Impact of waste segregation training on medical and recyclable waste in an operating theater a quasi experimental study

Abstract

This quasi-experimental study evaluated the effects of waste segregation training on medical and recyclable waste generation in the operating theater of Ankara University Cebeci Hospital. Conducted between March and June 2024, the study included pre-training, post-training, and two-month follow-up waste measurements, alongside a survey assessing staff awareness. A total of 53 operating room staff participated. Training significantly increased the amount of recyclable waste per surgery (from 1.30 kg to 1.80 kg, p = 0.01) in the first month post-training. Although medical waste per surgery decreased (from 4.92 kg to 4.14 kg), the reduction was not statistically significant (p = 0.09). However, two months later, waste levels began reverting to baseline (recyclable: 1.79 kg; medical: 5.07 kg per surgery), suggesting the effect of a single training session may diminish over time. Notably, 40% of doctors lacked sufficient knowledge pre-training, and those favoring training were often the least informed (p = 0.02), highlighting gaps in prior education. This study emphasizes the need for repeated and tailored training programs to reinforce sustainable waste practices in surgical environments.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-02797-z.

Introduction

The global climate crisis has become one of the most pressing challenges of our time, with greenhouse gas (GHG) emissions driving rising global temperatures and environmental degradation. The healthcare sector, often overlooked as a major contributor, is responsible for nearly 5% of global emissions, with a significant portion linked to energy-intensive activities and waste generation¹. Among these, operating rooms (ORs) represent a critical area of concern due to the high volume of waste they produce and their substantial use of anesthetic gases, which are potent GHGs. The European Society of Anaesthesiology and Intensive Care (ESAIC) has highlighted the importance of addressing Scope 3 emissions—indirect emissions from procurement, waste management, and transportation—as part of its sustainability guidelines². Effective waste management in ORs is essential for mitigating environmental harm, as it contributes to both direct and indirect emissions through the generation and disposal of medical and non-medical waste³.

Operating rooms generate a disproportionately large amount of hospital waste, contributing between 20% and 33% of total hospital waste despite occupying a small percentage of hospital space⁴. This waste includes single-use plastics, packaging, and medical waste such as contaminated sharps and surgical instruments, which have both environmental and health risks if not properly managed. OR waste is particularly harmful to the environment due to its contribution to landfill mass, toxic emissions from incineration, and potential contamination of natural resources⁵. Reducing this waste is crucial not only for minimizing environmental harm but also for cutting healthcare costs and improving overall sustainability in the health sector.

The complex nature of OR procedures require collaboration from multiple disciplines, including surgeons, nurses, anesthesiologists, and cleaning staff. Operating rooms are unique environments where the high intensity of care, sterility requirements, and the need for rapid decision-making can lead to increased waste production⁶. Among these teams, anesthesiologists hold a particularly important position, as they not only administer anesthetic gases—contributing to direct GHG emissions—but also manage resources like intravenous fluids and single-use equipment. Given their pivotal role in ensuring both patient safety and sustainability, anesthesiologists are increasingly recognized as key figures in driving waste reduction initiatives within the OR⁷.

Addressing the issue of waste in operating rooms requires a comprehensive approach, with targeted training playing a crucial role in fostering sustainable practices. Operating room teams—comprising surgeons, nurses, anesthesiologists, and technicians—work in a highly specialized and protected environment where quick decisions, sterility, and patient safety are paramount. These teams require tailored, hands-on training to integrate waste segregation into their workflow without compromising care quality^7,8. Face-to-face training has proven to be particularly effective, as it allows for direct engagement, real-time feedback, and the opportunity to address the specific challenges faced by OR staff. Studies in healthcare settings have shown significant improvements in waste management practices following training, with marked increases in the segregation of recyclable materials and reductions in medical waste⁹.

Medical waste in Turkey is managed under strict regulations that mandate the segregation of infectious and non-infectious waste at the source, followed by transport in licensed vehicles to authorized treatment facilities, where steam sterilization (autoclaving) or incineration is employed; sterilized waste may then be disposed of in sanitary landfills, while any item that has come into contact with biological or hazardous material must be treated as medical waste to prevent contamination, and only materials that have not been exposed to medical waste (e.g., certain packaging, paper, glass, or electronic components) can be diverted for recycling¹⁰. This study took place in Ankara, the capital of Turkey, which has a population exceeding 5.7 million and a regulated municipal solid waste management system that separates domestic, recyclable, and hazardous medical waste. According to publicly available information, Ankara’s municipal solid waste facility is located in the Sincan district and operated by the firm ITC; in line with national legislation, licensed contractors collect medical waste, which is then incinerated at designated facilities, and some local data indicate that medical waste constitutes roughly 2% of the city’s total waste. Meanwhile, recyclable materials such as plastic, paper, and metals are handled separately, with approximately 20% of Ankara’s waste diverted to authorized recycling centers¹¹. At Ankara University Cebeci Hospital, a color-coded bin system is employed—red bags for medical waste and blue bags for recyclable waste—in accordance with regulations set forth by Turkey’s Ministry of Environment and Urbanization.

However, despite the global focus on sustainable healthcare, the number of studies specifically evaluating waste separation training in operating rooms is relatively low. Most research in this area has focused on general hospital settings, leaving a gap in the literature for OR-specific interventions. Therefore, the aim of this study was to explore the impact of targeted waste segregation training for operating room personnel on the amounts of medical and recyclable waste.

Materials and methods

Study design

The study employed a quasi-experimental design to evaluate the impact of waste segregation training on the amounts of medical and recyclable waste in operating rooms. This model was designed to assess the differences between variables by comparing measurements taken before and after the training.

Population and sample

The study population consisted of healthcare personnel (doctors, nurses, anesthesia technicians, and cleaning staff) directly involved in waste production and management in the 7-room operating theater at Ankara University Cebeci Hospital. The sample included all medical and recyclable waste generated in the operating theater starting from March to June 2024. All surgical procedures conducted during March were included in the sample. Personnel directly contributing to waste production and involved in waste management were selected for the training program, while those on leave or sick leave were excluded.

Data collection tools

Data were collected using a participant survey form developed by the researcher to assess the environmental pollution awareness of the healthcare workers who consented to participate. Additionally, a digital hand scale (Bluefox-Turkey) was used to measure waste amounts in kilograms. The survey form, provided in Appendix 1, consisted of three sections:

• Demographic information (3 questions).

• Occupational work characteristics (2 questions).

• Assessment of medical waste knowledge level and satisfaction (15 questions).

Data collection process

Data collection began in March 2024 and continued intermittently over four months.

Figure 1 illustrates the timeline of the process. The steps proceeded as follows:

Fig. 1.

Timeline of training and data collection.

Pre-training data collection.

• For three weeks in March, waste generated in the operating room was weighed daily, and the results were recorded.

• Waste bags were weighed according to their color codes (red: medical waste, blue: recyclable waste).

During the study, the recyclable waste produced in the operating room primarily included paper-based packaging materials, uncontaminated plastics (such as intravenous fluid containers and wrappings) were eligible for recycling. Medical waste consisted of items contaminated with blood or bodily fluids, such as surgical gloves, contaminated drapes, used syringes, sharp instruments, and tissues.

All medical waste generated at Ankara University Cebeci Hospital was collected in red bags and transported by licensed waste management companies for incineration, consistent with national standards. Recyclable waste, collected separately in blue bags, was directed to municipal recycling facilities.

• Daily operation counts, types of operations, operation durations, and operating room working hours were also recorded.

Training process.

• A single 40-minute face-to-face training session was conducted one morning for all healthcare personnel working in the operating room. The training material was prepared based on literature and emphasized the climate crisis. It included defining types of waste and materials that need to be separated, stressing the importance of using designated color-coded bins, and discussing measures for a better future. In the afternoon, a practical session was held in the operating room where participants were shown which bins to use for different materials.

Post-training data collection.

• After the training, waste weighing was repeated for three weeks. In the second month after the training, waste weighing was renewed for one week to assess the long-term effects of the training.

Data analysis methods

All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were presented using means and standard deviations (SD) for numerical variables and counts and percentage frequencies for categorical variables. The Chi-square (X²) test was used for comparisons of categorical variables. Fisher’s Exact test was employed in cases where the Chi-square test was not suitable. The Student’s t-test was applied for comparisons of numerical variables. Results with a p-value of less than 0.05 were considered statistically significant.

Results

Participant characteristics

The study included 53 healthcare personnel with a median age of 37 years (range: 23–56) and a male-to-female ratio of 60:40. Participants represented diverse professional groups, including doctors (28.3%), nurses (32.1%), anesthesia technicians (20.8%), and support staff (18.9%). Table 1 details the demographics of the participants.

Table 1.

Demographic data.

Category	Subcategory	n	Percentage (%)
Gender	Male	32	60.0
	Female	21	40.0
Age distribution	Median Age: 37 (Range: 23–56)
	18–30	18	34.0
	31–40	17	32.1
	> 41	18	34.0
Educational level	High School	7	13.2
	University	46	86.8
Occupational group	Doctor	15	28.3
	Nurse	17	32.1
	Anesthesia technician	11	20.8
	Support staff	10	18.9
Years in profession	0–1 year	5	9.4
	1–3 years	5	9.4
	3–5 years	9	17.0
	5–10 years	12	22.6
	> 10 years	22	41.5
Previous waste training	Yes	39	73.6
	No	14	26.4
Awareness of waste segregation	Yes	38	71.7
	No	15	28.3

Table 2 summarizes participants’ awareness and attitudes toward waste segregation in the operating room. Table 3 highlights challenges and potential solutions for waste segregation.

Table 2.

Awareness and attitudes towards waste segregation.

Category	Subcategory	n	Percentage (%)
Awareness of color-coded bags	Red bag - aware	52	98.1
	Red bag - unaware	1	1.9
	Blue bag - aware	52	98.1
	Blue bag - unaware	1	1.9
	Black bag - aware	50	94.3
	Black bag - unaware	3	5.7
	Orange bag - aware	49	92.5
	Orange bag - unaware	4	7.5
Belief in in-service training	Strongly believes	28	52.8
	Moderately believes	21	39.6
	Does not believe	4	7.5
Trust in unit’s waste management	Trusts	31	58.5
	Does not trust	4	7.5
	Depends on situation	18	34.0
Awareness of bag capacity	Aware	42	79.2
	Unaware	11	20.8
Understanding of cost contribution	Aware	49	86.8
	Unaware	1	1.9
	No opinion	6	11.3
Internal compliance with waste management	Yes	30	56.6
	No	5	9.4
	Sometimes	18	34.0
Importance of waste management	Important	52	98.1
	No opinion	1	1.9

Table 3.

Waste segregation challenges.

Category	Subcategory	n	Percentage (%)
Challenges in segregation	No challenge	16	30.2
	Encounter challenges	37	69.8
Challenge type	Time-related	13	35.1
	Management-related	8	21.6
	Personal issues	9	24.3
	Multiple issues	7	18.9
Suggested solutions	Training	21	39.6
	Administrative action	11	20.8
	Rewards	21	39.6
Satisfaction with training	Satisfied	48	90.6
	Not satisfied	2	3.8
	No opinion	3	5.7

Pre- and post-training comparisons

During the study phases, a total of 489 surgeries were conducted, with operating room hours, total surgery counts, and the distribution of surgery types remaining consistent between the pre- and post-training periods. The amount of blue waste increased substantially from 18.90 kg to 25.81 kg (p = 0.001), while red waste decreased notably from 71.10 kg to 59.35 kg (p = 0.01). When analyzed per surgery, blue waste rose from 1.30 kg to 1.80 kg, showing statistical significance (p = 0.01), whereas red waste displayed a decreasing trend from 4.92 kg to 4.14 kg, which approached significance (p = 0.09). Figure 2 visually represents these trends, with detailed metrics outlined in Table 4.

Fig. 2.

Blue and red waste kg/ per surgery across training periods.

Table 4.

Surgical and operational metrics.

Variable	Pre-training	Post-training	2 months post-training
Duration (days)	15	18	5
Operating hours (hrs)	120	144	40
Total surgeries	225	264	60
Major surgeries	63	51	8
Minor surgeries	162	213	52
Surgeries < 1 h	80	107	25
Surgeries 1–4 h	96	110	25
Surgeries > 4 h	50	48	10
Total blue waste (kg)	283.57	464.62	99.34
Total red waste (kg)	1066.52	1068.3	290.05
Total waste (kg)	1350.09	1532.92	389.39

Pre- and post-training comparisons

Operating room hours, total number of surgeries, total waste amount, and types of surgeries remained consistent between pre- and post-training periods. The total amount of blue waste increased significantly (from 18.90 kg to 25.81 kg, p = 0.001), while red waste decreased (from 71.10 kg to 59.35 kg, p = 0.01) (Fig. 2). Additionally, the amount of blue waste per surgery significantly increased (from 1.30 kg to 1.80 kg, p = 0.01), while red waste showed a decreasing trend (from 4.92 kg to 4.14 kg, p = 0.09) (Table 5).

Table 5.

Comparison of pre- and post-training data.

Variable	Pre-training mean (SD)	Post-training mean (SD)	p-value
Operating room hours	8.00 (1.51)	8.00 (1.32)	1
Number of surgeries	15.00 (3.07)	14.67 (2.24)	0.72
Major surgeries	4.20 (2.33)	2.83 (1.46)	0.05
Minor surgeries	10.80 (4.09)	11.83 (2.93)	0.40
Surgeries < 1 h	5.33 (2.28)	5.94 (2.26)	0.44
Surgeries 1–4 h	6.40 (1.88)	6.11 (2.90)	0.74
Surgeries > 4 h	3.33 (1.17)	2.67 (1.10)	0.10
Total waste	90.00 (16.74)	85.16 (12.13)	0.34
Waste per surgery	6.22 (1.70)	5.95 (1.46)	0.62
Blue waste	18.90 (4.26)	25.81 (6.56)	0.001
Blue waste per surgery	1.30 (0.36)	1.80 (0.63)	0.01
Red waste	71.10 (17.24)	59.35 (9.05)	0.01
Red waste per surgery	4.92 (1.60)	4.14 (0.97)	0.09

Comparison of pre-training and second-month post-training measurements

Two months after the training, when the measurements were repeated and compared to pre-training levels, it was observed that the differences in the amounts of blue and red waste began to diminish, showing a tendency to revert toward their pre-training values (Table 6).

Table 6.

Comparison of pre-training and second month post-training data.

Variable	Pre-training mean (SD)	2.month post-training mean (SD)	p-value
Operating room hours	8.00 (1.51)	8.00 (2.00)	1
Number of surgeries	15.00 (3.07)	12.00 (3.46)	0.08
Major surgeries	4.20 (2.33)	1.60 (0.54)	0.03
Minor surgeries	10.80 (4.09)	10.40 (3.91)	0.85
Surgeries < 1 h	5.33 (2.28)	5.00 (1.73)	0.77
Surgeries 1–4 h	6.40 (1.88)	5.00 (2.73)	0.21
Surgeries > 4 h	3.33 (1.17)	2.00 (0.00)	0.02
Total waste	90.00 (16.74)	77.86 (9.72)	0.14
Waste per surgery	6.22 (1.70)	6.87 (1.75)	0.47
Blue waste	18.90 (4.26)	19.86 (3.32)	0.65
Blue waste per surgery	1.30 (0.36)	1.79 (0.69)	0.05
Red waste	71.10 (17.24)	58.01 (10.05)	0.12
Red waste per surgery	4.92 (1.60)	5.07 (1.17)	0.84

Discussion

This quasi-experimental study demonstrated that a single session of face-to-face waste segregation training significantly increased the amount of recyclable waste in operating rooms, while it produced a non-significant reduction in medical waste. These findings highlight the effectiveness of targeted educational interventions in raising awareness and transforming waste management behaviors among healthcare professionals.

The fundamental principle of healthcare practice is “do no harm,” but paradoxically, healthcare practices contribute significantly to environmental pollution. The healthcare sector must mitigate its adverse impacts on public health by minimizing medical waste. The importance of educational interventions in achieving this goal is well-documented. Numerous studies emphasize the value of educational programs in reducing medical waste, with many advocating the 5Rs—reduce, reuse, recycle, rethink, and research—as a guiding framework for waste management¹². Recommended strategies include decreasing overall waste volume, refining waste segregation procedures, reusing select medical equipment, recycling, rethinking outdated practices, investing in research, and implementing innovative measures to lower the healthcare industry’s carbon footprint^12,13.

Huang et al.¹⁴ demonstrated how well-structured waste management training reduces the carbon footprint of hospitals, underscoring that proper segregation and the prevention of unnecessary waste are integral to cutting carbon emissions^14,15. In our study, the training element exemplifies the “rethink” principle, while the observed rise in recyclable waste embodies the “recycle” aspect within the 5Rs. Developing waste management policies, along with continuous training, is essential for effective waste reduction in healthcare. Marsden et al.¹⁶ highlighted the importance of sustainability in clinical practice, while Vacharathit et al.¹⁷ demonstrated that physician-led protocols at Cleveland Clinic significantly reduced operating room waste through waste segregation and recycling education. Our study utilized a quasi-experimental design to assess the effectiveness of waste segregation training among healthcare personnel, including doctors, nurses, anesthesia technicians, and cleaning staff. A pre-training survey evaluated baseline knowledge, and post-training measurements assessed practical impacts. One of the strengths of our study is its identification of a significant knowledge gap in waste segregation, particularly among doctors, with 40% demonstrating inadequate awareness compared to other groups, highlighting the importance of profession-specific training. Although 73.6% of participants reported prior waste management training and 71.7% felt knowledgeable, these findings suggest potential shortcomings in the effectiveness of existing programs. Consequently, tailored training initiatives are crucial to address the distinct needs of different professional groups—doctors, nurses, anesthesia technicians, and cleaning staff—and to ensure that each group receives the targeted knowledge and skills necessary for effective waste management practices.

Key barriers to waste segregation included time constraints (35.1%) and personal issues (24.3%), aligning with studies that highlight resource limitations as common obstacles to sustainability in healthcare^16,18. To enhance eco-friendly practices in the operating room, 38.1% of participants recommended training, 9.1% suggested administrative sanctions, and 9.5% proposed incentives displayed insufficient knowledge of waste segregation (p = 0.04). Those favoring training as a solution had significantly less knowledge than others (p = 0.02), underscoring the need for foundational education. This aligns with literature highlighting knowledge gaps as a barrier to sustainable practices, where targeted training significantly improves environmental outcomes in healthcare^19,20. Post-training, 90.6% of participants reported satisfaction with the initiative, and 98.1% affirmed the value of waste management practices, demonstrating a strong commitment to adopting sustainable behaviors.

Throughout the study period, 489 surgeries were performed, generating significant volumes of waste. During the initial three-week baseline period, the operating theater produced a total of 1,350 kg of waste, averaging 6,22 kg per surgery. Following training, total waste generation slightly increased to 1,532 kg due to a marked rise in recyclable waste; however, the average waste per surgery decreased modestly to 5.95 kg. Statistical analysis revealed no significant differences in the total number of surgeries or operating room hours before and after the training. However, the amount of recyclable waste increased significantly (from 1.30 kg to 1.80 kg per surgery), while the amount of medical waste decreased (from 4.92 kg to 4.14 kg per surgery), though this reduction was not statistically significant. The variability in surgical bleeding amounts may account for this result. The increase in recyclable waste and the decrease in medical waste demonstrate the training’s effectiveness, reflecting improved awareness and positive changes in waste segregation behavior. Training programs have been shown to significantly improve waste segregation behaviors and support environmental sustainability in healthcare. For example, the American College of Surgeons reported both substantial cost savings and a 30% reduction in medical waste following waste management training²¹. Our study similarly found a 17% decrease in medical waste and a 30% increase in recyclable waste post-training. This aligns with findings from Mugabi et al.²², who highlighted the health risks associated with improper waste segregation, emphasizing the need for effective management practices. Our post-training data clearly indicate increased compliance with waste segregation, particularly reflected by the statistically significant increase in recyclable waste.

In a similar study, Fraifeld et al.²³ reported a statistically significant reduction in regulated medical waste from 0.33 kg/case to 0.09 kg/case (p < 0.001), alongside a 65% increase in correctly segregated regulated waste and annual cost savings of $28,392. These findings underscore the effectiveness of enhanced staff education and compliance with waste segregation practices, mirroring our own results in improving both waste management and environmental sustainability.

Ryan et al.²⁴ an evaluation of waste generated during otolaryngology procedures revealed a total average weight of 8.9 kg of waste per surgery, composed of 1.8 kg of recyclable materials and 7.1 kg of nonrecyclable materials. Across 22 surgeries spanning four otolaryngology subspecialties—facial plastics, pediatrics, otology, and head and neck oncology—197.4 kg of waste was collected in total, of which 40.2 kg (20%) was classified as recyclable and 157.2 kg (80%) as nonrecyclable. These findings highlight the substantial amount of nonrecyclable waste produced and underscore the need for targeted interventions to reduce and more effectively manage OR waste. According to a multi-center Australian pilot study²⁵ examining disposable waste from ocular surgery, the mean total disposable waste per phacoemulsification procedure was 1.38 ± 0.50 kg, and for pars plana vitrectomy procedures it was 1.47 ± 0.44 kg, with approximately 22% identified as potentially recyclable. These findings underscore the substantial amount of surgical waste generated even in relatively short procedures and emphasize the importance of proper segregation and recycling measures in operating rooms to reduce environmental impact and comply with local waste management regulations. Orthopedic procedures reveal a marked gradient; a general orthopedic case averages 6.2 kg of waste, whereas total knee arthroplasty may generate as much as 13.3 kg, largely owing to the extensive use of disposable drapes and instruments²⁶. Procedural factors such as complexity and reliance on disposable items consistently associate with larger waste outputs. In addition, studies^24,27 document that surgical waste typically consists of a mixture of recyclable materials (with some reports identifying 20–27% potential recycling rates), plastics, paper, biohazardous materials, and disposable linens (up to 39% by weight). Variations in institutional practices, including supply management and waste segregation, contribute further to the differences observed—recycling rates, for example, ranged from 0–44%—and regional differences impact waste outcomes even among similar procedures²⁸. Research also underscores the importance of regular refresher training, as the impact of initial training often fades within 3 to 6 months²⁹. In our study, an increase in recyclable waste was observed immediately after training, followed by a slight rise in medical waste two months later, suggesting that frequent refreshers may be necessary to maintain positive outcomes.

Integrating waste management strategies into healthcare operations can significantly reduce costs while promoting environmental sustainability. Studies show that improving waste segregation practices decreases the volume of hazardous waste requiring costly disposal, ultimately lowering operational expenses. For instance, Patel et al.³⁰ demonstrated that effective waste segregation in hospitals reduced disposal costs by nearly 20%, with an emphasis on recycling and minimizing single-use materials. Similarly, Mosquera et al.³¹ reported a 6.2% reduction in medical waste volume and significant cost savings of €125,205. Niino et al. addressed the “red bag problem” by implementing straightforward interventions in the operating room, yielding a statistically significant reduction in regulated medical waste (RMW) from 44 to 21.5%. This change not only led to substantial cost savings—approximately $7,930 per month and an estimated $95,000 annually—but also reduced the carbon footprint associated with surgical practices. These findings underscore the importance of adopting relatively simple process modifications to achieve both economic benefits and enhanced environmental sustainability in operating room waste management. Although our study did not calculate cost savings, effective waste segregation training could potentially offer economic benefits in addition to environmental improvements.

This study has certain limitations. It is single-centered, which may affect the generalizability of our findings. Additionally, the data collection periods varied in duration due to seasonal staffing changes: the pre-training and post-training phases each spanned three weeks to ensure consistent data collection under stable staffing conditions, while the two-month follow-up period was restricted to one week. This shorter duration was a deliberate methodological decision, as the summer term had begun and many of the originally trained staff were on annual leave. Extending the follow-up risked introducing variability by involving untrained personnel, thereby potentially confounding the results. Consequently, the one-week follow-up was chosen to maintain continuity and data integrity while still offering a preliminary perspective on the sustainability of training outcomes. Another key limitation is the relatively short follow-up period combined with reliance on a single training session. Seasonal staffing variability could have impacted consistent practice adherence, limiting the reliability of long-term extrapolation. Furthermore, the study did not account for surgery types, bleeding volumes, or disposable usage factors that could significantly influence overall waste generation and the statistical strength of observed reductions. To address these limitations, future research should adopt extended follow-up durations, multiple training sessions, and more detailed monitoring of clinical variables, enabling clearer insights and more generalizable outcomes.

This study evaluated the effects of waste segregation training provided to operating room staff on the amounts of medical and recyclable waste. The findings indicate that the training increased the amount of recyclable waste and reduced the amount of medical waste. Specifically, the increase in the amount of blue bin waste per surgery and the decrease in red bin waste highlight the positive impact of the training on waste management. Differences in the knowledge and awareness levels of the surveyed healthcare personnel suggest that training should be tailored to specific professional groups. Regular repetition and updating of the training are critical to maintaining the effectiveness of waste management practices. The increase in recyclable waste and the decrease in medical waste observed post-training indicate that the staff’s awareness of waste management has improved, and this increased awareness positively affects waste segregation behaviors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

B.N.E.F. designed the study, conducted the training sessions, collected the data, performed the statistical analyses, and wrote the main manuscript text. S.K.E. contributed to study design, supervised data collection, and provided critical revisions to the manuscript. M.Ö. assisted in study design, contributed to the development of the training materials, and supported literature review. D.Y. provided methodological guidance, contributed to data analysis, and critically reviewed the manuscript.All authors reviewed and approved the final version of the manuscript.

Data availability

The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Ankara University Faculty of Medicine Human Research Ethics Committee (Ethics Committee decision dated 15.02.2024, number I02-91-24). Written informed consent was voluntarily obtained from all participants before data collection, and all methods were performed in accordance with institutional and international ethical guidelines.