Toronto Western Hospital (TWH) Waste Audit

Greening the Operating Room: Auditing Anesthesia Generated Wastes and Exploring Strategies to Reduce, Reuse and Recycle

The goal of this observational study is to learn about the amount and types of anesthesia wastes generated for each surgical case at the Toronto Western Hospital (TWH). The main questions it aims to answer are:

• The amount of anesthesia waste generated per surgical case at TWH
• The amount of wastes that are inappropriately discarded
• The percentage of discarded waste that can be reused or recycled
• The percentage of recyclable waste that is actually recycled
• The percentage of discarded waste that is appropriately sent to landfill
• The financial cost of waste disposal
• The impact of a staff education program on waste reduction and proper waste disposal

The research team will conduct the audit by inspecting the contents of the waste bins and bags following completion of a surgery.

Study Overview

• Status: Recruiting
• Conditions: Audit of Medical Waste Disposal
• Intervention / Treatment: Other: Staff Education Program

Detailed Description

Environmental pollution by healthcare waste is a complex and pervasive problem. Canadian hospitals produce a staggering 300 tons of medical waste daily and ~30% of wastes are generated by surgery and anesthesia services. A quarter of the solid waste associated with surgery is likely to be of anesthesia origin, with plastics (e.g. face masks, breathing circuits and IV sets) forming almost half of the total anesthetic waste volume, and mostly being discarded in landfills. Not only do they pose serious environmental harm to wildlife, these plastics also pose health risk to humans. Because plastics are resistant to many natural processes of degradation, microplastics can persist in the environment for hundreds of years with the potential to contaminate and bioaccumulate up the food chains through agricultural soils and the water supply. The need for operating room (OR) greening initiatives is indeed desperately urgent.

Solid waste generated by anesthesia is classified as either general waste or medical / biohazardous waste. General waste includes papers, plastic disposables and packaging materials and clean general wastes are recyclable. Medical waste encompasses sharps, pharmaceuticals, and materials that are contaminated by blood or infectious materials. They are not recyclable and require expensive treatment (e.g., autoclave and incineration) prior to final disposal. Thus, proper understanding of the type of waste (i.e. medical vs. general, recyclable vs. non-recyclable) and awareness of proper waste management procedures is important to avoid improper waste segregation and unneeded expensive biohazardous processing.

Among all the waste management options, waste reduction is most important. This is followed by reuse / reprocessing to prolong the product life cycle. Recycling should be considered when 'reduce' and 'reuse' have been maximized, and can decrease the volume of waste sent to landfills. However, recent strict contamination limits on the importation of recyclable plastics, especially in China, have caused a major slowdown in global recycling. Additionally, a lack of institutional culture of environmental sustainability, a lack of knowledge of proper waste segregation and recycling, and concerns about the extra workload associated with sorting for plastic recycling are some of the major institutional and human barriers that impede waste reduction and proper disposal efforts. Fortunately, a staff education and improvement program can overcome these barriers.

Despite these environmental threats, there are few published studies on anesthesia waste or guidelines for anesthesia waste management. This study first aims to quantify the magnitude of anesthesia wastes generated in the Toronto Western Hospital (TWH) operating room, then implement a staff education and waste awareness program, and finally measure the impact of such an education program on waste reduction, reuse and recycling.

The study includes 6 phases.

i. Phase 1 (4 months): The planning phase to conduct meetings with Operating Room leadership and Environmental Services to plan for a general and medical waste collection system in the operating room for this study.

ii. Phase 2 (2 months): 1-week prospective collection of solid wastes for each type of surgical service at TWH without notifying anesthesia staff; the collection will continue for 5 consecutive working weekdays in 1 week.

iii. Phase 3 (2 month): Analysis of waste collection data and report to anesthesia staff.

iv. Phase 4 (3 months): Staff education and environmental awareness campaign and in-service to highlight the reduce, reuse and recycle concepts and proper waste disposal practice.

v. Phase 5 (2 months): Repeat 1-week collection of wastes for each type of surgical procedure.

vi. Phase 6 (1 month): A second analysis and report of waste generation and disposal to the Department of Anesthesia.

Data will be collected for a minimum of 10 cases for each surgical type of varying duration. Descriptive statistics will be used to describe surgical case volume during the study period. Two-sample Student's t-test will be used to compare the daily weight of general, medical and recyclable solid wastes between the baseline study period and the second assessment period after staff education. A P value < 0.05 is considered statistically significant.

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

• Study Contact: Name: Jayanta Chowdhury, MBBS, MD; Phone Number: 2016 416-603-5800; Email: jayanta.chowdhury@uhn.ca
• Study Contact Backup: Name: Vincent Chan, MD, FRCPC; Email: vincent.chan@uhn.ca

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5T 2S8
      • Recruiting
      • Toronto Western Hospital
      • Contact: Jayanta Chowdhury, MBBS,MD; Phone Number: 2016 416-603-5800; Email: jayanta.chowdhury@uhn.ca
      • Principal Investigator: Vincent Chan, MD,FRCPC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Anesthesia staff, residents and assistants within the Toronto Western Hospital.

Description

Inclusion Criteria:

• Must be an anesthesia staff, resident or an anesthesia assistant at Toronto Western Hospital.

Exclusion Criteria:

• Inability to give informed consent to participate in the study.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Staff anesthesiologists or anesthesia fellows; Participating study subjects will go through a staff education program to encourage proper waste disposal.

Other: Staff Education Program; A staff education and environmental awareness campaign and in-service to highlight strategies to reduce, reuse, and recycle waste, as well as proper waste disposal practice, will be implemented by way of instructional posters, e-learning modules, a grand rounds presentation, journal club discussion, and brainstorming sessions for waste reduction, reuse and recycle and a brief knowledge test at the end.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure the amount of all types of anesthesia waste generated per surgical case at Toronto Western Hospital.	Measure the amount of anesthesia waste (general waste and medical waste) generated on average per surgical case. All general and medical anesthesia waste will further be categorized into into plastic and non plastic, reusable and non-reusable, and recyclable and non-recyclable; all quantified by weight in kilograms.	Average 14 months after the beginning of the study.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure the incidence of inappropriate waste disposal	The incidence of inappropriate waste disposal i.e., general wastes into the medical waste bin and vice versa, and weight in kilograms of recyclables remaining within the general and infectious waste	Average 14 months after the beginning of the study.
Measure the incidence of reusable general wastes that is discarded at Toronto Western Hospital.	Measure of the amount of non-contaminated, reusable general wastes that is inappropriately discarded, measured by the average number of occurrence per surgical case and quantified in percentage.	Average 14 months after the beginning of the study.
Measure the incidence of recyclable general wastes that is discarded at Toronto Western Hospital.	Measure of the amount of non-contaminated, recyclable general wastes that is inappropriately discarded, measured by the average number of occurrence per surgical case and quantified in percentage.	Average 14 months after the beginning of the study.
The amount of soft plastic packaging waste generated per case that is discarded	The amount of soft plastic packaging waste generated on average per surgical case, that is discarded to landfill; quantified by weight in kilograms	Average 14 months after the beginning of the study.
To see the impact of anesthesia staff education program on the waste management and disposal behavior and practices among the anesthesia staff at Toronto Western Hospital..	The amount of change by weight of the appropriately disposed anesthesia waste by the anesthesia staff per surgical case in the second audit from the first audit will reflect the impact of staff education campaign on the staff behavior and practices; quantified in percentage.	Average 14 months after the beginning of the study.

Collaborators and Investigators

• Sponsor: University Health Network, Toronto
• Investigators: Principal Investigator: Vincent Chan, MD, FRCPC, University Health Network, Toronto

Study record dates

Study Major Dates

• Study Start (Actual): July 27, 2023
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): March 31, 2026

Study Registration Dates

• First Submitted: August 21, 2024
• First Submitted That Met QC Criteria: November 6, 2024
• First Posted (Actual): November 8, 2024

Study Record Updates

• Last Update Posted (Actual): November 20, 2025
• Last Update Submitted That Met QC Criteria: November 17, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Anesthesia; Waste; Medical Waste; Waste Disposal; Anesthesia Waste; Anesthesia Waste Disposal
• Other Study ID Numbers: 21-6124

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No