Work

Waste not, want not: assessing the impact of arthroscopic waste

Year: 2022

Type: article

Abstract: Health systems generate as much as (or at least) 4 per cent of the nation’s greenhouse gas emissions1–4. Between 20 per cent and 33 per cent of healthcare waste originates from the operating theatre, with up to 90 per cent waste unsorted (or improperly sorted) and sent for unnecessary ‘hazardous’ processing5–8. The World Health Organization has made recommendations to separate healthcare waste into different coloured, clearly labelled bags for disposal according to contents. Appropriate items should be recycled, while contaminated waste can be incinerated (ideally, with energy-harvesting methods) or sent to landfill. The choice of waste stream has up to a 50-fold impact on a procedure’s carbon footprint. Intraoperative waste from five each of arthroscopic anterior cruciate ligament (ACLR) and arthroscopic rotator cuff repair (RCR) procedures from four centres was measured. All procedures were undertaken by senior surgeons and data were collected prospectively. Clinical waste created by anaesthesia colleagues was excluded. The waste was separated into four bags: clean paper, contaminated paper, clean plastic, and contaminated plastic. Contaminated waste includes any waste directly used in patient care; it does not include product wrappers but includes each item in a multipack surgical set, even if unused. At the end of each procedure, each bag of waste was weighed using a theatre scale (DIGI® DS-502; Marsden Weighing Machine Group, Rotherham, UK). The mean measurement of waste was calculated for each procedure from each centre and is shown in Table 1. Mean plastic and paper waste, carbon emissions, and processing costs across individual hospital sites per anterior cruciate ligament (ACLR) or rotator cuff repair (RCR) procedure Mean plastic and paper waste, carbon emissions, and processing costs across individual hospital sites per anterior cruciate ligament (ACLR) or rotator cuff repair (RCR) procedure The waste-management policy of each hospital was requested alongside the tariff of waste management and CO2 emissions for processing waste. The cost of processing clean waste varied between €120 and €303 per tonne, and the cost to process contaminated waste between €247 and €819 per tonne. Despite the hospitals separating out clean plastic and paper waste, none of the hospital waste contractors provided a full recycling service—this waste tends to be incinerated with energy recapture. Of the contaminated waste, waste was either landfilled or incinerated. Carbon emissions were calculated using these figures (Table 1). A calculation was undertaken based on the annual surgical figures (pre-COVID-19 pandemic) from the hospital sites to calculate their annual burden of CO2 emissions for ACLR and RCR. The annual burden for ACLR was 7.53 tonnes of clinical waste and 1.7 tonnes of CO2, while the burdens for RCR were 15.4 and 4.5, respectively. The higher proportion of plastic waste in RCR generated a proportionally larger carbon footprint. The authors have no funding to declare. Ms Holly Morris is Chief Medical Officer for Revolution-ZERO. She co-authored the textile guidance provided to the Green Surgery Report.

Source: British journal of surgery

DOI: 10.1093/bjs/znac427