Anesthesia-Related Waste Streams

Introduction

The Scale of Anesthesia-Related Waste

• American healthcare facilities produce large volumes of medical waste per year and contribute about 8% of US greenhouse gas emisions.¹
• Surgical departments are major contributors to healthcare-generated waste, accounting for 20-30% of total hospital garbage production.²
• Anesthesia services may account for around 25% of all waste produced in operating rooms.³
• One study estimated that anesthesia services generated 2,300kg of waste per operating room (OR) per year.⁴

Types of Waste

• Waste produced in the healthcare setting is broadly divided into solid waste (SW) and regulated medical waste (RMW).

• SW includes noncontaminated products, which may be removed using standard waste removal protocols (or recycled, if eligible). The World Health Organization estimates that 80% of healthcare-generated waste should be categorized as SW.⁵
• RMW requires special processing to keep the public safe from contaminants, such as infectious agents.⁵ Subcategories of RMW may include:
  • materials soiled with bodily fluids or other potentially infectious materials; and
  • sharp objects, including needles, scalpels, or contaminated glass containers, which could cause bodily injury or act as a source of infection.
• Radioactive materials used in treatments of certain diseases, such as cancer.

Effects and Challenges in Anesthesia Waste Management

Environmental & Economic Impacts of Waste Types

• Solid waste generated by healthcare facilities poses no more risk than SW produced in any other setting.
• Regulated medical waste requires additional processing, through either steam sterilization before landfill placement or through incineration. Steam sterilization is an energy-intense process, and incineration produces greenhouse gas emissions and may release multiple environmental toxins.⁶
• As a result of the special handling and processing required, RMW is up to 500% more expensive to eliminate than SW.²

Possibilities for Improvement

Reuse, Recycling, and Donation

• One way to reduce anesthesia waste production is by utilizing multi-use products, such as nondisposable laryngoscope handles and blades. Such instruments are both more environmentally friendly and cheaper over time.⁷
• A large portion of waste generated by anesthesia practice is recyclable.³ Recycling items removes them from either the SW or RMW streams.
• Anesthesia equipment which is no longer useful in high-resource settings may be invaluable in low-resource settings. Items to be donated may be as complex as older-model anesthesia machines or as simple as disposable items which are no longer needed. However, care must be taken to avoid donating broken, unusable, or unmaintainable items.²

Opportunities for Quality Improvement and Education

• Though a large proportion of anesthesiologists support green initiatives, many report a lack of institutional support as a barrier to involvement.⁸
• Improving the amount and distribution of anesthesia-related waste requires action at the personal, departmental, and institutional levels. It also offers opportunities for anesthesia providers to become leaders and environmental champions within their workplace.
• Despite the challenges faced, many successful environmental quality improvement initiatives have been initiated by anesthesiology departments. These have included:
  • initiatives to reduce wastage of disposable products, like endotracheal tubes;⁹
  • an initiative to dispose of CO₂ absorbers into the SW stream instead of the RMW stream; and10
  • an initiative to promote better waste segregation by anesthesia providers, resulting in a dramatic reduction in RMW related to anesthesia care.¹

• All anesthesia-driven environmental initiatives require proper education of the anesthesia team, including anesthesia technologists, advanced practice providers, and anesthesiologists.