Mútua Terrassa- Reducing waste and carbon emissions through reusable textiles and recycling.

Date:  23 May 2024


The current economic model leads to large amounts of disposable materials in hospitals. Disposable materials are often packaged in single-use plastic for safety reasons. The surgery service nursing team and the professionals overseeing post-operative hospitalization collaborated on a project to tackle this at Mútua Terrassa Hospital in Catalonia, Spain. They promoted environmentally sustainable actions focused on plastic and paper recycling as well as the reuse of surgical textiles.

This project has been successfully adopted hospital wide. By using the innovative reusable textile material, there has been a substantial reduction (160.000 kg per year) in the volume of waste generated from single-use surgical textiles.


Mútua Terrassa is a social benefit organization committed to enhancing the wellbeing of citizens. Across 21 companies, its holistic scope involves vital sectors in social and health services, as well as the insurance field. These include a University Campus of Health and AXIOMA, a specialized laundry and sterilization company for health products serving hospitals throughout Catalonia.

One of the organization’s key objectives is to reduce the climate impact of its activities, following the principles of the circular economy and optimizing resource use. As part of this, there was a need to develop a strategy for plastic and paper recycling and textile reuse.  With the aim to become a benchmark for both citizens and other entities within the sectors where Mutua Terrassa operates, the organization showcases a commitment to environmental responsibility and sustainable practices.


The surgical nursing team had identified an increase in the use of plastic and paper waste in the pre-operative and intraoperative processes. From sterile gases to serum equipment, via syringes or catheters, everyday nursing teams use these materials to provide patient care. Historically, the waste generated from these materials was managed as group II waste.

Another challenge relates to economic incentives. Disposable materials, considered “goods”, have a 0% VAT rate, whereas reprocessed materials, considered a “service”, have a 21% VAT rate. This creates a challenge for promoting sustainable practices in healthcare delivery.

Legislation, at both European and national levels, needs to be updated to support and incentivize the transition to more sustainable practices in healthcare, particularly the reduction of disposable materials.

Solutions proposed

Plastic and paper recycling

The team adapted waste-carrying carts to include plastic and paper bins, and created dedicated, convenient spaces for recycling bins in the pre-surgical area and the operating room itself. They introduced the recycling strategy to the workforce in training and awareness sessions.

The postoperative care nurses also identified the possibility to segregate clean wrappers and include them in the recycling process comfortably and effectively.

The project was planned in phases for a gradual progression. This gave the team the opportunity to gain learnings at each step and then tailor the next phases to workforce needs. Throughout the process, they maintained consistent communication, and carried out surveys in each phase to identifying these needs.

Reusable surgical textiles

Mútua Terrassa created a reusable textile for surgical use. It is now widely distributed to hospitals across Catalonia through AXIOMA, its dedicated laundry and sterilization company for health products and sanitary textiles.

Hospitals order the textile sets they need and, once used, they return the sets to the company for cleaning and sterilization. These reusable textile products can be used dozens of times before reaching the end of their lifecycle. The estimated CO2-equivalent reduction for each operation is approximately 3.5 kg.

Expected impact and vision of the project

In surgical processes, plastic and paper segregation is now fully established. The hospital has extended these practices to other areas. This comprehensive approach enables Mútua Terrassa to recycle a substantial volume of products that would otherwise have contributed to landfill waste. This is a significant improvement in mitigating their environmental impact, reducing their annual greenhouse gas emissions.

Measurable impacts

The outcomes are highly promising.  The emissions, for the period of a week,  were 90 kg CO2 eq with the segregation and surgical textile reuse project, while they would be 854 kg CO2 eq without the project.

Moreover, the introduction of reusable textiles led to a substantial reduction (160.000 kg per year) in the volume of waste generated from single-use surgical textiles.

Mútua Terrasa proved that the supply, distribution, management, and hygiene of reusable textiles is not only more environmentally sustainable and economically viable, but also more reliable in terms of supply.  This was clear during the peak of the COVID-19 crisis in 2020. Health centres relying on disposable protective equipment, mainly sourced from southeast Asia, faced shortages, while those using reusable materials had readily available protection materials.


The project promotes the concepts of a “carbon footprint” and “climate change” as central to our present reality, rather than being remote issues.

A project is now running to make sure that each patient who has surgery at Mútua Terrasa University Hospital learns about this initiative through their discharge report. This includes adding a carbon footprint indicator: “since Mútua Terrassa began using reusable textile protection material in its surgical interventions, we have achieved a remarkable 54% reduction in our carbon footprint compared to the period when disposable material was used. By choosing reusable options, we not only safeguard your health but also contribute to the wellbeing of our planet”.

Building on its circular economy approach, Mútua Terrassa also plans to recommend to patients the most sustainable journey to visit the health centre in terms of carbon footprint. This holistic approach aligns with their commitment to raise awareness and encourage environmentally conscious choices in the community.


Written by:

Renzo Costa