Recommended Citation
Primuth H, Schmidt Oliver K, Lamptey M, Getzin A, Simpson A. Delivering Sustainability: Improving Medical Waste Segregation Through Staff Education on Labor & Delivery. Presented at: AIAMC NI X Meeting #3; October 9, 2026; Virtual.
Presentation Notes
Presented at: AIAMC NI X Meeting #3; October 9, 2026; Virtual.
Abstract
Introduction
Climate change has known impacts on the health of the maternal-fetal dyad. Economic instability, flooding and displacement lead to reduced access to care, disrupted crop yields and food supply challenges. Extreme heat has been linked to increased rates of fetal growth restriction, preterm delivery and stillbirth. Healthcare makes up 4.4% of net global emissions and work on Labor and Delivery (L&D) generates significant waste. Even when incineration of regulated medical waste (“red bag waste”) is done properly, there are still emissions which include greenhouse gases, heavy metals, toxins and particulate matter. It is estimated that 3-10% of total waste generated on L&D should be classified as regulated medical waste (RMW). The recommended standard percentage of overall medical waste disposed of as RMW is 15% based on national benchmarks, while the actual percentage is 50-70%.
Our aim: To decrease total RMW on L&D by 10% through education of OB/GYN residents and faculty regarding the environmental impact of our work on our patients and proper waste sorting.
Methods
Baseline weights for the red bag and municipal waste was obtained from 40 vaginal deliveries by L&D techs and then used to calculate baseline percentages of red bag waste relative to total waste. Protocol included measurement of the weight of end-of-delivery RMW and municipal waste. We also accounted for the total amount of fluid collected in the sterile drape, a portion of the delivery waste that will always contribute to the RMW weight. Four learning/assessment tools were developed: 1) a 34-question quiz to assess three domains of knowledge (ie, waste sorting, environmental impacts, Advocate Health’s sustainability priorities) and personal attitudes regarding sustainability efforts; 2) a gamification approach with simulated waste must be sorted into appropriate receptacles scattered about the room and tracked for time to completion and accuracy; 3) an interactive presentation focused on quiz knowledge domains; and 4) a simplified infographic highlighting applicable sorting guidelines to display on L&D. After 3 months, RMW and municipal waste was again weighed from 40 vaginal deliveries on L&D. Strategies 1 and 2 were repeated with new personnel starting work on L&D. Pre- and post-intervention waste measurements were analyzed using a Hodge-Lehmann difference and percent change with p values calculated using the Wilcoxon rank-sum test.
Results
A total of 21 participants completed the knowledge and attitude assessment quiz, including 16 resident physicians and 5 faculty OBGYNs. The quiz scores ranged from 45-94% correct, with an average score of 69%. Waste sorting activity was completed by 22 participants, including the same individuals who completed the quiz along with one additional faculty OBGYN. Time to complete the sorting ranged from 1.5 to 3 minutes. Faculty members demonstrated greater accuracy in sorting compared to resident physicians. Comparison of waste measurements found no significant difference in measured RMW between the pre- and post-intervention periods (median, 1,926.5 vs 1,726.5 g; HL difference, 157.0 g; 95% CI, −174.0 to 484.0; p = 0.329), representing a 10.4% decrease in the median. In contrast, municipal waste decreased by 75.9%, from a median of 763.5 g pre-intervention to 184.0 g post-intervention (HL difference, 552.1 g; 95% CI, 400.0–923.0; p < 0.001). Total waste was reduced by 29.4%, from 2,396.0 g to 1,690.5 g (HL difference, 728.4 g; 95% CI, 459.0–1,049.0; p < 0.001). The proportion of total waste classified as RMW increased by 42.6%, from 62.1% to 88.6% (HL difference, −22.9 percentage points; 95% CI, −29.6 to −15.7; p < 0.001). However, despite this increase in proportion, the absolute amount of fluid-adjusted RMW did not change.
Discussion
To date, the project has been well received. L&D staff members have been engaged and L&D surgical technicians have been instrumental in the weighing process. Residents and faculty found the game to be fun and educational. We were able to repeat the education intervention process with incoming residents in July 2026 who performed similarly to resident physicians in the first wave of the project. Comparison of waste weights pre- and post-intervention indicated no significant change in RMW, even when adjusted for total fluid collected in the sterile drape at the end of delivery; a contributor we believe to inflate the total weight of red bag waste at the end of a vaginal delivery. Given the small sample size utilized for analysis in our project, minute changes in waste sorting practices may not be captured in the collected data. Cultural shifts around staff motivation for proper waste sorting, even in those not directly receiving the project interventions, and clinician comfort with correct waste segregation protocols have been noted on L&D. Future project goals include broadening the scope of staff members receiving educational interventions and repeating delivery waste measuring to identify longitudinal change.
Type
Oral/Podium Presentation
Affiliations
Aurora Health Care