The Problem of Operating Room Trash (And a Solution to Fix It) | MedPage Today

by Max Feinstein, MD October 12, 2023

Anesthesiology resident Max Feinstein, MD, reflects on the quantity of waste produced by surgical operations and what can be done to address it.

Following is a partial transcript (note errors are possible):

Feinstein: One of the things that's always left an impression on me throughout residency is the amount of plastic waste that's produced just by opening everything I need to prepare for surgery. But don't just take my word for it. Let me show you exactly how much is produced when I'm opening up for this cardiac surgery.

The reason I got up so early to record this video is because I wanted to get my hands on something. It's very difficult to obtain. As anyone who has been in an operating room [OR] can tell you, the scrub nurse's table is something that is reserved for the scrub nurse, except today I got in early enough to be able to use it to show you how much plastic is produced when I open for this case.

I picked cardiac anesthesia for this particular video because we go through a lot of equipment for these types of surgeries and I'm going to start by just going through my normal "MS MAIDS" mnemonic, which I made a video that you can look at right here that goes through all of the basic components of what I need to safely provide anesthesia. So I'll go ahead and start with that right now.

Now that I have opened basically all of the equipment I'll need, I take all of the paper and plastic waste and put it in this green bag that is destined for a recycling facility nearby that we will actually take a field trip to later in this video.

This isn't the only receptacle in this operating room that's destined for recycling. There are also specially designated recycling bins that the nursing staff also uses when opening all of the surgical equipment. This is part of an effort at Mount Sinai Hospital to reduce the environmental impact of surgery, which as we'll discuss is surprisingly significant for a number of different reasons.

The person who has been spearheading that effort is Dr. Trinh, cardiac anesthesiologist and medical director of environmental sustainability at the Mount Sinai Health System. Thank you so much for talking with me and also for being the attending anesthesiologist in the case that we showed in this video.

Muoi Trinh, MD: Thanks so much for having me, Max. I'm really excited to talk about this topic.

Feinstein: Me too, and to start, I would be really curious if you can just give me a sense of what is the nature of the problem of environmental waste in operating rooms in the United States.

Trinh: This is a huge problem, right? The ORs contributed about 30% of 5 million tons of waste in the hospital annually.

Feinstein: Wow.

Trinh: That's a big problem, right? Twenty-five percent of that comes directly from the operating rooms, and of that, 25% is actually recyclable. That's why we're trying to promote this and that's why we're trying to push recycling a little bit more in the health system and working on this issue.

Feinstein: As the person who has spearheaded these efforts at Mount Sinai Health System, what are the barriers that a hospital system faces in order to have better environmental sustainability efforts?

Trinh: In terms of recycling, one of the major barriers is classification of waste. In the OR, waste is not all the same, right? We have solid waste that goes into the landfill. We also have special waste, such as regulated medical waste. Those are things that could be contaminated by blood or infectious materials, and so they need to be disposed of properly.

We also have chemical waste, which are hazardous waste, and they also need to be processed separately. We overclassify trash or waste. It can actually significantly increase the carbon footprint from, say, a piece of paper. A good example of this is if I take a piece of paper, and instead of putting it in the recycling container or even in the landfill in the regular waste, now I'm taking it and putting in a sharps bin, well that piece of paper now needs to be transported to a special facility where it is now incinerated and then gets transported again to a waste management facility where it then eventually sits. But transportation with diesel fuel is huge in these trucks. Now, instead of being recycled and being reused, we've actually significantly increased that carbon footprint of that one piece of paper. On the same token, we want to be able to keep patients and our staff safe and the public safe. We don't want to contaminate recycling with bloody products, for instance, so that's why proper segregation is so important and one of the major barriers to recycling.

Feinstein: In preparing to make this video, I was reading through some of the literature and I saw that it's estimated that 40% of anesthesia waste is recyclable and the majority of that comes from the opening of all of our equipment before a patient even steps foot into the operating room. To the extent that we're keeping recyclables clean or not contaminated, it makes a lot of sense that we're recycling everything that we're opening up at the beginning. Right?

Trinh: Correct, and that's part of the workflow that we've established at Sinai. We try to recycle a lot of materials before the patient enters the room, so opening up all those packages as you saw in the case that you did.

Feinstein: Now that we have a rundown of the perioperative recycling program, we are going to follow this recycling and see where it goes after it left the operating room.

I'm getting ready to hop on the subway and head up to the Bronx, where we're going to actually look at the recycling facility where everything from Mount Sinai's operating rooms are sent. Let's go see what we can find.

This kind of makes me feel like Casey Neistat, popular New York City vlogger. But at the end of the day, I'm just an anesthesiologist trying to make it in a big city.

Just got here. Got a nice little view of the water, although the view doesn't really matter. I feel like I'm in the water anyways because this umbrella is terrible. I know I'm in the right place because I see a recycling truck coming. I should probably... I need to get out of the middle of the road. But, look, we're here.

It smells a little bit like the Bronx plus that garbage smell with a whiff of, yes, saving the planet. When we got to the sorting facility, the first thing that we saw was this enormous conveyor belt that was basically splitting up recycling or classifying it automatically.

Trinh: The most ... thing to me was how big the facility was and also how many conveyor belts they had to segregate each of the plastic product or paper or aluminum. It was also very interesting that they used this optical laser to sort through [and] automate the process of segregating waste.

Feinstein: What was wild to me while we were there, trucks were coming in and dumping all of this new recycling to be sorted, and just the volume of it was shocking to me, which gave me a lot of hope to see how a hospital system can divert a lot of what would be waste into recycling that ultimately reduces the environmental impact that they have on the planet.

Going to the waste management facility was really eye opening. For anyone who is interested in learning more about perioperative recycling, there is a really wonderful article by Maggie Xiao, which I have linked right here. Thank you very much for watching and thank you very much for your time, Dr. Trinh. It was great talking with you.

Trinh: You too. Thanks so much.

Max Feinstein, MD, is a PGY-4 anesthesiology resident at the Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His YouTube channel focuses on perioperative medicine, especially the role of the anesthesiologist.