Greening the OR News
Greening the OR News- April 2012
Last week, New Orleans saw a huge crowd fill their hotels and conference center – and not just for the NCAA Final Four, but earlier in the week for the AORN 2012 Congress! AORN’s annual conference draws more than 5,000 perioperative registered nurses and health care suppliers and providers. Considering that this brings together one of the largest groups of key stakeholders in the Greening the OR Initiative, Practice Greenhealth was excited to have significant participation in many facets of the conference. In addition to having an exhibit booth on the expo floor, Cecilia Deloach Lynn and Julie Moyle presented on Greening the OR at an educational session that drew more than 100 participants. Later that evening, sustainability in the operating room was once again the topic of conversation at the Stryker/Pfiedler dinner. Over 1,000 attendees listened to a panel of clinicians—an OR nurse, an anesthesiologist and a surgeon— give their perspective on why sustainability in the OR makes sense and how they do their part in their respective roles.
The Healthier Hospitals Initiative launched April 3, 2012 beginning the three-year campaign to speed the greening of the health care sector. More than five hundred leading hospitals have joined the Healthier Hospitals Initiative to date, committing to reduce waste and energy use, employ smarter purchasing tactics, use safer chemicals, offer healthier food and beverage options, and engage leadership in environmental health issues.
Health care has significant purchasing power, representing 17 percent of the marketplace. A recent study indicates the OR is the leader in medical supply usage for the entire hospital, with supply costs at 56percent of the total budget for the operating room. The OR is also the largest generator of waste within the hospital, with 20 to 30 percent of the hospital’s total waste stream originating there. As the HHI team began to look at areas of opportunity within the challenges and specifically within the Smarter Purchasing challenge, it became evident that a key target to significantly reduce waste and employ smarter purchasing tactics was within the operating room.
One evident change in regard to smarter purchasing habits is to reformulate the OR kits—that is, review the kits on an annual or semi-annual basis to pull items that are often open and unused, but end up in the trash. By periodically reviewing these packs, hospitals can see savings on both the supply end from avoiding excess purchase, as well as eliminate unnecessary items ending up in the waste.
Another Smarter Purchasing challenge is the use of reprocessed single-use medical devices. Using a third-party reprocessor, medical devices dubbed “single use” by original equipment manufacturers can be safely and cost effectively reprocessed and reused. This practice reduces waste from entering the landfill by allowing these devices to have multiple lives. In addition to waste savings, using reprocessed medical devices reduces costs by allowing facilities to buy back the devices at about half of the original supply cost. The waste savings also saves in waste disposal costs as these devices do not enter the waste stream.
There are many examples of facilities who have safely and successfully implemented these programs – some available at Greening the OR and others at HHI. Facilities are encouraged to participate and commit to both of these free programs and join their peers in taking the next steps on the sustainability journey.
Bon Secours Good Samaritan Hospital in Suffern, NY had a busy year striving for sustainability in the OR! With nine ORs and 7,048 procedures in 2011, there was a lot of opportunity to see financial and waste savings. They saw success in the AES program, reduction of regulated medical waste, SUD reprocessing and bluewrap diversion. Staff engagement has been key to the success of their programs. Nursing assisted with the regulated medical waste (RMW) training and blue wrap collection in the OR. This blue wrap is collected every week and donated to local animal shelters – who use the blue wrap for animal bedding, absorbent pads, and more. The RMW reduction program is department specific throughout the hospital, and includes mandatory online training. Good Samaritan Hospital also reduced RMW containers throughout the facility and increased municipal waste containers in an effort to make segregation efforts easier. As another mechanism to reduce RMW, Good Samaritan Hospital utilized fluid management systems in every OR which saved over 21 tons entering the RMW stream. Physicians have also been supportive of the green efforts, evident through their increased support of using reprocessed and reusable medical devices. Reprocessing saved Good Samaritan Hospital $13,575 last year, and that number was a decrease due to the increase in reusable devices!
St. Anthony Hospital of Franciscan Hospital System, Catholic Health Initiatives, has five operating rooms and performed 3,694 procedures in 2011. Their goal was to expand single-use device reprocessing. Nursing staff, including the value analysis manager and nursing director for peri-op services worked to meet this goal by implementing the co-mingle recycling and SUD reprocessing in the ORs and other work areas. In addition to gaining support from nurses, St. Anthony’s saw physician buy-in to reprocessing when they agreed to use the SUD reprocessed items. They have multiple doctors that encourage the three R's – Reuse, Reduce, Recycle - throughout FHS. As a result of the staff engagement and educational outreach – developing signage and holding in-service trainings – St. Anthony Hospital’s savings from SUD reprocessing resulted in 2.03 tons of waste diverted from the landfill and $34,142 in cost savings in 2011.
Saint Joseph Hospital, part of Covenant Health System, has 10 operating rooms and performed 5,182 procedures in 2011.
Committed to pursuing sustainability, they hold yearly mandatory training of regulated medical waste (RMW), hazardous waste and pharmaceutical disposal practices. In this training, they highlight the proper regulations surrounding correct hazardous waste disposal, as well as discuss their approach to save on RMW waste. One of these strategies was providing smaller-sized RMW containers and larger regular trash containers in all patient rooms, outpatient clinic areas and anywhere there is an opportunity to properly dispose of RMW and regular trash waste. They also keep both containers side by side in all areas organization-wide so they may "make the correct choice" at point of disposal.
Another target for reducing waste was SUD Reprocessing – which saw 1.48 tons of waste diverted and $42,608 in cost savings. Similarly, they engaged in a reusable sharps container program which resulted in $14,400 in cost savings and 9.7 tons out of the landfill. Using reusable devices, such as grounding pads, reusable patient warming devices, and reusable rigid sterile cases for surgical items also helped to keep waste streams low.
To target energy use in the ORs, Saint Joseph Hospital utilizes occupancy sensors to reduce energy use in unoccupied operating rooms, as well as reduces the HVAC system when not in use. By using LED lighting, they saw another decrease in energy use by increasing thermal comfort. Already doing great work in 2011, Saint Joseph’s goals for 2012 include more work on Greening the OR and continuing to research and begin recycling blue wrap from ORs.
Dominican Hospital of Dignity Health had the goal in 2011 to reduce the amount of waste coming out of the OR and nursing units. In order to do so, they enlist the help of the materials manager, the OR director and nursing staff to dispense with prepared patient kits. These kits contained plastic items that were not always used. As a result, they had to throw some items out. Items they actually use are now stored on shelves. Nurses can pick the items they need thus reducing the amount of packaging and the materials items that are disposed of.
In 2001, staff at Dominican Hospital engaged in a medical waste reduction program. An infection control nurse trained every nurse in the proper segregation of medical waste. There is less medical waste now, less potential for accidents and they realized a financial savings. In 2012, they will engage in another training of nurses and staff in order to reduce medical waste even further and hopefully realize even more savings.
When Dominican Health implemented fluid management systems in 2007, the cost of disposing of red-bag liquid waste was .166 per pound – and a full bag weighed 80 pounds. they used eight bags a day over 260 workdays. The annual expense was $27,622 plus the addition of dozens of plastic canisters to the landfill. The cost of each fluid management sytem that year was $9,143 and the docking station was $8,912. The total came to $36,341 for three rooms with an additional three systems when the electrical upgrade was complete. It has now become an ingrained part of business and they no longer keep track of this data.
In another effort to realize waste savings, Dominican Health uses a third-party reprocessor for single-use medical devices, which saw a savings in 2011 of three tons of waste diverted from the landfill and a cost savings of $58,974. They also review OR kits and remove excess supplies or recycle or donate anything left over. Lastly, they use reusable items in the OR whenever safe and economically viable options are available.
Clinical staff also participated in a conference call with representatives from one of their vendors to let them know what was needed and determine what other or alternative products (steel cases) might be acquired in order to be more sustainable.
In 2012, Dominican Health hopes to green the OR, determine the content of the OR waste, identify opportunities for improved management of general waste, regulated medical waste and recyclables in the Operating Room and identify opportunities for waste reduction and green products.
Virtual Green OR Video
In the News, Articles of Interest & Upcoming Events
MDH2E’s Trailblazer Educational Series: Greening Surgical Services, Anne Arundel Medical Center
CleanMed is quickly approaching! Register for this year’s Greening the OR pre-conference workshop and have the opportunity to learn about OR-specific topics, talk with your peers and take home new ideas for immediate sustainable implementation. The workshop setup will follow a new format, designed so participants can really lead the discussion and learn about what interests them most.
It will begin with an introductory presentation, making the connection between sustainability and the operating room, and highlighting the latest developments across the sector and within the Initiative. This will be followed by breakout sessions where topic leaders will share their experiences, explore current research, and facilitate discussions among the groups. Participants will select their four priority issues from six (6) broad topic areas. Topic leaders will discuss the issue for around 10-15 minutes, and allow the rest of the slotted time for group discussion, questions, strategizing and brainstorming.
The proposed topics are:
- Reprocessing and gaining clinician acceptance
- Tackling Plastics: Medical plastics recycling, blue wrap, rigid sterilization containers
- Metrics: Establishing a benchmark, measuring the impact, tracking data and where to go from there
- The Virtual Green OR Tour
- Anesthesia and energy efficiency: Waste anesthetic gases, reusable anesthesia devices, anesthesia gas capture systems
- Lean and Green in the OR: Improving efficiency and flow, reducing supply purchase, and more
Greening the OR News - January 2012
Although a primary source of hospital revenue, the OR is also a significant cost center. It is the leader in medical supply usage for the entire hospital, estimated to account for approximately 33 percent of all hospital supply costs, and has large cost requirements relative to energy use and waste management.
Healthcare organizations are increasingly recognizing that third party reprocessing of medical devices labeled “single use” is a safe and effective process that can help redirect valuable financial resources back into patient care. This strategy also significantly reduces the volume of regulated medical waste generated by the organization and reduces the OR’s supply budget. The U.S. FDA stringently regulates the reprocessing of these devices and requires third-party reprocessors to meet the same quality and safety standards as originally manufactured single-use devices (SUDs).
Reprocessing of SUDs is now common practice in many ORs, with all of U.S. News and World Report’s “Honor Roll” hospitals choosing to reprocess SUD’s. In 2011, 96 percent of ELC Winners and 79 percent of PFC Practice Greenhealth Award Winners chose to reprocess medical devices, for a combined savings of more than $11,750,000.
Despite widespread adoption of this practice, many health care institutions continue to meet resistance from skeptical surgeons or clinicians. One of these institutions is Vanguard Health Systems, a system of more than 22 facilities across Arizona, Illinois, Massachusetts, Michigan and Texas. Dr. Amy Collins, Sustainability Coordinator of Vanguard Health Systems, received a lot of questions and concerns from fellow physicians and realized the key to addressing these concerns was through education. She enlisted Practice Greenhealth to assist in developing an educational event for dubious surgeons and physicians. A physician who embraced the use of reprocessed single use medical devices spoke to them.
Dr. Martin Makary, an active surgeon and researcher sitting in leadership positions at both the Johns Hopkins School of Medicine and School of Public Health, as well as for the United Nations World Health Organization (WHO), the International Union of Risk Management, and a regular medical expert on CNN – published an article, “Commentary: A Call to Go Green in Healthcare by Reprocessing Medical Equipment.”The article discusses the use of reprocessed medical devices, and is very supportive of the practice.
In addition to Dr. Makary’s personal support of the process, Johns Hopkins University Hospital has a supportive network and robust reprocessing program in place throughout the entire system. From November 2010 – October 2011, they saved $1,129,397 and more than 52,000 tons of medical waste diverted from the landfill.
In early January, Vanguard held a teleconference for all of its surgeons and physicians to listen to a presentation given by Dr. Makary. After the 30-minute presentation, the clinicians were able to ask many different questions, ranging from concerns over quality and safety, to compliance and reporting, to preference and opinion. The presentation was recorded so all Vanguard staff as well as all Practice Greenhealth members could access the recorded event to use for their own educational purposes.
The recorded presentation and supplemental FAQ sheet will be available soon on the Practice Greenhealth website!
Greening the OR aims to define best practices in the OR to reduce environmental impact, reduce cost, increase efficiency and improve worker and patient safety. These overarching goals parallel the goals of the EPA’s Sustainable Healthcare program to reduce pollutants through increased efficiency in the use of materials and energy. Practice Greenhealth and Health Care Without Harm received a collaborative grant from the EPA to focus educational and outreach opportunities of the Greening the OR Initiative on EPA Regions 1, 4 and 7. Any facility within those regions, whether Practice Greenhealth member or not, has free access to all Greening the OR webinars, Guidance Documents, and other resources.
Find out if your state is included! For a complete listing of states by region, please visit http://www.epa.gov/tribalportal/whereyoulive/regions.htm.
Please contact Kaeleigh Sheehan for more information on registering and taking advantage of this great opportunity.
In 2009 we began our Greening initiative on the Methodist Hospital campus of IU Health. To “sell” going green, representatives from Healthcare Waste Solutions first had to promote and establish a positive cardboard recycling program. This involved renegotiating our contract with our waste hauler and establishing reimbursement for each ton of cardboard we produce. Currently, on the Methodist Campus, we produce 30 tons of cardboard each month which equals a cost savings of $2,820 per month. On the IU & Riley Campuses they produce 23 tons of cardboard per month which becomes a $1,862 monthly savings. Each campus has different needs which equate to different cost savings.
Once we had cardboard established with positive results from that recycling program, we were able to tackle paper and plastics. Through our inquisitive ways, we learned that we pay $2.60 to have each of our shredder boxes emptied—whether it is full or not. So our paper-push began. We initiated this by training the surgery staff to save the paper inserts from sterile packaging, as well as product instruction sheets and anything else that is paper. We collect this with our patient schedules and other protected information and all of it, whether confidential or not, is deposited in the shredder bins thus maximizing the utilization of this service. We also discovered that everything in the shredder bin is shredded then recycled, so its win-win. This process better utilizes an already existing service. This can be accomplished on every unit in the hospital in-situ.
Plastic recycling introduced a different type of problem to overcome. First we needed space to place a collection container for all of the recyclable plastics from surgery: empty irrigation bottles, plastic cases from implants and laparoscopic devices, etc. Anything with a triangle on it could be recycled except betadine bottles (because of the brown color and leakage/staining) and styrofoam. Secondly we needed space for a small cardboard baler used for making bales of blue-wrap (surgical instrument wrap), a #5 polypropylene plastic which can be used to make rubber mulch, railroad ties and bicycle helmets.
We kicked off both initiatives at the same time, in December of 2009 at Senate Street Surgery Center, located on the Methodist Campus, after almost a year of planning and preparation to get everything in place. This included: training and educating perioperative staff, arranging pick-up locations and dates with the hauler, being trained to operate and trouble-shoot the blue-wrap baler, and more.
The process began slowly but has progressed steadily. At the beginning of 2010, we filled one plastic bin about every 2-3 weeks, and it took almost a month to collect enough blue-wrap from sterile supplies and surgical instruments to make each 800-pound bale. However with participation from Senate Street Surgery Center, Methodist Main Operating Room, Methodist Cath-lab, and Methodist Labor & Delivery, we now produce one bale about every 12 days and fill 4-5 plastic bins per week. In 2011 we turned over 9 tons, or 18,000 pounds, of blue-wrap into bales for recycling.
Through our meetings and processes, we had decided early-on that it would be best to use the 8-operating room Senate Street Surgery Center (which is attached to the main hospital) as a test-site for our green initiatives before involving the 36-operating room main hospital. This has worked very well for us, allowing many of the kinks to be worked out on a small platform prior to engaging the large platform with its own kinks to be worked out.
Unbeknownst to us, IU Health took an independent step in the right direction with a corporate decision to promote going green. This included cleaning up preference cards, eliminating unused products sitting on shelves in sterile supply, and continuing to support our perioperative push to go green. We are a very large hospital with many departments and are blessed by having “champions” in various areas; the cath-lab, labor and delivery, main operating rooms, and the surgery center all have different go-green champions. These staff members direct, educate and involve the employees in each area to fit the individual culture and individualized obstacles that each area has.
Some of our obstacles have included education, getting the word out about recycling, and establishing a written procedure. Our biggest challenge has been to branch out amongst the other IU health facilities with eager team members who want to participate. These other facilities, which include the other two major down-town hospitals, have some of the same concerns and obstacles that we had initially. A big plus is the muscle of upper management, so we are hopeful that we will be able to engage these other two downtown hospitals in the near future.
Some other facilities have had success. One of our sister surgery centers (Beltway Surgery Center and Spring Mill) has developed an active Go-Green Committee, and another is actively working on it. Our system-wide IU Health Perioperative Go-Green Committee meets monthly to monitor progress, solicit new ideas on ways to improve processes, and share our successes. We have also been active in supply reprocessing, medical supply recovery-for mission trips, proper use of sharps bins (for sharp items-not trash) and proper separation of hazardous trash verses regular trash. Each activity saves us money and reduces our carbon footprint.
Eddy Wenzel, RN, CST, CNOR
Clinical Educator and Neurosurgery Coordinator
Senate Street Surgery Center
 Farmer, A. and Merbler, K. Cost Accounting in the Operating Room. TriNetHealthcare Consultants Inc. Accessed on April 15, 2010 at: http://www.trinethealth.com/Articles/Cost%20Accounting%20in%20the%20Operating%20Room.pdf
 Perioperative Services. Picis Website. Accessed on February 20, 2011. Available at: http://www.picis.com/solutions/perioperative-services.aspx
Anne Arundel Medical Center (AAMC) is committed to identifying best practices in the surgical services that can reduce costs while also reducing energy, waste and occupational exposure to hazardous chemicals.
- 90 percent energy conservation
- further reduction of mercury in the facility
- improved lighting levels due to less shadows during operations
- increased comfort due to the removal of heat from surgical lights
- reduced air conditioning requirement, for a huge cost savings
- A $81,373 in operating room devices savings, (March 2011 – August 2011)
- Increased purchasing of FDA-approved third-party verified reprocessed medical devices
- 20,825 pounds of CO2 emissions prevented
- 35,098 pounds of plastic kept out of the landfills
- 2,711 pounds of cardboard kept out of landfills
- End of January, AAMC will replace the single-use, industrial mop heads currently used in the operating rooms with micro fiber mops.
- In March, AAMC will convert the disposable pillows currently used in the pre-op and recovery areas to reusable pillows.
- AAMC will developing a mission statement for the workgroup and invite surgeon champions and environmental services to join the workgroup
The Spectrum Health Surgical Services Green team is off to a great start in 2012. Currently we are brain storming ideas for our “Greening the OR” video to submit to Practice Greenhealth. In February, we will begin trialing light handle covers made from pre-consumer recycled plastic and evaluate reusable surgical textiles.
In 2011, incredible strides were made with our single use device reprocessing program, which has become a key component of the organizations financial gap closure initiative. Our single stream recycling program experienced significant growth as we continually evaluated and added additional recycle components including blue wrap, Styrofoam and maintenance IV Bags. We also continued reducing blue wrap by adding more rigid containers and reviewed all custom kits to remove excess waste. Our Green Team was involved in educating OR staff on the harmful effects of Styrofoam through educational displays and organizing events such as, “Bring in Your Own Mug Contest” to encourage less Styrofoam usage. The contest had seven categories including oldest mug, most creative mug and the mug with the funniest saying. Staff engagement was outstanding and we had an OR group make their own mugs from clay, then fire and glaze them for contest entry. The OR staff voted and the winners received a $10 gift card for the Spectrum Health Coffee Cart.
Our team is looking forward to planning an exciting earth day celebration, as last year’s was a big success complete with plenty of “dirt cake” for staff enjoyment. The green team’s morale is high as we reflect on 2011’s success and future endeavors. The impact we’ve had within our department, the health care system and community is being recognized and put into practice by staff at home.