Reducing Medical Waste

In this issue of the International Journal of Dermatology, Silva and colleagues [1] provide a timely examination of regulated medical waste (RMW) management, addressing a pressing issue as climate change and healthcare sustainability become increasingly prominent in public discourse. While environmental discussions are often politicized, inefficient medical waste management significantly increases costs for all, making waste reduction not just ethically but also financially important for clinics and healthcare systems [2, 3]. The authors' study presents an opportunity to reassess how medical waste is generated, why inefficiencies persist, and what steps can be taken to improve sustainability.

While medical waste discussions often focus on RMW, other types of waste in clinics and supply chains come to mind. Excessive packaging, with small items shipped in oversized boxes, creates unnecessary cardboard waste (Figure 1). One potential solution may be a cooperative purchasing model, where practices place bulk orders and share supplies to reduce waste, costs, and shipping inefficiencies [4]. Pharmaceutical waste is another significant issue in certain practices where strict institutional policies often treat multi-use vials of medications, like local anesthetics, as single-use, resulting in avoidable waste. Similarly, single-use suture removal kits create waste by including gauze and other packaged items already stocked in patient rooms. Additionally, the relatively dull disposable instruments included in these kits are often discarded in favor of sharper surgical tools. A more efficient alternative may involve using a disposable No. 11 or 15 blade with autoclaved reusable forceps, reducing reliance on disposable kits while maintaining sterility. In the Veterans Affairs system, outpatient surgery clinics often use disposable instruments instead of sterilizing and reusing them. Finally, laboratory-generated waste from stains, solvents, and reagents also contributes to a practice's environmental impact. Minimizing spills, reducing excess use, and raising awareness of proper handling can help limit waste (Figure 1). Addressing these sources of non-RMW waste alongside RMW-reducing strategies can reduce a practice's overall waste footprint, promoting sustainability and cost efficiency.

Silva and colleagues highlight the kick bucket as a key source of procedural waste, particularly in surgical settings where workflow efficiency influences disposal behaviors. In many dermatologic procedures, the amount of biohazardous waste per case is insufficient to fill a kick bucket, yet a red biohazard bag is changed between every case. This results in unnecessary waste of both bags and some improperly placed materials. The issue is compounded by suboptimal waste bin placement in procedural areas. Under pressure, assistants may dispose of nonbiohazardous waste in red bags simply because they are more accessible (Figure 1). This is not a knowledge problem but one of convenience, where staff prioritize speed over sorting and unintentionally increase RMW. Ideally, education on RMW should begin on day one, with clear, hands-on training during onboarding to distinguish biohazardous waste from regular trash. Early reinforcement through direct supervision may help prevent the formation of inefficient practices and support sustainable waste reduction practices in the long term.

The authors' results also highlight a key challenge: educational interventions do not always translate into improved disposal practices. While the study does not pinpoint a single cause for this observation, differences in clinical roles, workflow constraints, and competing responsibilities may play a role. Interestingly, their intervention was more effective for nursing staff than for physicians, potentially because nurses interact more directly with waste disposal. This presents an opportunity for physicians to recognize potential knowledge gaps, address these deficiencies, and lead by example in guiding their teams toward better waste management practices.

The study's low survey response rates suggest that individuals already invested in waste reduction were more likely to respond, whereas those with lower interest may have opted out. This complicates the interpretation of the intervention's effectiveness, as those most in need of change may have been least likely to participate. To address this, methods like direct observation and feedback, recognized as the gold standard for increasing hand hygiene compliance, could similarly be implemented to improve waste practices [5]. Observing disposal behaviors and gathering staff input through surveys can help identify barriers such as workflow inefficiencies or misconceptions about RMW. Unlike traditional audits, this approach fosters collaborative problem-solving and allows medical practices to adjust strategies based on real-world challenges.

In summary, it is likely that increasing knowledge alone does not guarantee behavioral change, especially when varying levels of commitment, existing practice norms, and differing attitudes toward waste reduction exist from the outset. For effective waste reduction, education must be paired with systemic solutions like optimized packaging and delivery, strategic exam room layouts and waste bin placement (Figure 1), structured onboarding, and ongoing feedback. Ultimately, proactively identifying sources of RMW and other waste, along with continuously brainstorming solutions, will be essential for long-term sustainability.

The authors declare no conflicts of interest.