Waste management in an Italian Hospital's operating theatres: An observational study

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

BACKGROUND

Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery.

METHODS

A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics.

RESULTS

We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO2eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery.

CONCLUSION

This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.

Toward Environmentally sustainable surgery: Waste recycling in general surgery operating room. Preliminary cognitive audit

BACKGROUND

It is common practice to classify waste from the operating theater as "clinical". The development of sustainable policies could have a significant impact. In the first phase, our study aims to measure general surgery waste and to assess the potential financial and carbon savings of appropriate recycling. Based on this information, we will plan for a second phase in which educational interventions will be put in place to promote waste segregation in surgical environments.

METHODS

We conducted a preliminary cognitive audit of the most common general surgery procedures to examine the types and quantity of waste produced. We calculated the economic and environmental impacts of disposing of waste treated as clinical or general, and we measured how much of it could actually be recycled. Then, we attempted a projection of the savings we could expect if recycling policies were implemented.

RESULTS

We found that more than 30% of total waste was actually recyclable. Considering a projection based on annual procedures performed in our hospital, we estimated that for each kind of surgical procedure, we could expect a reduction of the carbon footprint by approximately 6%, and an average 3% reduction in costs every year, only by improving waste segregation in the general surgery operating rooms.

CONCLUSION

There could be a great potential for reducing environmental and economic footprint of the operating rooms by promoting waste recycling protocols. Surgeons are in a unique position to implement for these protocols. Interventions should be codesigned with theater staff to create a "green culture".

[Sustainable waste management in general surgical operations]

BACKGROUND AND OBJECTIVE OF THE STUDY

Hospitals, especially surgical departments, are among the largest producers of waste in Germany. Data on waste management in the operating room (OR) are largely lacking. The aim of this study was to assess and discuss the possibilities of reducing waste and recovering recyclable materials in general surgery against the background of current practice.

METHODOLOGY

Surgical departments throughout Germany were surveyed on waste management. First, the theoretical waste separation possibilities for laparoscopic appendectomy were determined. Subsequently, a simple system for the separation of recyclables was established and practically tested in 35 operations. These were compared with 35 appendectomies without separation.

RESULTS

Only 25.7% of hospitals perform waste separation. Theoretically, 20.7% of waste can be recycled, in practice up to 18.9%. Paper, cardboard and plastics, especially polyethylene terephthalate (PET) and high-density polyethylene (HDPE) were separated. This leads to a significant reduction in residual waste without extending the operation time.

DISCUSSION

Separation of recyclables can contribute to more sustainable waste management in the OR. High-value recyclables can be recycled and the residual waste mass can be significantly reduced. This is possible without special effort and does not delay the processes in the OR. The opportunities for this have hardly been used in Germany to date.

Analysis of healthcare waste management in hospitals of Belo Horizonte, Brazil

Healthcare waste (HCW) management is a challenge for establishments that generate this type of waste, especially hospitals, as they are one of the largest generators. A determining factor in waste management is the amount of waste generation, which must be used for management planning. This study aims to compile and evaluate information on the management of HCW generated in Belo Horizonte's (located in Brazil) hospitals declared in their respective Healthcare Waste Management Plans (HCWMP) sent for approval by the municipality's Superintendency of Urban Cleaning. Therefore, a comparative analysis of the hospitals' generations in relation to their characteristics (nature, specialty, and size) was carried out, using the Kruskal-Wallis statistical test with post hoc in Nemenyi. For the study hospitals, a generation rate of 7.18 (6.17-8.23) kg·bed-1·day-1 was estimated, a generation rate close to that of developed countries. When comparing the generation according to the specialty of the hospitals, it was identified that the maternity hospitals (9.00 (7.05-10.90)) kg·bed-1·day-1 had a significantly higher generation rate than the low-complexity hospitals (4.75 (3.28-6.18)) kg·bed-1·day-1. It was also possible to demonstrate that the specialty and size of hospitals influence the structure available for waste storage. Finally, it can be observed that there are few treatment alternatives, with incineration and autoclaving being the technologies most commonly used by hospitals. It is expected that the results presented can serve as a reference for waste managers, in a context where there is little shared information on the subject.

Identifying and Predicting Healthcare Waste Management Costs for an Optimal Sustainable Management System: Evidence from the Greek Public Sector

The healthcare sector is an ever-growing industry which produces a vast amount of waste each year, and it is crucial for healthcare systems to have an effective and sustainable medical waste management system in order to protect public health. Greek public hospitals in 2018 produced 9500 tons of hazardous healthcare wastes, and it is expected to reach 18,200 tons in 2025 and exceed 18,800 tons in 2030. In this paper, we investigated the factors that affect healthcare wastes. We obtained data from all Greek public hospitals and conducted a regression analysis, with the management cost of waste and the kilos of waste as the dependent variables, and a number of variables reflecting the characteristics of each hospital and its output as the independent variables. We applied and compared several models. Our study shows that healthcare wastes are affected by several individual-hospital characteristics, such as the number of beds, the type of the hospital, the services the hospital provides, the number of annual inpatients, the days of stay, the total number of surgeries, the existence of special units, and the total number of employees. Finally, our study presents two prediction models concerning the management costs and quantities of infectious waste for Greece's public hospitals and proposes specific actions to reduce healthcare wastes and the respective costs, as well as to implement and adopt certain tools, in terms of sustainability.

Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives towards a circular economy transition

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.