Use of Coolsticks in district general hospital

Abstract

Introduction: Ethyl chloride spray is conventionally used for testing cold sensation during spinal or epidural blocks.Coolsticks are reusable, durable, non-toxic stainless steels wants that can be cooled and are a cheaper alternative to ethyl chloride spray. The aim of this studd was to estimate the cost and carbon savings of switching from ethyl chloride spray to Coolstick use.

Methods: The use of Coolsticks at a single district general hospital’s (Good Hope Hospital, Sutton Coldfield, UK) main theatres was audited in July 2023. The volume of ethyl chloride use in the obstetric theatre in 2022-23 was calculated based on pharmacy requisition forms. Estimates of CO₂ equivalent emissions per stick and per ethyl chloride spray use were based on published data (Green Ward study from Dorset). Cost and CO₂ equivalent emissions savings with cold sticks were calculated and extrapolated onto all seven theatres within Good Hope Hospital.

Results: Only 25% of anaesthetists used Coolsticks, despite all being aware of their availability. The main reason stated for this was “adherence to usual practice”. In the obstetric theatre in 2022-23, 104 cans of ethyl chloride were used. Switching to Coolstick use would save £2,080 and 1,693kg CO₂ equivalent per theatre per year. Extrapolating across the hospital, the potential saving was £14,560 and 11,852 kg CO₂ equivalent per year.

Conclusion: Use of Coolsticks is cost-saving and carbon-efficient. National associations should consider publishing formal recommendations to support their uptake. Research around clinical efficacy and patient satisfaction would speed uptake into clinical practice.