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Reduce, Reuse, and Recycle in the Operating Room

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As modern surgical techniques have developed, so have modern surgical instruments and equipment. Much of the equipment used in ORs today, particularly in higher income countries, is disposable. Additionally, much of this equipment, even if nondisposable, is often wrapped in plastic, leading to high amounts of plastic waste in ORs around the world. With climate change as a leading health care issue in the upcoming century, and with the heavy burden of plastics contaminating our oceans and food sources, it is important that medical professionals are mindful of our contributions toward the plastic crisis and climate change. Additionally, conscious usage of OR supplies is cost effective for the health care system and allows redistribution of supplies to low-resource settings. 

Studies have shown that OR waste accounts for a large portion of hospital waste. The Minneapolis VA Hospital showed that about 30% of the hospital’s waste came from the OR. This amounted to 231.3 kilograms of waste per day. Of this waste, 84.5% was general waste, 8.8% recyclable waste, 3% biohazard waste, and 3% blue wrap paper. Neurosurgery ORs collected 32 pounds of waste daily, while each orthopaedic surgery case generated 6.2 kilograms of waste. Overall, 2 million pounds per year of medical supplies are recoverable from U.S. academic centers for potential redistribution in low-resource settings: a potential for donation of up to $15 million dollars.

In a survey of 1,300 ophthalmologists, 90% agreed that OR waste is excessive and concerning. When I am in the OR, I make a conscious effort to ask the nurses very specifically for what I would like. For example, often the surgical preparation tray with Betadine has an excessive amount of dry gauze and cotton tips. I always make sure to ask the nurse to reduce what is in the tray, or I will ask them for the specific amount I need and no extra. 

Various strategies can be adopted to decrease OR waste and both improve carbon footprint and aid the health care systems of developing countries. Systems-based solutions include limiting the amount of items included in disposable packs, minimizing use of single-use items, advocating for reusable instruments, and implementing energy-saving solutions. Recycling initiatives implemented at one hospital diverted 6.5 tons of medical waste in one year. Replacing disposable foam OR padding with reusable gel saved the hospital about $50,000 a year. 

In addition to systems-based changes, many ophthalmologists and surgeons are involved in redistribution initiatives. Items included in disposable packs that are opened during surgery but are unused become nonsterile but are still clean as they have not been used. One ophthalmologist donated such supplies to her nearest veterinary clinic for redistribution. These supplies can also become lifesaving when redistributed to low-resource settings in developing countries, and many programs exist between donor and recipient hospitals to facilitate this exchange.

As threats from climate change continue to grow, reducing waste and recycling should be a primary concern in all areas of life. Large portions of hospital waste are due to OR excess and waste, and medical society should be more conscious of this fact. Reducing the use of disposable supplies, reducing energy use, maximizing the use of reusable instruments, recycling, and redistributing supplies to low-resource settings are all solutions to improve this issue of OR waste. Cost-effective and environmentally conscious surgery should never mean sacrificing patient care, but when done correctly, it can supplement care by creating more thoughtful and empathetic surgeons and medical teams. 

How do you reduce waste in the OR? Share in the comments.

Dr. Rabia Karani is a vitreoretinal surgery fellow at the Johns Hopkins Wilmer Eye Institute. She finished her ophthalmology residency at Columbia University in NYC and is a native of Houston. Her interests include public health ophthalmology, prevention of chronic diseases such as diabetes, and using imaging and technology to further develop treatments for retinal disease. Outside of work, she enjoys exploring museums and cities, learning about nature and animals, and traveling. Dr. Karani is a 2022–2023 Doximity Op-Med Fellow.

Collage by Jennifer Bogartz / Anastasia Usenko / Elena Bordyuzhova / Getty

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