Ditch the Incopad

Ditch the Incopad: Greener Anaesthesia

This project was completed as part of the 2025 Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) Green Team Competition, implemented by the anaesthetics team.

Team members

• Dr Ricky Lewis (ST7 Anaesthetics)

•  Dr Sameen Kausar (ST4 Anaesthetic)

• Dr Amy Greengrass (Consultant Anaesthetist)

Setting / patent group: 

Patients requiring IV antibiotics in the ED.

Issue:

At NNUH, incontinence pads (‘incopads’) are widely used in theatres, for purposes other than continence management.  E.g. padding for patient positioning or protection of trolley surfaces.  In the last 12 months, there were 4,631 emergency theatre cases, each using on average 3 unnecessary incopads, equating to an estimated 13,893 pads used unnecessarily. Each disposable incopad has a carbon footprint of 0.24 kgCO2e, resulting in 3.3 tonnes CO2e emissions from emergency theatres alone.

Aim:

To reduce inappropriate use of incontinence pads within emergency theatres at NNUH by:

Identifying current patterns of incopad use and sources of waste.

Implementing alternative, reusable positioning and protection strategies.

Engaging theatre staff to ensure sustainable practice becomes routine.

Intervention: 

This project explored the use of reusable gel pads for arm positioning to reduce inappropriate incopad use.  Staff surveys were conducted to explore attitudes, perceptions, and suggestions for alternatives.  Baseline incopad usage in emergency theatres was calculated and impact modelling undertaken.  A tailored education and engagement programme was designed, including tea trolley training, appointing champions, posters and a governance presentation. 

Outcomes:

Outcomes were measured to identify the sustainable value using the triple bottom line approach. 

Clinical Outcomes

• Patient safety, dignity and comfort are maintained through using purpose designed products.

• Population outcomes 

Reusable products improve resilience and reduce supply chain reliance.

Environmental Outcomes 

• Swapping from 3 disposable incopads per theatre case, to 10 reusable gel pads (lifespan of 2-5 years) cleaned with clinell wipes, could save 2,886 kgCO2e annually in emergency theatres.  The equivalent to driving 8,492 miles in an average car.

Financial Outcomes

• This has the potential to save £972 annually in incopad procurement, with unquantified savings in staff time and waste disposal.

Social Outcomes

• This project addresses staff frustration with wasted disposables and empowers staff to make sustainable changes.

• Improved workflow efficiency from reduced time spent ordering, stocking & disposing of incopads.

Key learning point 

• This project demonstrates the environmental and financial burden the inappropriate use of incopads has in emergency theatres. By promoting reusable gel pads and waste process changes, the project offers a safe, cost-neutral, and scalable intervention. Staff surveys indicate support, suggesting high adoption potential.

• Key success factors included staff engagement, leadership support and validation for gel pads from the tissue viability nurses. 

• The next steps for this project include implementing changes via tea trolley teaching, theatre champions, and governance engagement, followed by expansion to all NNUH theatres.