Green Theatre Checklist

Welcome to the Intercollegiate Green Theatre Checklist compendium of evidence.

According to the World Health Organisation, humanity faces its greatest ever threat: the climate and ecological crisis. Health care services globally have a large carbon footprint, accounting for 4-5% of total carbon emissions. Surgery is particularly carbon intensive, with a typical single operation estimated to generate between 150-170kgCO2e, equivalent to driving 450 miles in an average petrol car.

The UK and Ireland surgical colleges have recognised that it is imperative for us to act collectively and urgently to address this issue. Here we present a compendium of peer-reviewed evidence, guidelines and policies that inform the interventions included in the Intercollegiate Green Theatre Checklist. This compendium should support members of the surgical team to introduce changes in their own operating departments. Our recommendations apply the principles of sustainable quality improvement in healthcare, which aim to achieve the “triple bottom line” of environmental, social and economic impacts. 

This is an emerging field, and therefore this is an iterative document that will evolve with new evidence. 

How to use the checklist: 

The checklist is divided into four sections, the first dedicated to anaesthetic care, and the subsequent three looking at preparation for surgery, intra-operative practice and post-operative measures.

We suggest the checklist is initially used at the daily brief at the start of an operating list, as an aidememoire for the team of the modifications that could be applied there and then. Once these practices become embedded into practice, then the checklist may be used less frequently. At present, some theatres will lack the infrastructure required to enact all the suggested interventions and so the checklist can serve as a roadmap for discussion with management, or at departmental meetings, to guide required changes. Finally, if completed regularly, the checklist could also be used as a scorecard to monitor progress.

However you choose to use the checklist, we hope that it will be a valuable tool for staff to identify and understand interventions and considerations to decrease the environmental impact of their work.

We are grateful for feedback and any information on new research and developments, so please do contact us at or by using the Contact us form on the colleges’ Sustainability webpages.

Read the full Green Theatre Checklist document here: 

Download the Green Theatre Checklist poster here:


An A3 version is also available here if you would like to print this for your theatre.

If you would like to present Green Theatre practices to your Trust, colleagues, and peers, please find a PowerPoint template here to aid you in your presentations.

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