Waste streaming in theatres: A simple sustainable change

Authors: Myo J, Eaton P


Recently, The Lancet Countdown published their report regarding climate change. The 1°C rise in global warming has resulted in extreme environmental changes, new infectious diseases and significant threats to food security. If continued, it will define the health of future generations and ultimately, undermine any progress achieved under the United Nations Sustainable Health Goals.1

The Royal College of Anaesthetists published their sustainability strategy; ‘reduce, reuse, recycle’.2 An area requiring improvement in Cardiff University University Health Board (CAVUHB) is theatres’ waste management. In University Hospital of Wales (UHW), the majority of waste is treated as clinical or ‘infected’ and we lacked the simple means of additonal waste streaming into recycling and general waste.

The aim of this project was to quantify the current costs incurred, as a measure of sustainability and make improvements. It was undertaken prior to the COVID-19 pandemic. Since then, there are huge disruptions to any progress made to waste streaming.The costs savings lost and environmental impact now are unknown but are inevitably compounded.


Obstetric theatres were chosen for their consistency in caseload for more accurate calculations. Three separate days were chosen and waste was weighed according to bag segregation: clinical ‘orange bin’ waste or general ‘black bin’ waste. Data was then collected and analysed.


11 cases required surgical intervention in theatre between 07.00-19.00. A total of 77.58kg clinical waste and 7.03kg general waste was collected. The average amount of clinical and general waste produced from one case was 7.05kg (range 4.40 - 9.68kg) and 0.54kg (range 0.12 - 3.34kg), respectively. No recycling bins were present in theatres.


Clinical waste is sent for an energy intense three-step alternative heat treatment process costing £290/tonne. General and recycling waste costs are £75 and £50 per tonne, respectively.

In 2017-18, CAVUHB undertook 1,933 procedures in obstetric theatres.3 Currently, obstetric theatres generates roughly 13,500kg of clinical waste equalling £3,951 in costs per year. If extrapolated to all theatres, equating to £80,000 - if only 3.5 cases are carried out in each theatre per day. If theatres alone can reduce clinical waste by 1/3 and increase its general waste by this amount, a cost saving of nearly £20,000 can be generated.

Changes are being made to address this. A meeting with Cardiff County Council was undertaken to clarify recyclable consumables. Infographic posters were developed and were piloted at the ‘Designing the futures of the theatre’ workshop for theatre staff.

The posters are displayed in all theatres in UHW. Bins for general and recycling waste have been ordered for all theatres and anaesthetic rooms. The results will be presented locally and further data collection will be undertaken to compare results.

The potential cost savings are clear and this is implicitly linked to a smaller carbon footprint and a more sustainable future for CAVUHB.

Anaesthetists have the ability to make a significant impact on this agenda. In the face of COVID-19, we must engage, motivate and educate ourselves to slow the progress of this climate emergency.


1. Watts, N., Amann, M., Arnell, N., et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet (2019), 394(10211), pp.1836-1878.

2. Royal College of Anaesthetists (2018). Our Strategic Plan 2018-2021: Sustainability Strategy 2019-2022. [online] Rcoa.ac.uk. Available at: https://www.rcoa.ac.uk/sites/default/files/documents/2019-09/RCoA-Strategy2018-2021.pdf [Accessed 14 Feb. 2020].

3. Welsh Government (2018). Experimental Statistics: Maternity Statistic, Wales 2017-18. [online] Gov.wales. Available at: https://gov.wales/sites/default/files/statistics-and-research/2019-01/maternity-statistics-financial-year-2017-to-2018-experimental-statistics.pdf#page16 [Accessed 14 Feb. 2020].