How Can Surgical Teams Reduce Waste and Improve Sustainability?

Incision · · 7 min read

Surgery must adapt if we’re to meet the environmental challenges that define our times. In this blog, we dive deep into the murky waters surrounding waste in surgical care, and shine a light on some of the teams around the world helping us work towards a brighter, more sustainable future.

Waste on Unprecedented Scale

Globally, we generate about 1.47 billion tons of solid waste each year. Over 5 million of these come directly from hospitals in the US healthcare system [1]. Hospitals in the UK's National Health Service (NHS) contribute a comparatively modest 156,000 tons; for reference, this is still the equivalent of around 400 Boeing 747 jets fully loaded with waste per year [2].

Surgical care contributes disproportionately to these numbers. Between 20 and 70% of all hospital waste can be directly traced back to the operating department [3, 4]. In a single day, US operating rooms (ORs) generate up to 2000 tons of waste [5]. Using the same calculation, this equates to just over five jumbo jets full of waste produced each day. Whatever side of the Atlantic you look at it from, waste in surgery is a problem on an unprecedented scale.

Every day, surgical care in the US generates the equivalent of over five Boeing 747 jets fully loaded with waste.

A Giant Environmental Footprint

Healthcare is one of the largest contributors to environmental pollution. The US healthcare sector generates around 10% of national greenhouse gas emissions, polluting the air to a level that causes the annual loss of 400,000 disability-adjusted life years [6]. Waste on this scale comes at a tremendous ecological cost. But what actually happens to it?

About 85% of hospital waste is general, non-hazardous waste. This is usually sent to landfills without processing or (ideally) it is recycled. The remaining 15% — hazardous waste — is anything that poses a health risk. This includes sharps, infectious material, pharmaceuticals and radioactive products. Hazardous waste is often treated using high-temperature methods like incineration. These processes are far more energy-consuming, environmentally damaging, and financially expensive than general waste disposal, contributing up to 86% of a hospital's waste disposal costs [7].

Many facilities improperly dispose of general waste as hazardous waste — by as much as 90% — driving up costs and worsening their environmental footprint [8]. A large teaching hospital recently reduced hazardous waste output by 75% through a simple audit, additional bins, and educating staff on correct waste separation protocol [9].

Correct separation of hazardous and non-hazardous waste can significantly reduce a hospital's waste disposal costs and environmental footprint.

The Rise of Disposables

There has been a large shift in the makeup of surgical waste towards disposable (single-use) equipment. Many disposable items are now more common than their reusable alternatives; these include gowns, drapes, various instruments, and breathing circuits. This rise in disposables is explainable through enhanced convenience, cost reductions, and arguments around infection prevention. These reasons are now under increased scrutiny.

One study compared two large US medical centers in Maryland and Washington to evaluate the impact of switching to reusable supplies in place of disposable ones. Reusable items included surgical basins, gowns, surgical table and Mayo stand covers. The research, published in the AORN Journal, found that reusable products enabled ORs to safely reduce their total waste by an average of 65%. As well as reducing landfill and carbon emissions via incineration, these changes saved the hospitals over $13,000 per year [10].

The Role of Reusables

A large body of research now supports the superior environmental and financial outcomes of reusable surgical supplies [11, 12]. The World Health Organization states that reusable drapes and gowns do not pose any additional risk of harm over disposable products [13]. Reusable products have proven to offer hospitals a safe and waste-reducing alternative to disposable ones. Reusable surgical gowns, for example, have repeatedly been shown to be well-accepted by staff, comfortable, and sustainable [14].

Reusable (A) and disposable (B) sterile surgical gowns. Image from: Niewenhuizen, K. et al. 2023.

Grassroots initiatives have successfully introduced reusables into local protocols and supply chains, significantly cutting both environmental and financial waste. In 2022, a team from Leeds Teaching Hospitals NHS Trust ran a project to reduce the carbon footprint of laparoscopic appendectomy. They did this by implementing several new measures, including eliminating single-use gowns and drapes and rationalizing their equipment tray [15]. In an award-winning initiative, the team successfully reduced their carbon footprint, lowered waste, and cut the cost of each laparoscopic appendectomy performed in their region.

A “rationalized equipment tray” for laparoscopic appendectomy. Image from: Boag, et al. 2022.

Switching from disposable to reusable supplies is safe, well accepted by staff, and can significantly reduce OR waste and costs.

A Mandate for Change

Waste in surgical care carries a powerful mandate for change. Whether presented environmentally or financially, two things are clear: first, change is needed, and second, change is coming.

In 2020, Kaiser Permanente became the first healthcare system in the US to achieve carbon-neutral status. The NHS aims to become the world's first net-zero national health service by 2045. Moving toward this, a team at Solihull Hospital in the UK recently performed the world’s first net-zero carbon operation [16]. Across countries and specialties, teams are relentlessly innovating in order to cut waste and improve sustainability in surgical care.

When healthcare workers are asked, we resoundingly want to reduce our waste and mitigate our environmental impact. A multicenter study of surgeons found that 95% were willing to modify their workflow to reduce waste [17]. In a recent survey of cataract surgeons, 92% felt that operating room waste has become excessive and needs to be reduced, and 99% were concerned about global warming and strongly wanted more reusable options [18].

Surgical teams are uniquely positioned to lead sustainability initiatives, with access to key stakeholders and the ability to initiate meaningful supply changes.

Changes in healthcare are challenging. To succeed, we need technological solutions that empower us to make transparent and informed decisions about cost and resource allocation. Together, we can share our strategies and implement the changes that need to happen — to the benefit of our environment, and our patients.

Here at Incision, we’re dedicated to writing blogs that inspire conversation, bring teams closer together and educate in a dynamic way. When we learn together we grow together, so join the conversation!

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