Waste Management in the Operating Room: A Green Anaesthesia Perspective
Dr Priya Sadawarte,
MD, DNB
Cosultant Anaesthesiologist, Nagpur
drpriyasadawarte@gmail.com
Ever wondered what the carbon footprint of a single surgery is? It might surprise you to learn that your routine day in the operating room could equal a cross-country flight—at least in terms of Greenhouse Gas (GHG) emissions. In the high-stakes world of surgery; precision, sterility, and speed are paramount. But behind the sterile drapes and state-of-the-art monitors lies a less visible cost — environmental degradation. Operating rooms (ORs) are among the most resource-intensive and waste-generating environments in healthcare. Green anaesthesia is no longer a fringe concept. With healthcare contributing nearly 5% of global GHG emissions(1), anaesthesiologists have a critical role to play in reducing that impact. While reducing volatile anaesthetic use, transitioning to TIVA and low-flow techniques are vital steps in reducing carbon footprint, managing OR waste effectively is an equally important — and often overlooked — strategy.
Why OR Waste Matters?
ORs generate around 30% of hospital waste, and studies reveal that majority of it is non-infectious. Yet much of it is treated as clinical waste and incinerated — a costly and environmentally damaging practice!
Waste management in the OR stands as one of the most immediate and actionable pillars of the ‘Go green’ movement. It is not just about waste disposal, but it starts upstream in choice, procurement, use and education.
Here’s what we can do:
1. Segregate Smarter
Proper waste segregation at source is crucial. When clean plastics, packaging, and paper are tossed into clinical waste bins, they end up being incinerated or landfilled at high environmental and financial costs.
Simple measures include:
- Clear bin labeling and colour coding
- Regular staff training and reminders
- Department-wide audits to monitor compliance
Improved segregation can reduce clinical waste volumes by up to 50%, lowering both emissions and
costs.
2. Rethink Single-Use Culture
The use of disposable items — syringes, airway devices, anaesthesia circuits — has skyrocketed over the past two decades. While infection control concerns have driven this trend, many items can be safely reprocessed. For instance, switching from single-use LMA, anaesthesia circuits to reusable equivalents can significantly reduce both cost and waste.
Lifecycle assessments (LCAs) have shown that reusable equipment often has a lower environmental impact when accounting for energy and water use during sterilization(4,5). Policies encouraging reuse — where safe and feasible — should be prioritized.
3. Tackle Pharmaceutical Waste
Over-preparing drug trays, discarding unused medications, and improper disposal of controlled substances are all common in anaesthetic practice.
Sustainable approaches include:
- Drawing up drugs only when needed
- Using pre-filled syringes and ready to use drugs (e.g. PhenPress LS instead of PhenPress) to
reduce waste - Partnering with pharmacy for inventory management
- Segregating pharmaceutical waste correctly to prevent environmental contamination
Institutions that adopt “draw-as-you-go” policies have reported up to 30% reductions in drug wastage(6).
4. Recycling: More Possible Than You Think
Though contamination poses challenges, a surprising amount of OR waste can be recycled: Clean
plastic packaging, paper, cardboard, saline bottles etc. Partnering with local recycling vendors can
significantly reduce landfill burden(7).
5. Smarter Procurement
Every product brought into the OR has an upstream carbon cost. Hospitals should consider ‘green
procurement policies’ that prioritize: minimal packaging, manufacturer take-back programs and local
suppliers to reduce transport emissions.
Sustainability officers should be part of procurement teams to weigh environmental impact alongside
cost and quality (8).
6. Lead with Education and Culture
Sustainability must become a core part of OR culture. Anaesthesia departments can foster change by:
Nominating “Sustainability committee”
- Including sustainability in clinical education at undergraduate and postgraduate level.
- Including sustainability in CMEs: to educate educators
- Dashboards displaying metrics and progress updates
- Encouraging inter-professional collaboration
Clinician awareness is key: when educated about environmental impact, most healthcare professionals
are eager to adapt their practices
Anaesthesiologists: Champions of Climate-Conscious Care
Few specialties are better placed to influence OR sustainability than anaesthesia. We control drug
preparation, equipment use, and often dictate workflows that influence how other team members operate. By embedding green principles into our daily routines, we can make every case a win not only for the patient — but also for the planet.
The future of medicine isn’t just high-tech — it’s low-impact as well. And it starts with us!
References:
- Watts N, et al. The 2020 report of The Lancet Countdown on health and climate change. Lancet.
2020;397(10269):129-170. - Kagoma YK, et al. People, planet and profits: the case for greening operating rooms. CMAJ.
2012;184(17):1905–1911. - Sherman JD, et al. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg.
2012;114(5):1086-1090. - McGain F, et al. Environmental sustainability in anaesthesia and critical care. Br J Anaesth.
2017;119(2):250-256. - Eckelman MJ, et al. Environmental life cycle assessment of reusable and single-use laryngoscopes.
Anesth Analg. 2012;114(5):1067–1072. - Sherman J, et al. Environmental footprint of anaesthetic drugs: A neglected impact. Anaesthesia.
2020;75(9):1111–1112. - McGain F, Story D. A survey of anesthesiologists’ views on operating room recycling. Anesth Analg. 2009;109(3):979-980.
- Morris DS, et al. Surgical waste and its environmental impact: A review. Br J Surg.
2013;100(2):150-158
