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Frequently Asked Questions

Getting Started | Waste | PurchasingEnergy Efficiency & Built Environment

Getting started

What is Greening the OR?

Greening the OR® (GOR) is a free Initiative of Practice Greenhealth aimed to identify best practices and substantiating data around products and practices that reduce waste, increase efficiency, increase worker and patient safety and reduce environmental impact. Begun in April 2010, the GOR Initiative has over 400 endorsing facilities and 11 sponsoring companies, and has reviewed eight strategies that significantly reduce cost and waste for facilities.

How do I become involved?

If you’re a healthcare facility and know you want to target cost or waste savings in the OR, then sign the commitment form. This is a free commitment, and enrolls you in the Greening the OR® community, giving you access to the Greening the OR Newsletter, guidance documents, Virtual Green OR, regular updates and assistance specific to the OR. You can also note if you’d be willing to participate in pilot projects with companies, participate in case studies, and gives you the opportunity to share your stories and successes, and strategize with others.

There are also a number of opportunities to participate if you’re a business. Sponsorships of the Initiative entitle you to close interaction and recognition for your commitment to this body of work, as well as opportunities to collaborate with facilities on pilots, case studies, webinars, and other valuable resources driving sustainability in the healthcare sector. Please contact Lara Sutherland if interested.

How do we get started Greening the OR® at our facility?

One of the goals set by GOR is to identify “low hanging fruit” for facilities to make sustainability easy and effective. Getting started at your facility depends on what you’re already doing, the culture and attitude towards sustainability, and the driving factors (reducing cost, improving community health, etc.). To get an idea of some opportunities within your OR, try using the Greening the OR® Checklist tool – this might give you a better idea of where opportunities lie at your facility, or show you that you’re already well on your way to being green!

Many facilities have found that the ‘simpler’ strategies – those that don’t require capital investment or much behavior change – are the best to get started with.  Once those have been tackled, making the business case for capital investment may be easier with the data highlighting cost savings and success in hand.

Another important factor is to make sure you have a diverse Green Team in place – with representatives from all of the many voices in the surgical department – nurses, surgeons, surg techs, anesthesiologists, anesth techs, physicians, environmental services, waste management, central sterile, purchasing, etc.  Having a well-rounded group makes it easier to vet new strategies, addressing each unique perspective and making sure it’s a strategy that works for everyone.

Once a strategy has been decided on, education is the next critical piece. There are sample educational materials throughout Practice Geenhealth. Hold in-services or grand rounds, have workshops, hang up posters – make sure that whatever you’re doing is clear, purposeful, and has been thoroughly explained. Provide a comment box for feedback.  Make sure education is ongoing and fun!

What do we do to green the OR?

There are a number of opportunities to make a dent in the environmental footprint of the operating room including: reducing and properly segregating waste, increasing recycling of medical plastics, utilizing reprocessed and reusable devices and textiles, installing occupancy sensors and LED lights to reduce energy consumption in the OR, utilizing a fluid management system and rigid sterilization containers to reduce waste, and more. For more information, visit www.greeningtheor.org and complete the Greening the OR Checklist!

I’m a blank, (nurse, administrator, sustainability coordinator, physician, anesthesiologist, surgeon, other) trying to get more buy-in from blank – how do I go about doing that?

While different audiences respond to different messages, it’s important to be able to back up any claim you’re making. If you’re speaking with an administrator trying to rationalize the need to spend money on a new product – have the data in hand to show what the ROI will look like, what the benefits will be. If it’s a physician or surgeon, make sure to have research ready to back up any claim.

Similarly, sometimes a way to really drive a point is to have that conversation come from a peer.  Find a surgeon champion to talk to the other surgeons. Have a nurse champion lead the training of other nurses on the new procedure or process. Ask your OR manager to find an administrative ally to speak with the folks in purchasing or other contract positions

Senior leadership is not fully on board, especially with strategies requiring capital expense; what do I do?

Gaining support for something seen as an intangible or not a high-priority initiative can be difficult, especially when it requires up-front capital expenses. That’s why knowing what speaks to senior leadership is an important first step to making your case. Highlighting the tangible benefits by working out the estimated cost savings, ROI, reduced likelihood for staff exposure to pathogens or chemicals, etc and having both data and research on hand to support this argument is important.

Finding the ‘low hanging fruit’ for your facility, something done easily without too much struggle, and demonstrating how successful that example is, suggesting those cost savings be allocated back to continue purchasing more sustainable items, etc. could be another way to gain senior leadership buy-in.

Lastly, make sure to celebrate your success, even for the small wins, and communicate it widely.  Sample press releases, newsletters, and banners are located back in the Greening the OR Toolkit


Waste

Right now, almost everything goes in as red bag waste – what is the argument against that process and how do I remedy it?

While this process may seem easier, and makes some people feel more comfortable about eliminating any possibility of contaminated material entering regular waste streams, it quickly adds in waste disposal costs, and increases the environmental footprint of the facility through the more intense treatment process necessary.

Regulated Medical Waste Minimization and Segregation Case Study and Implementation Module

More information on Regulated Medical Waste

What really needs to go in RMW, and what can be segregated out into other waste streams?

A helpful hint is the “squish and drip test" – if it’s squishing and dripping it goes in red bag. Otherwise it can go in regular waste streams.” Different requirements per state can be found at: www.hercenter.org/rmw/rmwlocator.cfm, and some helpful educational posters are available here.

What medical plastics can be recycled? How do I set up a program like this?

This can depend on your vendor and local market for these recycled plastics, but some regions have found they can recycle all of the medical plastics coming out of the OR. Others are restricted to X. Have a conversation with your vendor and waste service to determine if you can expand your recycling program at your facility.

For more information on setting up a successful recycling program,  
Greening the OR Medical Plastics Recycling Case Study  and  Implementation Module

I notice a lot of items from our surgical kits are often ending up in the trash – how can we fix this?

This problem is two-fold, beginning on the supply/purchasing side. Reviewing kits to determine which items are actually used a majority of the time, and which items are unnecessary or not often used will help reduce the amount of unused medical items ending up in the trash. This conversation will need to involve the entire surgical team, the purchasing team, and the vendor. Ask the vendor to remove the unnecessary items from the surgical kits. This will have an effect on waste disposal and supply costs, saving your facility quite of lot of money.

Read more on surgical kit review in the OR Kit Review and Reformulation Implementation Module and Case Study.

What is the cost differential by waste stream?

Disposal costs differ by region and vendor, but averages look something like:

  • $0.28/pound for RMW
  • $0.01 / pound for Recycling
  • $0.05 / pound for Solid Waste.

More information on waste categories can be found here .

What opportunities are out there to reduce the amount of waste coming out of the OR?

Reducing waste in the OR encompasses a broad array of areas – purchasing, behavior, waste segregation, and more.  These opportunities can include:

  • Utilizing reusable textiles, devices and apparati whenever possible
  • Using reprocessed single-use medical devices
  • Employing a reusable-canister fluid management system
  • Reviewing OR kits to reduce unnecessary surgical instrumentation
  • Developing waste segregation and recycling programs
  • Using rigid sterilization containers for surgical instruments in place of disposable sterilization wrap

More ideas can be found by reviewing the Greening the OR® Checklist

What are effective methods for making waste segregation easiest on staff & other educational tools?

Asking staff to participate in program planning – identifying the most convenient locations for container placement, the simplest strategies for segregation, and clear descriptions of what can go in each receptacle will help a waste segregation program become successful. Using regular educational opportunities such as in-services or monthly meetings, webinars, posters, and other resources can serve as useful explanations and reminders of what it is they are supposed to do and why.

Items that have been opened & unused, or their shelf-life has expired because of our large inventory – what can we do to reduce this problem or not see these items in the trash?

Some facilities donate these medical supplies to healthcare providers in third world countries, which is incredibly valuable. However, truly targeting this issue would be source reduction; reducing the number of these items purchased in the first place to reduce the amount ending up in the trash or donation bin later. This conversation needs to include purchasing and materials management, as well as clinical staff to identify items and strategies.

Fluid management in our OR yields a lot of RMW – what options do we have?

A reusable canister fluid management system requires up-front capital expenditure, but the typical payback period is 2-4 years, and there are many intangible benefits that accompany it. Utilizing one of these systems reduces the need to purchase solidifier and the canisters themselves, reduces OR turnover time, reduces worker spash risk, reduces the weight of RMW waste stream, and so on.

More information on fluid management as a sustainability strategy can be found in the Fluid Management Implementation Module and Case Study.


Purchasing

What opportunities can we take on the front-end of the process to reduce costs and waste?

Overage in supplies purchased and included in OR kits plays a significant role in the amount of clean or unused devices ending up in the trash. Clearly, this also has a significant impact on the hospital’s bottom line. Working with clinical staff to systematically review OR kits and remove items that are rarely ever used can save hospitals considerable financial resources. Reviewing OR kits with clinical staff is also an opportunity to take into account staff preferences and increase collaboration.

Try the Case Study and Implementation Module on OR Kit Reformulation.

Click here for more Environmentally Preferable Purchasing ideas.

Are “green” alternatives more expensive?

While it may have been factually correct at one time, this statement is no longer accurate. The healthcare industry and its suppliers has made significant strides to deliver environmentally preferable products at cost-competitive prices. Often, by making the switch to more environmentally sustainable products or strategies, facilities realize significant financial savings. Sometimes, items or strategies do require an upfront investment or might still be more expensive; however other aspects such as worker and patient safety, waste generation, energy consumption, chemical and hazardous by-products, and others need to be factored into the equation.

Find more information on getting started with EPP here.

Are disposable items less expensive than reusable items?

One answer does not hold true for all cases. However, it’s important to look beyond the list price of the product, and take into consideration the possibility for reuse and purchase at a lowered cost, waste generation and disposal costs, chemical or hazardous by-products, and the product’s entire life-cycle.

We’re thinking about reusable linens, but is the barrier protection sufficient?

Today, linens used in the operating room are held to very high standards. Reusable and disposable linens must meet specific barrier protection requirements for each type of procedure performed. Recent studies have found that reusable linens meet or exceed these criteria, with clinical staff reporting these linens to be more comfortable and cool during long procedures. 

Visit the Reusable Textiles in the OR Case Study  and  Implementation Module.

We are looking at starting a reprocessing program, any suggestions on how to get started?

Education, teamwork and communication are vital. Identifying a team, including a physician and nurse champion, so that staff can see their peers in support of the program will be helpful. Having educational materials – both peer reviewed and industry articles, trends, webinars and other tools – on hand to support the safety, efficacy, and financial benefits of the program and address any questions that arise is also essential.

An implementation module offering step by step guidance on initiating a reprocessing program at your facility is available here.

Click here for the Case Study on Medical Device Reprocessing.

We’re seeing a lot of physician push-back on reprocessing, how do we go about addressing these issues?

Patient care and safety should be the utmost concern, so some healthy skepticism is a good thing. However, third party reprocessors are held to incredibly stringent standards in terms of the quality and efficacy of the devices they sell back to hospitals. Physicians tend to listen to their peers and scientific research. Finding a physician to support and champion this initiative will be encouraging to other clinical staff. Additionally, there are numerous reports and peer-reviewed studies to support this practice, some available here.

What research is out there supporting reprocessing of single-use medical devices by third party reprocessors as an effective strategy?

There’s a plethora of peer-reviewed literature on reprocessing. To start, some key pieces include:

1. Government Accountability Office (GAO) Reports on SUD Reprocessing:

2. FDA Info:

3. A Sample of Peer-Reviewed Literature Supporting SUD Reprocessing

4. PGH Educational Resources on SUD Reprocessing


Energy Efficiency & Built Environment

What can we do to reduce the energy consumption in the OR?

The operating room is an extremely energy intensive department within the hospital – monitoring equipment and other medical apparatus, lighting, air exchanges and temperature are just a few of the biggest culprits. Some facilities have found occupancy sensors and setback programs for lighting, temperature and the HVAC systems significantly reduce energy consumption. Similarly, utilizing more efficient equipment such as LED lighting decreases energy consumption in several ways: LED lights require less energy; have longer life spans; and generate considerably less heat. This in turn reduces the energy require to cool the room for clinician comfort as well as reduces the need for patient warming devices.

Review the HVAC Setback Program and Lighting Setback Case Study.

Is an HVAC setback program safe? How does it work? What if an emergency arises and we need to use the room?

HVAC setback programs are devised of multiple occupancy sensors to provide a “fail safe” – if one sensor does not register a human occupant entering the room, the other sensor will. Detection of human presence for a set amount of time (if someone remains in the room or continues to enter and exit the room for longer than 3 minutes, for example), this will turn the HVAC system back to run at full-capacity. 

Is there any opportunity for green cleaning in the OR?

One method for ‘greener’ cleaning in the OR is to utilize reusable microfiber mop heads. This generates considerably less RMW, while also reduces the cross-contamination factor between rooms and is less work intensive for staff.

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