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.

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.

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.

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