Operating room greening initiatives – the old, the new, and the way forward: A narrative review

Abstract

Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.

Surgical Locker room Environment: Understanding the Hazards (SLEUTH) study

“…Healthcare waste is a rampant issue in Australian hospitals and requires initiatives to promote reusable medical products. 12 However, most hospitals do not have a practice of measuring their waste, which makes the scale of the medical waste problem very difficult to determine. Medical waste generated from the surgical operative environment contributes to a disproportionally large amount of the total medical waste produced by hospitals.…”

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…As a consequence, the cost of indiscriminate waste disposal after a dialysis session (disposing all supplies together, without attention to careful emptying) may be as high as 50-70% of new single use disposables [19]. General (household-type) waste is usually directly disposed of in landfill or incinerated; plastic-derived toxins can leak into the soil and groundwater, while organic waste can be a source of methane [19,31,[82][83][84].…”

AORN Position Statement on Environmental Responsibility

“…58 Two-thirds of the surveyed physicians believe the amount of surgical waste generated in the operating room is excessive and increasing, 58 and the majority (95%) of the physicians supported efforts to reduce waste by opting for the use of reusable surgical tools, instruments, and equipment over disposable items where clinically equivalent. 58 However, barriers to environmentally responsible practices exist and include a lack of knowledge of appropriate waste segregation practices, 57 lack of leadership buy-in, 59 and overall resistance to change. 60 It is important, however, to balance environmental impact with patient safety concerns.…”