ArticleJournal of anesthesia, analgesia and critical care2026
Behavioral nudges and targeted education as sustainability strategies to reduce hazardous waste generation in intensive care and perioperative settings: a prospective interventional study.
Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntensive care units (ICUs) and operating rooms (ORs) are resource-intensive hospital areas and major contributors to healthcare waste. Proper segregation of hazardous and residual waste reduces carbon-intensive disposal and supports sustainability, yet practices depend heavily on staff behavior and knowledge.
methodsWe conducted a prospective three-phase interventional study in the ICU and ORs of Merano Hospital, Italy (September 2023-May 2025). Baseline hazardous waste generation and staff knowledge/barriers were assessed (phase 1). Subsequently, low-cost behavioral nudges (enhanced bin visibility, labeling, placement-phase 2) and targeted online education on waste segregation (phase 3) were introduced in sequence. The primary outcome was the reduction in hazardous waste, normalized to ICU patient-days and surgical procedures; secondary outcomes included changes in perceived barriers and knowledge.
resultsHazardous waste generation declined across all phases in both ICUs and ORs. In the ICU, waste decreased from 3.31 (± 1.07) to 2.97 (± 1.40) kg/patient-day after behavioral nudges (- 10.3%, p = 0.31) and further to 1.97 (± 1.33) after education, representing a 40.6% reduction versus baseline (p < 0.001). In ORs, waste fell from 5.84 (± 1.40) to 4.38 (± 2.58) kg/procedure post-nudges (- 25.0%, p = 0.027) and to 3.84 (± 1.46) post-education, corresponding to a 34.4% reduction (p < 0.001). Structured questionnaires identified limited bin availability and unclear sorting rules as key barriers; behavioral nudges addressed structural obstacles, while education improved knowledge and confidence.
conclusionsIntegrating low-cost behavioral nudges with targeted education effectively reduces hazardous waste in ICU and perioperative settings. Environmental changes improve waste practices, while education enhances staff knowledge, awareness, and confidence, emphasizing that infrastructure alone is insufficient without supportive training.
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