Anaesthesia waste comprises a quarter of total operating theatre waste, with around 60% as potentially recyclable [1]. Clinical waste is our facility’s most expensive waste stream, and its disposal has the largest carbon footprint of any waste stream due to high temperature incineration in gas-fired furnaces [2]. Hence, there are significant financial and environmental implications from inappropriate clinical waste disposal. As healthcare professionals, we must be eco-responsible, recognising the larger environmental impact of improper sharps disposal in line with local and national clinical waste disposal guidelines. 

The aim of this audit was to assess the appropriate disposal of clinical waste sharps in the operating theatres (OTs) of a major tertiary centre. The standard set was the ANZCA 2019 position statement on environmental sustainability in anaesthesia and pain medicine practice [3].

An initial prospective observational audit was conducted between February-April 2022 in the OTs of Flinders Medical Centre, South Australia, with a re-audit between February-April 2024. Photos were taken of clinical waste sharps bins from 14 OTs, 2 endoscopy suites, and 1 procedure room. An assessment of appropriate sharps disposal was achieved by visually cataloguing the contents of 19L sharps bins using "Bird’s Eye Photos" during both study periods into “non-sharps items” or “tempered glass vials.” Bins were excluded if they did not have a complete top layer of contents inside. 

The re-audit then evaluated the impact of interventions, involving half-yearly educational teachings to Anaesthesia and theatre staff, the creation and distribution of visually appealing posters on proper sharp disposal above all clinical waste sharp bins, and provision of separate tempered glass bins. 

Figures were described in counts and percentages, comparing the quantity of inappropriate items disposed of before and after interventions, aiming to determine improvements in waste disposal practices.

Ethics exemption:

SALHN Quality Register: ID 4836

A total of 60 and 58 photos of 19L clinical waste sharps bin in 2022 and 2024 respectively were analysed. The findings revealed an improvement in appropriate sharps disposal, with a decrease in the average number of "non-sharps items" per bin from 5.96 (95% CI 4.84-7.10) in 2022 to 2.75 (95% CI 2.12–3.38) in 2024, and a decrease in the average number of "tempered glass vials" per bin from 4.12 (95% CI 3.56–4.68) in 2022 to 2.76 (95% CI 1.97–3.55) in 2024.

The audit demonstrates improvements from targeted interventions in clinical waste sharps disposal following biannual educational sessions, posters, and designated tempered glass bins. These interventions reduced non-sharps items and tempered glass vials in sharps bins, suggesting financial savings and a reduced carbon footprint. However, some inappropriate disposal remains, indicating a need for ongoing education with routine audits to achieve optimal compliance. 

Future efforts focusing on quantifying the weight of theatre waste, including general, dry, and clinical waste, and their respective impacts on carbon footprint, could contribute to more quantitative assessments of its environmental impact. This audit data could inform the development of tailored waste management strategies aligned with sustainability goals. 

This audit highlights the effectiveness of raising awareness about proper disposal of clinical waste sharps via educational initiatives, posters, and dedicated tempered glass bins, resulting in improved compliance with sharps disposal guidelines at a tertiary healthcare facility. 

None

1.     McGain, F., Hendel, S.A. and Story, D.A. (2009) ‘An audit of potentially recyclable waste from anaesthetic practice’, Anaesthesia and Intensive Care, 37(5), pp. 820–823. doi:10.1177/0310057x0903700521.

2.     Rizan, C. et al. (2021) ‘The carbon footprint of waste streams in a UK hospital’, Journal of Cleaner Production, 286, p. 125446. doi:10.1016/j.jclepro.2020.125446.

3.     ANZCA (2019) Environmental sustainability, ANZCA. Available at: https://www.anzca.edu.au/about-us/our-culture/environmental-sustainability (Accessed: 24 April 2024).