

Mid and South Essex NHS Foundation Trust

The NHS contributes 5.4% of the UK’s carbon footprint and 19% of government expenditure, with medicine manufacture, packaging, transport, and disposal as key contributors. Anaesthetists routinely prepare emergency drug trays with manually drawn-up syringes, discarded after each case to prevent cross-contamination. This practice generates avoidable clinical and recyclable waste and substantial carbon emissions.

In February 2024, we introduced pre-filled syringes (PFSs) for two UK-licensed emergency drugs—Ephedrine and Atropine—across 18 theatres at Broomfield Hospital. PFSs can be placed on trays, opened only if required, and reused if unopened, reducing waste and improving operational efficiency. Procurement, clinical and recyclable waste, staff productivity, and patient safety were evaluated over 20 months before and after implementation.

Outcomes: Ephedrine PFSs reduced ampoule, syringe, and needle procurement, reducing emissions by 475.2 kgCO2e (equivalent to a London–New York flight) and £58,356.16. Clinical waste fell by 97.65 kg, recyclable waste by 23.8 kg. Staff productivity improvements of 221 hours per year saved a further £6,590. Zero clinical safety incidents were reported.

Atropine PFSs reduced clinical waste by 25.9kg and recyclable waste by 100.8kg. These, along with reduced ampoule procurement, reduced the departmental carbon footprint by 191.0 kgCO2e (equivalent to driving from London to Barcelona) but incurred a net loss of £731.82. Staff productivity improved by 48 hours of clinician time per year. No safety incidents occurred.

PFSs reduce procurement, clinical waste, emissions, and operational costs while maintaining safety. Ephedrine PFSs are cost-effective (£1,945.21 savings per theatre per year) and reduce the theatre carbon footprint (15.84 kgCO2e per theatre per year). Atropine PFSs improve sustainability (6.37 kgCO2e per theatre per year) but at higher cost (£24.39 net loss per theatre per year). National PFS adoption could save hundreds of millions of pounds and thousands of tonnes of CO2e annually, supporting NHS net-zero targets.