Within the University’s Clinical Skills Centre, staff and students are engaged in many University initiatives to work more sustainably. We are aware of the reduced window of time to make meaningful change to slow global warming We want to reduce our environmental impacts in our Centre, leading by example for the students.
We’re aware that healthcare education can be very wasteful. Each cannula, for example, comes in a plastic packet, and students may use several of these in a thirty-minute session. This creates a significant amount of waste in clinical skills centres due to the routine use of single-use equipment, combined with students’ need to repeat techniques to master them.
What is artificial blood used for?
Water mixed with red food colouring creates artificial blood. The Clinical Skills Centre uses it regularly for undergraduate medical and nursing students, as well as international graduates. Healthcare professionals use it for teaching intravenous or intra-arterial skills such as cannulation (inserting a port into a patient’s hand or arm to deliver medication), venepuncture (obtaining a blood sample), and obtaining an arterial blood gas. Artificial blood has been used in the past for its likeness to real blood to create an authentic learning experience for students.
The waste management team deal with all types of waste, of which there is a large variety from a hospital and university. To do this, they regularly inspect the contents of bin bags. For example, if the waste management team find a red-soaked gauze swab in a general waste bin, they must process the whole bag as clinical waste. They cannot distinguish between real and artificial blood; therefore, they have to presume that the rest of the contents in the bag are contaminated. As such, all red artificial blood used in teaching must be disposed of using extra clinical waste procedures, rather than being disposed of in general waste.
NHS Lothian circular waste and minimisation team supplied the following approximate figures:
| KgCO2e/tonne | £/tonne | |
| Clinical Waste | 295 | 532 |
| General Waste | 16 | 220 |
Why should we use green blood?
A sustainability medical education fellow introduced me to the Bleeding Green case report. This involved staff within Oxford Medical School cleaning, repackaging and reusing non-sharp, single-use equipment as part of a wider sustainability movement across the medical school. The reuse of equipment was their primary focus. I introduced the clinical skills team to the Flowing Green project and they are supporting me in implementing our own version of sustainable skills teaching. We obtained green food colouring in August and have been replacing the red blood as it runs out.
Using green blood opens up discussions about why we are making sustainable changes. It plants a seed for students at an early stage in their learning to be mindful of sustainability. We hope that they go into their workplaces aware of the effects healthcare has on climate change and think holistically before ordering a blood test or putting in a cannula, for example.
A potential disadvantage of using green blood instead of red is the reduced authenticity. Some may argue that there is a need to introduce students to red blood to identify any squeamishness or nausea because these challenges can be better addressed during learning, before their first patient experience. We are tackling this by only using red artificial blood for students who are learning skills involving blood for the first time. This was also important when gathering feedback for the Flowing Green project, to allow students to have a comparison between the use of green and red blood.
Feedback from students
Green blood was trialled in a session with nursing and medical students. They provided thoughts and feedback, and the results were positive. It is encouraging to learn the value our students place on sustainability.
| ID | Name | Responses |
| 1 | Anonymous | Using green blood makes no difference for me. We might as well use it if it’s better for the environment/costs. |
| 2 | Anonymous | It was good but it needs to be a darker green to more realistically mirror a green version of blood. |
| 3 | Anonymous | I think it is absolutely worth using green blood for practice sessions due to sustainability benefits. However, I think during the first session where students are learning the skills for the first time, it might be easier to use red blood to make it clearer. |
| 4 | Anonymous | If the blood was a tiny bit darker, it might make it easier to see flashback, but it was fine regardless. |
| 5 | Anonymous | Great option for changing to green blood. |
Jill Burnett, Senior Implementation Manager at the University’s Social Responsibility and Sustainability department said: “It’s great to see examples of colleagues going above and beyond to try new techniques that cut waste and promote re-use whilst continuing to deliver such a high standard of teaching. Through our sustainability framework we’re seeking to empower more staff to embed environmentally friendly approaches and ideas in their day-to-day activities.”
Realistic Medicine
In 2016, the Chief Medical Officer for Scotland used her first Annual Report to encourage the practice of Realistic Medicine (RM). RM focuses on personalised care, shared decision-making between medics and patients and reducing waste. It supports patients, their families and health care providers to discuss care and treatment options and together formulate the best treatment plan.
There are six RM pillars: Personalised Approach to Care; Shared Decision Making; Managing Risk Better; Reduce Harm and Waste; Reduce Unwarranted Variation and Become Improvers and Innovators. Reduce Harm and Waste and Reduce Unwarranted Variation relate to the green blood initiative. The RM initiative encourages clinicians to make patient-centred decisions. For example, blood tests and scans are costly, increase the amount of time a person spends in hospital, and it may be painful for patients. In the Clinical Skills Centre, we are in a privileged position to promote good habits when teaching students a skill for the first time. We can instil mindful decision-making as a part of optimal clinical practice.
What’s next?
I am leading on a paper with the research question: ‘Can sustainable simulation reduce our carbon footprint and still deliver effective learning?’
Image credits: University of Edinburgh Clinical Skills team
