Project: Replacing vapo-coolant sprays with CoolSticks

Organisation: Bolton NHS Foundation Trust

What was the issue? Vapo-coolants such as ethyl chloride and dermogesic are common anaesthetic sprays employed to induce a cold sensation during regional anaesthesia that have a significant environmental in terms of production, use and waste and cost. The sprays are commonly used to induce spinal and epidural anaesthesia blocks and during regional anaesthesia procedures such as during hip and knee replacements. However, once discharged into the environment, ethyl chloride can persist in the atmosphere for as long as two months, while posing toxicity for animals and plants.

What action was taken? In October 2022, the reusable CoolStick devices were introduced to all theatres to replace vapo-coolant sprays such as ethyl chloride and dermogesic. CoolSticks are devices comprised of a stainless-steel body with a screw-on plastic handle that is kept in the refrigerator and can be decontaminated for reuse.

What was the Delivering a Net Zero NHS benefit?  Moving to lower carbon options for high-impact areas such as anaesthesia. Since the beginning of the project, all operating theatre areas are using CoolSticks. This includes eight main theatres, two day case theatres, one urology theatre and three maternity theatres. Prior to taking up the use of CoolSticks, the trust had reduced the number of ethyl chloride cans used per week. From February-August 2022 to February-August 2023, the main theatres reduced the can usage from 52 to 44, the maternity theatres from 196 to 131 and on the maternity delivery suite where they are used to test the epidural block, usage dropped from 90 to 61. 

What are the wider benefits? The introduction of the CoolSticks at Bolton NHS Foundation Trust shows that there is a potential to encourage a wider use of CoolSticks across other hospital sites in the North West. The shift in practice represents a conscious decision to reduce the use of vapo-coolant substances that contribute to greenhouse gas emissions. By lowering carbon emissions and reducing reliance on substances with harmful environmental effects, the NHS is taking concrete steps towards achieving its net-zero emission goals and contributing to delivering more sustainable healthcare.

Links for further information: Nichols W, Nicholls J, Bill V, Shelton C. Temperature changes of CoolSticks during simulated use. International Journal of Obstetric Anaesthesia. 2023; DOI: 10.1016/j.ijoa.2023.103890.

Reducing ethyl chloride usage with innovative cool sticks – BJA Open

Key contacts and email:       

Amy Hobbs – amy.hobbs@boltonft.nhs.uk

Abby Jones – abby.jones@boltonft.nhs.uk