doeHealth Care Waste & Toxics Reduction Tips

for small and medium size health care facilities


Health care facilities offering outpatient surgery on-site can benefit from waste reduction and resource efficiency efforts.

Opportunities to reduce waste and reduce the use or generation of toxic materials can be found in surgical operating, procedure and recovery rooms, and also in surgical pathology units.


knifeReasons for Change

By implementing one or more of the outpatient surgery practices described here and on the accompanying downloadable table, health care facilities can enjoy:

            • Reduced regulatory obligations and oversight, through managing mercury wastes under streamlined Universal Waste rules ;

            • Increased safety and reduced risks for patients,  staff, visitors and the community by using safer products and materials, and properly segregating/managing wastes;

            • Less waste in supplies, work space, work flow and staffing; and

            • Improved cost control at your health care facility through reducing and eliminating unused items, and paying less for properly segregated/managed waste materials.


Opportunities for Action

Specific tips on ways Outpatient Surgery service providers can reduce and prevent toxic wastes and resource inefficiencies are listed in this fact sheet’s downloadable/printable table. A sampling of these tips is listed below. 

Basic Best Management Practices

  • Reduce and separate solid waste from biomedical waste.

  • Neutralize and dispose of used formaldehyde and formalin solutions or waste as dangerous waste, not via trash, drain or sewer.

  • Dispose of biomedical wastes and sharps in proper containers.

  • Determine whether and how to dispose of waste tubing, IV bags, and waste pharmaceutical containers as dangerous waste or solid waste. 

  • For used PVC-containing materials which can be disposed as solid waste:

    -Whenever possible dispose via landfill rather than high temperature thermal destruction, to avoid generating toxic air pollutants such as dioxins. 

    -Where a landfill option is not available, use a high temperature thermal destruction unit with proper pollution control systems to avoid generating toxic air pollutants.

  • Dispose of preserved tissues as medical waste. Neutralize and dispose of used formaldehyde as dangerous waste.

  • Recycle waste mercury-containing equipment and fixtures as Universal Waste.

  • Manage and dispose of any dangerous waste pharmaceuticals appropriately, including those containing mercury. Do not dispose to sharps bins, red bag, garbage, sewer or septic system.


Next Steps to Improve Outpatient Surgery Practices

  • Eliminate unused items, and those that expire quicker than other items in custom and standard surgical packs.

  • Switch to reusable medical instruments, medical devices, linens, gowns, totes, trays and containers.

  • Invest in reusable surgical case packs, eliminating the need for blue wrap and associated waste management efforts.

  • Donate clean, unused operating room (OR) supplies to clinics and relief organizations.

  • Consider investing in on-site regulated medical waste treatment technology to reduce off-site disposal costs and support pandemic reaction plans/recovery actions.

  • Purchase tubing, IV and blood bags, gloves and other medical products manufactured without PVC, DEHP or other phthalates. 

  • Use less toxic alternatives to formaldehyde, formalin, gluteraldehyde and other fixatives and sterilants.

  • Use a formalin recovery unit to reduce costs and eliminate disposal risks.

  • Use mercury-free thermometers, barometers and sphygmomanometers (blood pressure cuffs).   

  • Use low-mercury bulbs and mercury-free batteries and switches.




Additional Resources

This resource guide’s home page has links to additional fact sheets in this series, plus other useful tools and information from the Washington Department of Ecology and other experts.

Information from the Minnesota Technical Assistance Program (MNTAP) on reducing waste in the operating room.

Health Care Without Harm’s “Purchasing for Pollution Prevention: Mercury-Free Medical and Surgical Supplies Fact Sheet.”

Information from Sustainable Hospitals on alternatives to plastic tubing, IV and blood bags, gloves, and other products containing PVC, DEHP and phthalates: specifically, alternatives to PVC and DEHP and alternative sources for IV solutions and sets.

Information on using formaldehyde-free fixatives for tissue preservation, from Sustainable Hospitals and the Massachusetts Toxics Use Reduction Institute (TURI).

Information on an environmentally safe formalin neutralizer product and the University of Washington’s formaldehyde treatment protocol.   

The Sustainable Hospitals comparison of advantages and disadvantages for mercury, electronic and digital sphygmomanometers (blood pressure cuffs).

Fact sheet on hospital P2, also relevant to many small and medium health care facility practices, from the Alaska Green Star program.      



This information is brought to you by the Washington Department of Ecology/Toxics Reduction Unit with assistance from the Pacific Northwest Pollution Prevention Resource Center (PPRC) . June 2010