Environmental sustainability in neurointerventional procedures: A waste audit.

Background And Aims: Operating rooms contribute between 20-70% of hospital waste. This study aimed to evaluate the waste burden of neurointerventional procedures performed in the Radiology department and to identify areas for waste reduction and improving greening initiatives. Method(s): We performed a waste audit of 17 neurointerventional procedures at a tertiary-referral centre over a 3 month period (November 2019 to January 2020). Waste was categorised into five streams: general waste, clinical waste, recyclable plastics, recyclable paper and sharps. The Radiology department started recycling soft plastic from 13 December 2019. Hence, an additional recyclable soft plastic waste stream was added. The weight of each waste stream was measured using a digital weighing scale. Result(s): Waste from seven cerebral digital subtraction angiograms (DSA), six endovascular clot retrievals (ECR), two aneurysm coiling procedures, one coiling with tumour embolisation and one dural arteriovenous fistula embolisation procedure was measured. Seventeen procedures generated 135.3kg of waste in total: 85.5kg (63.2%) clinical waste, 28.0kg (20.7%) general waste, 14.7kg (10.9%) recyclable paper, 3.5kg (2.6%) recyclable plastic, 2.2kg (1.6%) recyclable soft plastic and 1.4kg (1.0%) of sharps. An average of 8.0kg of waste was generated per case. Coiling cases produced the greatest waste burden (13.1kg), followed by embolisation (10.3kg), ECR (8.8kg) and DSA procedures (5.1kg). Conclusion(s): Neurointerventional procedures generate a substantial amount of waste. Green practices such as engaging with suppliers to revise procedure packs and reduce packaging, digitising paper instructions, opening devices only when necessary, implementing additional recycling programs and appropriate waste segregation have the potential to reduce the environmental impact of our speciality.