New guideline advises reduce, reuse, recycle, and rethink

Reduce, reuse, recycle, and rethink can be applied in Canadian operating rooms (ORs) to increase environmental sustainability, advises a new guideline published in CMAJ (Canadian Medical Association Journal)

As the Canadian health care system produces almost 5% of the country’s greenhouse gas emissions and 200,000 metric tons of other pollutants, many generated in ORs, it makes sense to focus on reducing these harms.

An evidence-based guideline that updates guidance from 2020 outlines 21 recommendations that include reducing energy use by turning off lights and heating in ORs when not in use, using reusable surgical devices and gowns, developing recycling programs, and rethinking disposal of unused supplies and older devices.

“Adopting these recommendations will generally confer both environmental and financial benefits, and will often also benefit the people providing and receiving care,” writes Dr. Sarah Ward, an orthopedic surgeon at St. Michael’s Hospital at Unity Health Toronto and assistant professor, University of Toronto, Toronto, Ontario, with co-authors.

A multidisciplinary team of clinicians, administrators, environmental specialists, and patient partners developed the guideline.

“Successful implementation will require tailored strategies, and not all recommendations will be feasible for every hospital. Barriers to implementation of these recommendations exist, including limited resources (financial, time, and personnel), staff buy-in, site-specific restrictions (e.g., access to reusable sharps containers, portable nitrous oxide canisters) and administrative restrictions (e.g., OR occupancy sensors, current purchase agreements, space restrictions),” write the authors.

The guideline team hopes that hospitals and surgical departments will act on the recommendations.

“Given the large environmental impact of ORs and the danger to human health represented by climate change and other global ecological challenges, we urge those involved in providing surgical care to review this guideline carefully and adopt as many recommendations as are feasible within their own organizations,” they conclude.