An initiative that encouraged surgery patients to bring their own reusable bags for belongings and a reusable water bottle led to reductions in surgical carbon footprints, waste, and cost, a new study indicated.

“Operating rooms are among the most resource-intensive areas of the hospital,” Julie Strychowsky, MD, pediatric otolaryngologist at Children’s Hospital in the London Health Sciences Centre (LHSC) and researcher at LHSC Research Institute in London, Ontario, told Medscape News Canada. “They are estimated to contribute 20%-30% of total hospital waste and use three to six times more energy than the average hospital unit.”

“Much of this waste, particularly plastics, is preventable,” said Strychowsky, who also leads the Operating Room Planetary Health Intervention Team at LHSC.

The goal of the study was to test whether a small behavior change could meaningfully reduce plastic waste without compromising care in three clinical settings, she explained.

The aim of having 50% of day surgery patients bring their own bags was surpassed at all three settings, although the aim of having 50% of patients bring their own reusable water bottle was surpassed at only one.

Nevertheless, Strychowsky said, “What surprised me most was how willing patients and staff were to participate…. When changes are intuitive and patient-centered, people want to help, and the environmental impact can be meaningful even with simple interventions.”

The study was published online on January 6 in the Canadian Journal of Surgery.

‘Bringing Reusable Bags Is Easy’

Researchers used the Plan-Do-Study-Act (PDSA) method, guided by CASCADES, Canada’s “bring your own reusable bag” perioperative charter. They conducted three PDSA cycles, first at Nazem Kadri Surgical Centre (NKSC) and then at Victoria Hospital and University Hospital. They used educational interventions to inform staff and encourage patients to bring their own reusable items.

Outcome measures included environmental carbon footprint savings, waste savings, and cost savings over 1 year. Process measures included the percentage of patients who brought their own reusable bags and water bottles, the percentage of plastic belongings bags purchased, and the percentage of patients informed to bring their own reusables. Balancing measures assessed patient satisfaction and administrative workflow changes.

At NKSC, 87.4% of patients brought their own reusable bags for belongings and 80.5% brought their own water bottles. At University Hospital and Victoria Hospital, 60% and 78% of patients, respectively, brought their own reusable bags, and 15.7% and 57.8%, respectively, brought reusable water bottles.

Overall, there was a 45.7% reduction in plastic bags purchased annually for patient belongings, which equaled a reduction of 2141 kg of carbon dioxide equivalents and 10,393 km driven equivalent emissions, as well as savings of $1259.55 and 252 kg of waste.

“Most patients and staff agreed that bringing reusable bags for surgery is easy,” the authors wrote.

The main challenges in implementing the program were related to change management and stakeholder alignment, Strychowsky said. “Successful implementation required early and ongoing engagement with surgeons and their administrative staff, nursing, perioperative teams, and infection prevention and control to ensure that patient safety standards were fully maintained. However, again, everyone wanted to help.”

Even clinicians who are not part of an initiative such as this can help reduce surgical waste, she noted. “Clinicians have more influence than they may realize. Asking simple questions like ‘Do we need this?’ or ‘Is there a reusable option?’ can spark change. Modeling sustainable behaviors, engaging patients, and partnering with quality improvement teams can lead to safe, incremental improvements. Small clinician-led changes often build the momentum needed for broader system transformation,” she said.

Mobilizing and Engaging Teams

“Reusables are an extremely important intervention in healthcare with respect to decarbonization, and ‘bring your own bag’ is one of multiple ways of intervening in this specific context,” Fiona Miller, director of Collaborative Centre for Climate, Health, and Sustainable Care, University of Toronto, Toronto, told Medscape News Canada.

“In British Columbia, some health authorities have purchased reusable linen bags for patients to use. So there are different ways of doing this,” said Miller, who is also director of CASCADES, an initiative that informed the methods used in the paper. Miller was not involved in the study.

Many people must be involved in these types of initiative, which is why some institutions don’t embark on them, she said. “It’s so much work to get a team involved, and the authors themselves comment that if they didn’t have a green team within the operating room, they wouldn’t have had a place to start.”

That said, she added, “What’s interesting about this specific initiative around Ontario is how many teams have wanted it because it’s not complicated, it’s not difficult to do, and it doesn’t impose a burden. It’s a high-impact, low-effort initiative, so it didn’t take a lot of convincing.”

“The advantage is the extent to which the team is mobilized, engaged, and get to feel like they’ve made a contribution,” she said. “I know from colleagues in North York who did this that a big part of the motivation was the general sense from the secretaries on through to the surgeons and the nurses that they were all collectively involved in this enterprise.”

This study was supported by the Opportunities Fund of the Academic Health Sciences Centre Alternative Funding Plan of the Academic Medical Organization of Southwestern Ontario. Strychowsky reported having no relevant financial relationships. Miller is director of CASCADES, an initiative that informed the methods used in the study.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.