According to the Joint Commission, healthcare facilities represent a significant source of pollution around the world, contributing to climate change.1,2,3 Operating rooms (ORs) contribute up to 30% of a hospital’s waste.4 Additionally, 90% of OR waste is improperly sorted and sent for unnecessary biohazard waste processing, including recoverable medical supplies that can be reused through sterilization or reprocessing.5

A new study in the October issue of The Joint Commission Journal on Quality and Patient Safety (JQPS), “Sustainability Initiatives in the Operating Room,” by Samantha Wu and Elizabeth Cerceo, MD, FACP, FHM, at Cooper University Healthcare, Camden, New Jersey, conducted a narrative review to identify evidence-based green practices and sustainability strategies to reduce waste in the OR, including:

  • Forming an OR committee or a hospital Green Team dedicated to environmentally sustainable initiatives.
  • Changing the supply chain with preferences for reusable devices, effective recycling, repurposing instruments and donating items to divert waste away from landfills.
  • Reducing unnecessary packaging and instruments to eliminate excess in the waste stream.
  • Curtailing energy and water usage to improve cost and environmental savings.
  • Transitioning away from certain inhaled anesthetics to minimize greenhouse gas impact.
  • Educating staff across all levels of the health care system to drive and maintain change.

“All these practice strategies require engagement by members of the OR community, including anesthesiologists, surgeons, nurses, biomedical engineers, environmental services, and facilities staff,” notes an accompany editorial by Fiona A. Miller, PhD, at the Institute of Health Policy, Management and Evaluation, University of Toronto. “Thus, Wu and Cerceo highlight the importance of education and committee structures to foster teamwork in support of sustainability.”


References provided by The Joint Commission

  1. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016 Jun 9;11:e0157014.
  2. Holmner A, et al. Climate change and eHealth: a promising strategy for health sector mitigation and adaptation. Glob Health Action. Epub. 2012 Jun 5.
  3. Eckelman MJ, et al. Health care pollution and public health damage in the United States: an update. Health Aff (Mill- wood). 2020;39:2071–2079.
  4. Practice Greenhealth. Home page. Accessed Jul 12, 2021. https://practicegreenhealth.org/.
  5. Kwakye G, Brat GA, Makary MA. Green surgical practices for health care. Arch Surg. 2011;146:131–136