Greening the Operating Room: A Quality Improvement Initiative to Boost Recycling

BACKGROUND: The operating room (OR) produces large volumes of single-use plastic waste due to stringent sterility requirements. Despite the increasing use of recyclable plastics in medical packaging, recycling practices in OR remain limited due to workflow constraints, unclear waste segregation processes and lack of staff. To address this, our quality improvement (QI) initiative aims to increase plastic and paper recycling rates in OR. AIM: Our primary aim is to increase the percentage of waste recycled by 50% from 5% to 7.5% within 6 months in Singapore General Hospital (SGH) ORs. Our secondary aims are to assess changes in staff environmental awareness, the environmental and operational impact of the intervention. STUDY DESIGN: Using the Sustainable Quality Improvement (SusQI) framework, we carried out the following four steps: set recycling goals, study the current existing recycling system, design improvement and measure impact. Our project was conducted in the OR of a tertiary hospital. Success of the interventions were assessed across three key domains: environmental, which is the key measure of primary aim; social and process related outcomes for measurement of secondary aims, using both quantitative (e.g., weight of recyclables, percentage improvement in knowledge) and qualitative (e.g., end-user feedback) measures. RESULTS: Our study was conducted from January 2023 to March 2024. Top causes of low recycling were identified using root-cause analysis. Interventions implemented were duo-bin recycling, recycling posters educating end-users on recyclables and staff engagement through educational talks. After implementation of improvement measures, OR recycling rates doubled from 5% to 10%. Our improvement measures reduced 2024.7 kg CO2eq every month. For social impact, awareness of recyclable materials in the OR increased from 51% to 97.3%. CONCLUSIONS: With improved availability of recycling bins, education of recyclables and cultural shift towards recycling, recycling in a busy OR can be a reality. RELEVANCE TO CLINICAL PRACTICE: This project is a practical model for other healthcare teams seeking to embed sustainability efforts in clinical practice. Useful initiatives that can be replicated in other healthcare locations, contributing to the growing body of work on greener healthcare systems.