B.C. Cancer eliminates exam paper, saves 32 tonnes of emissions

The thin crinkly swath of paper pulled over an examination table has long been part of the experience of visiting the doctor. It suggests a fresh, clean surface, but as Dr. Caroline Mariano, a medical oncologist with B.C. Cancer in Vancouver, points out, the paper actually serves no purpose when it comes to hygiene. 

"Table paper has just been around in medicine forever and ever and I think in the past people would use it instead of wiping the table, which is not great for infection control," said Mariano.

The cleaning protocol between patient visits already included wiping the table with disinfecting wipes before covering it with fresh paper from the roll, according to Mariano — and it's the wipes that actually keep things sterile. 

Along with a team at B.C. Cancer known as the Planetary Health Unit, Mariano set out to address the waste associated with table paper. They succeeded in eliminating the paper's use at four B.C. Cancer centres: Vancouver, Victoria, Kelowna and Surrey.

"We calculated that in a year we would use about 2,000 kilometres of paper," she said. "In some of the sites we were using up to 70 rolls a month, and the use switched down to essentially zero after we rolled out this initiative."

The Planetary Health Unit took the project one step further: they studied the waste and emissions associated with table paper use at the agency and published a peer-reviewed study in the latest edition of the B.C. Medical Journal.

As reported in the published study, the authors assumed the paper being used had no post-consumer recycled content. Mariano said it was also being disposed of by incineration, as it's medical waste.

"It was about 32,000 kilograms of emissions saved, which, to translate that, is about driving 130,000 kilometres in a gas-powered car," said Mariano, characterizing the actual impact at an institution as large as B.C. Cancer as "modest."

According to a 2023 annual climate report, the Provincial Health Services Authority, which operates B.C. Cancer and other health services and programs in B.C., purchased a carbon emission offset of 18,754 tonnes of carbon dioxide equivalent, at a cost of $510,851.

Mariano said many people who work in health care will be aware of how much unnecessary waste is produced in the medical system. She said it was satisfying to demonstrate how some of the "low-hanging fruit" can be cut.

"We did want to put it out there so that other organizations could take this and say, listen, this is an organization that has a big cancer population, immunocompromised patients, and we were able do this in prevention and save both carbon and money," she said.