Reducing Waste in the Operating Room - Sustainability: Community

Reducing Waste in the Operating Room

By Sara Booth | Posted: Wednesday, July 1, 2015 2:00 pm

Of all the waste a hospital generates, as much as 20 to 30 percent comes directly from the operating room.

Surgical procedures sometimes result in hospitals discarding tools that have been opened but never used. What’s more, disposing of operating room waste isn’t a simple matter of throwing it in a dumpster bound for the landfill; state and federal laws require some materials to get special treatment that can cost 10 to 15 times as much as ordinary waste disposal.

So, there are a lot of good reasons for a hospital to take a second look at how it’s handling OR waste. But there are complicating factors, as well.

“Hospitals are fairly risk-averse, and for a very good reason,” says Kelly Weisinger of Emory University. “It’s challenging to be the first to try something.”

Weisinger is the sustainability programs coordinator for Emory, and one of her department’s major projects is the “greening” of Emory University Hospital and Emory University Hospital Midtown. Starting in July 2014, the two hospitals joined the university in implementing a comprehensive plan to keep waste out of the landfill, aiming by the end of 2015 to divert 65 percent of total waste into other disposal streams, such as recycling and composting.

While the university was already recycling and composting quite a bit when the program began, operating rooms were further behind. “We had some ad-hoc recycling happening, but we hadn’t taken a comprehensive look at healthcare waste,” Weisinger said.

Any such look will turn up a variety of complexities that might surprise people who aren’t medical experts. It can be difficult for healthcare workers to see how to make changes, but Gundersen Envision, the “green” arm of Wisconsin-based Gundersen Health System, offers a number of initiatives to help out. Eric Bashaw, program manager for Comprehensive Waste and Environmental Compliance, understands the complexity of the problem.

“A hospital is one of those weird facilities that generates every industry’s form of waste. There’s food waste, and facility operations waste such as light bulbs, and the same sort of paper waste that office buildings generate,” Bashaw says.

“But then in the operating room, think of the variety of waste you’re working with. You have medical supplies, wrappings, the devices themselves. Pharmaceuticals. Blood and fluids and tissues. The gowns and drapes become contaminated with fluids, and then they’re bio-hazard waste. Even the heavy-duty disinfectants that are used become chemical waste that has to be disposed of.”

In the case of the Emory hospitals, one discovery involved the way surgical supplies were purchased. Supplies for surgery can be ordered in a prepackaged kit, with all the necessary tools and supplies placed on a single-use tray and shrink-wrapped. “When we did a little supply-chain thinking, we realized that it might be easy to purchase pre-packaged trays, but often they contain more or different instruments than a particular surgeon uses,” Weisinger says. So instead the hospitals began assembling their own surgery kits, using trays that can be sterilized and reused, packed with only the instruments and supplies that will actually be used.

Some instruments must be discarded after use. But these can now be collected by Stryker, a medical technology company, for recycling. Other devices, from laparoscopic devices to blood pressure cuffs, can be reprocessed and reused. In 2014, Emory diverted more than 12,000 pounds of these and other devices from the landfill.

Sometimes medical supplies and equipment are neither used nor expired, but simply no longer useful at a particular facility. Emory has partnered with MedShare to donate these to needy medical facilities, where they can be used rather than discarded.

Some OR waste is fairly simple to deal with. Surgical instruments arrive wrapped in plastic, cardboard, and “blue wrap” (a fabric-like substance made of polypropylene plastic. If these materials are taken into the operating room, there's a risk of contamination during surgery so they have to be discarded. Gundersen’s nursing staff instead separate these materials outside the OR, allowing them to be recycled.

Disposing of bio-hazardous waste costs an average of 28 cents a pound, while recycling costs an average of just a penny a pound. So it’s easy to see how processes like this, while they take time, can save thousands of dollars in waste processing fees simply by keeping clean cardboard separate from bio-hazards.

In the case of blue wrap, some was recycled and some was used by volunteers to create aprons, tote bags, wheelchair and walker bags. This saves both the cost of recycling and the cost of purchasing those items, not to mention building volunteer relationships.

While changing habits can be difficult, changes like these tend to reduce costs, which makes them easy to consider. “It’s a win-win,” Weisinger says.

Still, patient health is often a concern in a variety of ways. If a patient has a highly infectious condition, no amount of sterilization is going to make it a good idea for the staff to reuse the gowns they wore during the surgery. And even something as simple as a recycling bin can be bad news if it clutters up the operating room and slows response times.

“We try to think downstream,” Bashaw says. “You don’t want anyone coming in contact with it. And if you’ve ever been to a recycling center, you know that if you send it, they will be in contact with it; they’re not following healthcare procedures.

“We always try to ask ourselves: Would we recycle this if this patient had MRSA (a staph infection)?”

And yet, says Bashaw, the best green champions are in the operating room. “When you’re a surgeon removing a tumor, you think about how environmental conditions affect health. You think, ‘Could this have been prevented?’ “

“Hospitals began using disposable equipment and supplies for a good reason, and they resulted in a far lower infection rate,” Weisinger says. “But the technology has advanced so much that it now makes sense for the operating room to be a little less disposable.”