"Can we get the table up?" the surgeon asks as she and her team prepare my patient for her very first c-section. I stumble behind the blue drapes, hurriedly feeling for the cold remote and sliding my fingers over the correct button.
"Table up," I repeat, remembering my role in maintaining the efficiency of the case and hoping I reacted quickly enough.
Immediately after the podium lifts, the case begins, and I quickly lose myself amidst the hum of the operating room. A cacophony of whispered mumbles from the surgical team, laughter from the OR nurses, the whirring of suction, and the clatter of metal instruments mix beautifully in the air. Behind the blue drapes, the anesthesia team and I create our own concert of noises as we rhythmically shut the anesthesia drawers, clink medication vials, crinkle empty plastic wrappings, and gush with our patient about how excited we are to meet her baby boy.
In the OR's high-stakes environment, its surgeons, anesthesiologists, and nurses who are known for their precision and efficiency -- important traits for anyone responsible for tempering emergencies, curing diseases, and keeping patients alive. Yet, amidst this precision, there is often one detail that escapes us at the expense of our efficiency: the improper disposal of OR trash.
U.S. hospitals produce approximately 6 million tons of waste annually, with a 2017 study estimating that improper waste disposal could cost the U.S. more than $700 million over 5 years. Thus, there is a rising interest in containing costs and decreasing waste in hospitals, especially with growing pressure to move towards more sustainable hospital practices and to decrease the medical system's carbon footprint.
In a hospital system, the OR is a major source of medical waste, accounting for roughly 20-30% of the total waste. Approximately 90% of medical waste in the OR is considered to be non-infectious and non-regulated. However, such waste is frequently and inappropriately disposed of into infectious regulated medical waste containers lined in red bags, astutely referred to as "red bag waste." According to Practice Green Health, regulated medical waste can make up less than 8% of a hospital's total waste production, yet handling it can cost more than 40% of their waste management budgets.
One study estimates that the costs of proper waste disposal and landfill management of "red bag waste" is between 25 cents and 30 cents per pound. This is compared to 1.6-to-3 cents per pound to dispose of non-infectious and unregulated waste -- "normal trash," or better yet, "white bag waste." An approximately 10-to-15-fold difference!
Some may question why the proper disposal of trash matters so much in the context of patient care. Because hospitals generate roughly 29 lb of waste per bed per day, with 916,752 total staffed beds in U.S. hospitals, the U.S. generates roughly 26 million lb of waste a day. Because ORs generate roughly 42% of a hospital's revenue, and roughly 30% of its waste, let's break down some potential costs of inappropriate waste management in the OR.
Let's assume 100% of trash is properly disposed of in the U.S. each day, 30% of that being in the OR, and of that, 90% being "white bag waste." Simple math gets us $444,600 per day to properly dispose of OR waste in the U.S.
Now, let's pretend that only three fourths* of this waste is being properly disposed of in white bags, while the rest is thrown into "red bags" (25% vs the level it should be at, 10%). More simple math gets us to a cost of $760,500/day for U.S. ORs to dispose of the waste when only 75% is being correctly disposed of as "white bag waste." Over a year, this mistake may cost U.S. hospitals upwards of $115,303,500 of avoidable spending, depending on how well OR staff follow proper disposal guidelines.
While being particular about how to properly dispose of OR trash when a patient needs critical attention on the surgical table may seem silly, the effects on the environment and hospital administrative costs remain salient to patients and hospitals. The proper disposal of hospital waste can positively impact patients through a cleaner environment, more amenable to promoting health. It also helps hospitals by decreasing costs, and benefits the environment through less plastic and paper waste being unnecessarily incinerated as biohazard waste. Over time, cost savings may allow hospitals to have more money to (hopefully) spend on improving hospital quality, safety, and care.
Ultimately, it is important to consider proper waste management in the context of reducing hospital waste and cost. Waste reduction and proper waste management are not only sustainable and ethical but also cost-saving. Hospital investment in waste segregation initiatives and increased staff education in proper waste disposal is important for reducing costs.
One 2021 study showed that a waste segregation initiative -- which was designed to increase staff knowledge and compliance with waste segregation and optimization of existing disposable containers through education modules -- found a 65% increase in correctly segregated regulated hospital waste. This led to a collective savings of $15.60 per OR per week, or $28,392 annually.
Scaling this initiative across all healthcare systems in the U.S. would have an exponential impact on decreasing our country's collective healthcare waste and save millions of dollars in healthcare spending. In optimizing and minimizing incorrect use of "red," hospitals can find themselves seeing a lot more "green."
*Due to the lack of regulation and standardization of data estimating how much hospital waste is inappropriately disposed of, I use 25% as an estimate to simplify this exercise. The true percentage of inappropriately disposed of waste could fall below or above this estimate.
Catherine Marudo is a fourth-year medical student at the University of Miami Miller School of Medicine in the MD/MPH Program.