Environmentalism in the Operating Room: Quality Improvement for Appropriate Disposal of Surgical Waste

INTRODUCTION: Surgical waste is differentiated into biohazardous waste and non-biohazardous waste. Biohazardous waste items are those that are saturated and/or dripping with human blood or body fluid and are incinerated to prevent disease spread. Non-biohazardous waste sorted as biohazardous waste leads to increased unnecessary incineration of waste and increased health care costs. Incineration of waste creates air pollution, such as particulate matter and greenhouse gases, as well as releases toxic chemicals into the local water and food supply. OBJECTIVE: This project aims to reduce the amount of non-biohazardous waste that is sorted and disposed of as biohazardous waste in order to decrease the production of greenhouse gases resulting from the incineration of waste as well as decrease cost for the hospital system. METHODS: First, we performed an audit of hazardous waste by weighing the bags of biohazardous waste “red bags” and then re-sorting this waste and weighing the non-biohazardous waste that was wrongly labeled as biohazardous. This was done 11 times for each of the following types of cases: total laparoscopic hysterectomy (n= 2), hysteroscopy dilation and curettage (n= 3), cesarean section (n= 3), total robotic hysterectomy (n= 1), and laparoscopic bilateral salpingectomy (n= 2) from 9 different surgeons. Education was provided for resident physicians on what should be disposed of as biohazardous waste from non-biohazardous waste using Rhode Island Medical Waste Regulations and environmental implications of incorrect sorting. A pre- and post-survey were taken of resident physicians regarding views on biohazardous waste and personal contribution to environmental sustainability. Following this intervention, the audit was repeated for 15 surgical cases. RESULTS: Sixteen resident physicians participated in the pre-survey and 10 in the post-survey. Prior to intervention, 41.3% of residents felt comfortable discerning biohazardous waste from non-biohazardous waste, 53.4% felt a personal responsibility for hospital-generated waste, and 68.8% felt they could make a difference in environmental sustainability. Following intervention, 100% of residents felt comfortable discerning biohazardous waste from non-biohazardous waste, 100% felt a personal responsibility for hospital-generated waste, and 100% felt they could make a difference in environmental sustainability. It was found that 45.6% (2.43 kg/surgical case) of waste that was originally sorted as biohazard was actually non-biohazardous waste according to Rhode Island Medical Waste Regulations based on our audit process. Following intervention, 58% (3.2 kg/surgical case) of waste that was originally sorted as biohazard was actually non-biohazardous waste upon audit. The highest inappropriate biohazardous waste was produced by total laparoscopic hysterectomy followed by cesarean section. CONCLUSIONS: Non-biohazardous waste is frequently sorted as biohazardous waste, leading to unnecessary incineration of waste and hospital spending. Resident physicians were uncomfortable discerning between biohazardous waste and non-biohazardous waste; however, following intervention, comfort levels improved. Intervention increased residents’ sense of personal responsibility for hospital-generated waste and sense of ability to create a difference in environmental sustainability (Figure 1).