Making a diagnostic microbiology laboratory more sustainable: LEAF Pilot

What was the problem?

Pathology testing underpins all of healthcare. All patients are tested; from swabs to diagnose COVID, to bloods in community to monitor diabetes, and tests to diagnose the acutely unwell in ED and secondary care. Indeed, NHS diagnostic laboratories in England process over 1 billion tests per year. They also consume large quantities of energy and water; an average laboratory uses 3-6 times the amount of electricity of the equivalent size office. These tests use large amounts of single-use plastic and laboratories produce vast sums of non-recyclable waste. Laboratories contribute significantly to healthcare’s carbon footprint, and must therefore equally contribute to Greener NHS’ pledge towards a Net Zero service.

What was the solution?

LEAF (Laboratory Efficiency Assessment Framework), run by University College London is an established audit tool that is used by academic laboratories to reduce their environmental impact. The LEAF team adapted the framework to be used as a pilot in diagnostic laboratories and we, in microbiology at Lancashire Teaching Hospitals (LTH) jumped at the chance to be involved.

The framework uses 16 audit standards covering seven overarching areas:

1. People: We formed the Microbiology Greens, a small group of keen individuals, who went about engaging the whole lab team. Lab sustainability is now regularly discussed at all lab meetings, we have a prominent notice board with a space for suggestions outside the lab, and the subject is included in the pathology induction for new starters.
2. Waste: We ensured that our waste streams are as segregated as possible. We made sure that nothing goes into clinical waste unless necessary, as this is much more expensive and has a worse carbon footprint than domestic waste. Our trust already utilises a company that sorts domestic waste to recycle plastic bottles, tin cans, and glass. All remaining waste is incinerated to create electricity, and nothing goes to landfill.
3. Purchasing: All new capital purchases and contracts have a score attached to them based on several factors, including the environmental impact of the equipment or products.
4. Equipment: We scoped out the who lab to identify pieces of equipment that could be powered down when not in use.
5. IT: All non-essential PCs are centrally powered down over night. All screens had their brightness reduced to 25%.
6. Samples & chemicals: Strict purchasing restrictions, and limited storage space means that nothing is wasted and over-ordering is eliminated.
7. Ventilation: Faults with the physical estate are reported promptly. Safety cabinets are powered down when not in use.

What were the challenges?

Some audit standards were easier to meet than others. The issues around samples and chemicals was straight-forward, as these are a requirement as a UKAS-accredited lab. Likewise, having centrally controlled IT made powering down PCs easier. Procurement is an ongoing challenge. Whilst it is a positive step forward that bids and business cases take the environmental credentials of a supplier into account, in the current financial environment, other factors may override this.  

We are also constrained by an ageing estate, with poor insulation, and ventilation, which are out of circle of influence at this time.

What were the results/Impact?

The microbiology department at LTH were awarded the Bronze LEAF Award after undergoing a successful audit. We have demonstrated positive first steps to reduce the environmental impact of our diagnostic service. We have improved staff engagement to a point where environmental sustainability is now regularly discussed in all meetings, and all staff are actively encouraged to contribute suggestions to help us do even better.

One measurable impact was the identification by one team member that a benchtop incubator was switched on 24/7 when it was only required to be used one day per week. Switching this off for the other six days has saved the equivalent energy of boiling 51 full kettles every week. We have adopted a ‘Green Kettle’ logo and these stickers have been applied to all pieces of equipment that can be safely powered down when not in use.

What were the learning points?

We learned that people feel that this is important and want to contribute to help us do better. What were the key enablers /conditions for success? Knowing that team members feel that this is worthwhile means that, whilst not everything is easily implementable, we are ‘pushing at an open door’ with many interventions.

If other laboratories are interested in doing similar work, then I’d strongly encourage to form local groups to do so. Small wins quickly build up, and you may be surprised at the enthusiasm of your colleagues.

Next steps

We have set ourselves several priorities. We’d like to progress to Silver LEAF once the framework is re-launched after the pilot. Likewise, we’d like to support colleagues in the other pathology disciplines at LTH to attain their Bronze LEAF awards. Furthermore, we are working towards more accurately measuring the savings created, and a team member has attended a carbon footprinting course run by the Centre for Sustainable Healthcare.

The vast majority of the carbon footprint associated with laboratory testing is associated with the pre-analytical stages: the patient travelling to the location where the sample will be taken, the energy used in manufacturing and transporting the plastic components (tubes, swabs, specimen containers etc.), and then transporting the samples to the laboratory for analysis. We also know that many tests are requested unnecessarily. This over-testing has great financial and environmental impacts, as well as the potential for patient harm. We are actively engaged in several diagnostic stewardship projects to ensure that the right patient gets the right test at the right time to minimise these impacts.

Want to know more?

Dr Rob Shorten, Consultant Clinical Scientist, [email protected]