Evaluating and reducing environmental waste in oculofacial plastic procedures

To identify, develop, and implement interventions that reduce the environmental impact of oculoplastic procedures.

Oculoplastic procedures performed in either office-based surgery suites or ambulatory surgery centers at 2 sites were observed by an independent observer. Waste audits were performed to quantify the number of used and unused discarded items. Targeted interventions were developed from meetings with surgeons and staff, and procedure setups were adjusted accordingly.

The study included 59 clinic procedures and 44 operating room procedures across 2 sites. Most waste was from textiles, plastics, and medications. The most commonly performed procedures were blepharoplasty, eyelid lesion excisions, and botulinum toxin injections. The most commonly opened yet discarded surgical supplies were cotton-tip applicators (12.8 ± 6) and gauze (9.5 ± 7). Our intervention consisted of reducing the preemptive opening of excess disposable items during oculoplastic procedures, with the option to open more as needed. We reduced preprocedure setups of cotton-tip applicators from 20 to 8 and 4 × 4 gauze squares from 10 to 8 for the office-based procedure, and reduced cotton-tip applicators from 20 to 10 and gauze from 20 to 10 for operating room procedures. These measures reduced wasted cotton tips from 12 to 3 per procedure and gauze squares from 10 to 3.

Environmental waste in oculoplastic surgery can be significantly reduced with targeted interventions. We strongly recommend against the preemptive opening of excess cotton-tip applicators and gauze squares for procedures. Other potential interventions include multiuse of topical medications between cases, minimal surface area draping, and optimizing surgical supply packaging and instructions for use.