Health care utilization contributes to a significant portion of total greenhouse gas emissions in the United States (up to 10%). Operating rooms (ORs) have a particularly large carbon footprint, consuming more than 30% of solid waste in hospitals, with a large percentage being plastic from biohazard packaging and disposal. In hysterectomy surgeries, a recent study showed that almost 80% of OR waste was plastics, comprised of bottles, basins, gloves, gowns, and drapes. Similar statistics apply to midurethral sling procedures, and reducing the waste associated with these 2 procedures could greatly impact overall carbon emissions associated with them. This study was designed to assess noninferiority between the proportion of cases with culture-proven urinary tract infection (UTI) within 2 weeks of minor cystoscopic OR procedures before and after the implementation of a green draping protocol. This was a preimplementation and postimplementation study focusing on a grouping of minor urogynecology procedures between January 1, 2021 and June 30, 2023. The “green” draping protocol stopped the usage of leg drapes, top drapes, and gowns and used sterile towels when needed. UTI symptoms were reported through telephone and office encounters within 2 weeks of the index procedure. The primary outcome for this study was the proportion of confirmed UTI cases before and after the implementation of the green draping protocol. Secondary outcomes included rates of UTI treatment regardless of culture status, the proportion of individuals with UTI or surgical site infection, and estimated waste and cost savings of the protocol. Final analysis included 240 individuals, with 120 before and after the protocol implementation. UTI treatment rates were low both before and after the protocol was implemented, and the post-protocol group showed a noninferior culture positivity rate compared with the pre-protocol group. Treatment without a positive culture was not significantly different before and after protocol implementation. A history of recurrent UTI did increase the risk of developing a post-procedural UTI, as did greater age. Approximate savings from the green protocol for cystoscopy were 1403. 92 for disposal costs, along with ∼165 pounds of waste diverted from landfills. These results show that the green draping protocol during minor cystoscopic procedures in the OR was noninferior for postoperative culture-positive UTI. The great majority of patients experiencing a UTI had other risk factors that likely contributed more to the development of UTI than the draping protocol. With green draping, costs were lower, and significant waste was diverted from landfills, which would be compounded if applied over a larger cohort. These findings are consistent with previous literature surrounding the implementation of green protocols and support the push from many specialties toward reducing the carbon footprint of hospitals and health care. Future research should assess barriers to the implementation of this and similar protocols, as well as methods of increasing uptake and support among OR staff for both this and other similar waste-reducing interventions. (Summarized from Melnyk AI, Mowers EE, Janmey I, et al. Green cystoscopy: Does minimizing the use of drapes increase infection rates? Urogynecology (Phila). 2025;31 (11): 1024-1032. doi: https: //doi. org/10. 1097/SPV. 0000000000001602)
Alison C. Weidner (Sun,) studied this question.