GuidelineCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2026
Increasing the environmental sustainability of operating rooms in Canada: an evidence-informed guideline for policy.
Abstract readGuideline
In one paragraph
Guideline in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Research Priorities in Perioperative Nursing Across the Lifespan: An e-Delphi Consensus Study.Nursing reports (Pavia, Italy) · 2026Article
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Authors and funding
17 authors.
Jamie GoldmanDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Emily A PearsallDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Kathy LiuDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Charmaine De CastroDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Nam LeDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Syed A AbbassDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Reeba PhilipDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Laura L DonahoeDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Yasir KhalidDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Ashlie NadlerDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Alexander D VincentDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Martin Van Der VyverDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Husein MolooDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Sean McKellarDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Karen DevonDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Fiona A MillerDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont.
Sarah E WardDepartment of Surgery (Goldman, Pearsall, Liu, Donahoe, Nadler, Vincent, McKellar, Devon, Ward), University of Toronto; St. Michael's Hospital (Goldman, Liu, Ward); Mount Sinai Hospital (Pearsall, De Castro, Philip); North York General Hospital (Le); Department of Anesthesia (Le, Abbass, Van Der Vyver), University of Toronto; St. Joseph's Health Centre (Abbass); Collaborative Centre for Climate, Health and Sustainable Care (Abbass, Miller, Ward), University of Toronto; Patient partner (Khalid); Sunnybrook Health Sciences Centre (Nadler, Van Der Vyver), Toronto, Ont.; Faculty of Medicine (Moloo), University of Ottawa, Ottawa, Ont.; Women's College Hospital (Devon); Institute of Health, Policy, Management and Evaluation (Miller, Ward), University of Toronto, Toronto, Ont. Sarah.Ward@unityhealth.to.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCanada's health care systems contribute about 4.6% of Canada's greenhouse gas emissions and 200 000 tonnes of other pollutants, with operating rooms (ORs) having a substantial environmental impact. In this guideline, we provide actionable recommendations to increase the environmental sustainability of ORs.
methodsThis guideline was developed by the Best Practice in Surgery Group from the University of Toronto, with national representation. We followed the Appraisal of Guidelines for Research and Evaluation (AGREE) Health Services tool, ADAPTE, and Guidelines International Network principles. Given the nature of the evidence, we created a unique grading matrix based on the triple bottom line (people, profit, planet) and did not assess quality of studies. Twenty-four rapid reviews informed the guideline, and we used a modified Delphi approach to reach consensus. We conducted external reviews with various hospitals across Canada. RECOMMENDATIONS: We outline 21 recommendations to improve the environmental sustainability of ORs, grouped into 4 categories: reduce, reuse, recycle, and rethink. The "reduce" category focuses on decreasing unnecessary waste by way of appropriate waste segregation, decreasing pharmaceutical waste, reducing instruments in surgical trays and custom packs, and lowering unnecessary energy use. We also provide recommendations for reducing emissions from inhalational anesthesia. "Reuse" emphasizes replacing disposable items - such as medical devices, textiles, and sharps containers - with reusable alternatives. "Recycle" includes recommendations for traditional and specialized recycling programs. "Rethink" includes strategies with limited direct evidence but considered essential to long-term sustainability, such as donations, alcohol hand rub, and environmentally preferrable purchasing policies.
interpretationOperating rooms greatly contribute to the environmental burden of the Canadian health care system and these recommendations can help to reduce this impact.
Indexed as
Operating RoomsCanadaHumansRecycling
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