Hospital operating suites create large amounts of waste in their daily operations. Part of this waste is clinical waste (for example blood-stained items) which is costly to dispose of because it requires special treatment such as incineration or chemical processing, prior to disposal to landfill.
Non-clinical waste originating in operating suites can be placed in the general waste stream or can be recycled, either though commingled recycling or specialised recycling streams. In addition to undertaking a wide range of important tasks in a hospital, nurses play a key role when it comes to sorting waste appropriately during daily hospital operations. Unfortunately, for a variety of reasons, waste in high intensity environments, such as operating theatres, does not always end up in the most appropriate stream. This means that recyclable waste (for example paper, cardboard or recyclable plastics) can be found in the general waste stream, leading to avoidable landfill, or general waste and recyclable waste being disposed of in the clinical waste stream, which increases disposal costs and its environmental impact.
Between 2018 and 2020, Sustainability Victoria in collaboration with the Department of Health engaged BehaviourWorks Australia to improve waste separation in operating suites. The project aims were to:
a) increase recycling in the operating suites and
b) reduce the amount of general waste and recyclable items that were placed in the clinical waste stream. Doing so would reduce the weight of the clinical waste stream and therefore its disposal cost.
We tackled these issues in partnership with three Victorian public hospitals.
From the interviews and waste maps we learned that nurses’ waste sorting behaviour was influenced by a number of factors:
The interviews and waste maps identified some key common influences on nurses’ waste sorting behaviour across hospitals, but they also clearly highlighted that there exist many differences between hospitals. This included their existing waste and bin infrastructure, task allocations and contractor agreements around the collection and disposal of waste. This meant that for each hospital, the hospital-specific facilitators and barriers needed to be taken into account when designing interventions to improve waste sorting behaviour.
The co-design workshop was held in October 2019. During the workshop, we designed three intervention packages, one for each hospital. Co-designing interventions together with key hospital staff was an important part of this project to ensure that staff had ownership over the interventions and considered them acceptable and feasible in their daily hospital operations.
Unfortunately, the implementation of the interventions coincided with the rapid spread of COVID-19 in the beginning of 2020. Therefore, we were only able to fully roll out the intervention package of one hospital, which is described in detail below:
The implementation of this intervention package was led by the hospital’s own staff, specifically their Waste Officer and their operating suite green team. Having the support of these implementation champions was crucial for the project and the roll-out of the intervention package would not have been possible without them.
While our immediate plans to evaluate the intervention had to be cancelled due to COVID-19, the following year the hospital contacted us to report a success: With a lot of hard work and input from the hospital’s own enthusiastic theatre green team, the project had helped to divert an estimated five tonnes of sterilisation wrap from landfill over one year.
This feedback demonstrates that even during uncertain times, behaviour change is possible – particularly when working in collaboration with engaged and dedicated project partners.
This project was part of the larger “Waste Education in Healthcare Project” which was delivered by the Victorian Health Building Authority, with support from Sustainability Victoria through the Victorian Waste Education Strategy.
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