This doesn’t directly involve anesthesia but I thought this was interesting so I wanted to share with our readers.
Author: Victoria Stern
When Stephanie M. Barman, RN, saw how much waste a single procedure in the OR generated, she knew something needed to be done.
“One procedure created an entire case cart of trash,” said Ms. Barman, a nurse coordinator for high-risk OB/GYN surgeries at UnityPoint Health–Meriter in Madison, Wis.
Producing large quantities of waste is hardly unusual for hospitals. One analysis published in 2010 estimated that hospitals in the United States create just under 34 pounds of waste per staffed bed per day, which translates to approximately 11.5 billion pounds of trash each year. The OR generates a substantial portion of that waste, with estimates as high as one-third of a hospital’s total (JAMA 1992;267:2765-2768).
Ms. Barman had a hunch that Meriter could do better. “A nurse at the University of Wisconsin, where I used to work, had implemented a recycling project,” she said. “I saw how one nurse could do something on a grassroots level to change a hospital’s culture, and felt inspired.”
Before implementing any changes, Ms. Barman wanted to understand the challenges that staff faced with the hospital’s current recycling efforts. When she traced the path that discarded items took from the OR to the hospital’s recycling vendors, she discovered that OR staff and environmental services were sorting trash from recyclables, just not correctly.
“Ultimately, I realized we had no standardized knowledge about what could be recycled,” Ms. Barman said.
Lack of clarity about recyclables may be fairly common. A 2019 study published in the American Journal of Surgery found that almost 60% of 524 hospital staff surveyed at four Mayo Clinic campuses reported being “unclear which OR items are recyclable,” and close to 50% said “the greatest barrier to recycling was lack of knowledge” (2019;217:634-638).
On Jan. 1, 2018, Ms. Barman and her hospital’s Green Team implemented an educational initiative, explaining which items could be recycled and how OR staff could incorporate recycling into the fast-paced OR environment.
“We didn’t have to change our workflow in the OR, but we were able to create awareness about what to recycle and a standardized process for how to do it,” Ms. Barman said.
Three months after starting the initiative, the Green Team found the average monthly mixed recycling in the OR increased from three to five tons per month.
“The volume could fill approximately 157 garbage trucks,” Ms. Barman said. “This effort represented an enormous cherry on our sundae.”
Ms. Barman is not alone in her concern about the amount of waste produced in the OR.
In 2011, Practice Greenhealth—an organization dedicated to improving sustainability and environmental stewardship in health care—launched the Greening the OR Initiative to help hospitals develop tailored interventions to reduce their waste footprint and improve energy efficiency.
“Environmental stewardship encompasses so much more than recycling,” said Kaeleigh Sheehan, who manages the initiative. “Hospitals can target many other low-hanging fruits.”
At the 2019 AORN conference, Barbara Belanger, RN, an OR staff nurse and the chair of the OR Recycling Committee at Massachusetts General Hospital (MGH) in Boston, reported how her hospital implemented a range of sustainability practices. In addition to improving recycling, Ms. Belanger worked with OR staff and industry to reprocess compression boots and reduce the use of foam products; physicians and nursing staff collaborated to streamline surgical kits; and MGH began working with a farm in Maine to encourage composting.
“These efforts have shown great success and staff engagement so far,” Ms. Belanger said.
Other institutions have focused on reducing emissions from anesthetic agents. Patients metabolize only 5% of the anesthetic gas administered to them; the remaining 95% is expired and vented out of the hospital. A study from 2010 found that global emissions from inhaled anesthetics are comparable to carbon dioxide emissions from 1 million passenger cars (Br J Anaesth 2010;105:760-766).
To reduce greenhouse gas emissions, a team at the University of Wisconsin, Madison replaced more volatile agents, such as desflurane, with more environmentally friendly ones and reduced the flow rate of these gases—an effort that amounted to a 64% decrease in carbon dioxide equivalent emissions per case (Anesth Analg 2018 Sep 10. [Epub ahead of print]). In addition, companies in Canada have developed technologies to capture unused anesthetics (Can J Anesth2013;60:38-43).
“Realizing the environmental impact of anesthetic gases was a big ‘Aha’ moment for the whole health care sector,” said Julie Moyle, RN, a clinical perioperative nurse who co-manages the Greening the OR Initiative with Ms. Sheehan. “As health care professionals, we’re in the business of healing people and preventing illness, and these environmental determinants represent a significant health risk.”
Follow the Data
But how can institutions find their areas that need remediation?
“Using available data is key,” said Denise VanBuren, RN, BSN, a clinical program manager at Owens & Minor, a health care logistics and medical supply firm in Richmond, Va. Ms. VanBuren, who has since left Owens & Minor, spoke at the AORN meeting about strategies to identify and reduce OR waste.
For example, data show more than 2 million pounds of unused surgical supplies—representing about $15 million—become waste each year at large non-rural academic medical centers in the United States (World J Surg 2015;39:29-35).
However, hospital staff can use this information to their advantage. “There are so many statistics available to us that can help us track and identify problem areas,” Ms. VanBuren said. “Review data on inventory and purchase history, OR turnover time, and costs associated with case cart pulls. Using this data to our advantage will improve the quality of care and the costs.”
Simple observation may be a provider’s greatest asset, Ms. VanBuren said. Are OR supplies being opened in error? Are custom packs optimized?
“It doesn’t cost institutions anything to observe, chart and increase awareness,” Ms. VanBuren said.
Go Green and Save
In addition to environmental benefits, hospitals have documented cost savings from their green practices.
“Institutions having trouble getting started on environmental efforts or are wondering what’s in it for them may find the data on financial saving compelling, especially given the rising costs of health care delivery,” Ms. Sheehan said.
The anesthesiology team at the University of Wisconsin reported saving $25,000 per month with their anesthesia campaign (Anesth Analg 2018 Sep 10. [Epub ahead of print]). A recent study from Mayo Clinic researchers found that an eight-week pilot project to recycle blue wrap—a notoriously difficult material to manage and repurpose—in the Department of Neurosurgery saved $31,680 (Neurosurgery 2018 Jul 27. [Epub ahead of print]). Surgeons at the Carolinas Medical Center in Charlotte, N.C., described how recycling single-use devices, replacing disposable OR foam with reusable gel pads, reusing batteries, and turning off OR lights and equipment when not in use resulted in $92,000 in savings per year (Am Surg 2013;79:666-671).
“Hospitals can save money in the long run by making simple changes,” Ms. Sheehan said. “We don’t leave the lights and air conditioning on full blast when we leave home, so why would we think it’s acceptable to do that at work?”
Although reducing waste in the OR may seem like a daunting task, it’s important to start somewhere. “No one is coming to do this for you,” Ms. Moyle said. “Start by doing one thing differently and go from there.”