TM
Greening the Operating Room
Janet Brown for Kaeleigh Sheehan
Project Manager
Practice Greenhealth
Is this sustainable?
Why is the OR Important?
• “Generates ~40% of patientrelated revenue…high dollar,
high impact cost centers”
• Healthcare organization’s
reputation often tied to surgical
outcomes.
Is this Sustainable?
• OR represents 1/3 or more of total hospital
supply expense
• Materials In  Waste Out
• Within the OR, supplies are 47% - 56% of OR budget.
• OR typically largest generator of waste (20-33% facility total)
and largest generator of regulated medical waste (RMW)
• One of most energy-intensive departments within hospital
• Energy, waste and waste anesthetics = large carbon footprint
Operating Room Fast Facts
• Stressful, high-paced environment
• Multiple surgical services and critical stakeholders – from worldclass surgeons, anesthesiologists, nurses, techs to environmental
services staff.
• 54,000 ORs in North America
• Studies show that over 50% of budget can be supply costs
• Department often not integrated with rest of hospital—closed
system
OR Environmental Footprint
©Brandon Medical, 2011.
© Woods, 2010.
© Seabrook, 2010.
© Nussbaum, 2010.
A Few Waste Stats
 Almost 80% of packaging waste from procedure
generated before the patient enters the OR
 Approximately 20% of surgical waste is blue
wrap
 Approximately 40% of waste is fluid canisters
Environmental Responsibility
What are the Opportunities?
• Increase efficiency.
• Protect or IMPROVE worker & patient
safety.
• Reduce environmental impact.
• Improve staff satisfaction.
• Reduce cost!
• Support healthcare’s goal to reduce
environmental footprint.
Biggest Perceived Challenges to
Implementing Green Practices in the OR
Inadequate/inferior technology
11.8%
Lack of information or data
12.9%
Patient safety concerns
18.2%
Culture
20.0%
36.4%
Cost
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Practice Greenhealth’s Greening the OR Survey, 2011.
35.0%
40.0%
The Greening the OR Initiative is
designed to coalesce and build the
body of knowledge around
environmental best practices in the
OR that can also improve patient
safety, worker health and the bottom
line.
TM
Waste
• Reduce RMW through effective segregation
• Recycle medical plastics and other recyclables
• Reduce suction canister waste (RMW) through fluid
management system
• Send appropriate devices for third party reprocessing
• Philanthropic donations of clean, unused medical supplies
Regulated Medical Waste Reduction
•
Up to 60% of RMW comes from
ORs
•
Segregate non-infectious waste
•
Virtually all pre-op waste in NOT
RMW
Case Study: Regulated Medical Waste
Reduction and Minimization
• INOVA Fairfax Hospital
 900 bed Trauma 1 hospital
 29 Operating Rooms
 19, 402 inpatient surgeries, 16,362 outpatient
surgeries in 2010
• Problem:
 Not recycling, no waste segregation,
non-infectious items ending up in RMW stream
• Strategy:
 Clinical leader, senior leadership, sustainability
consultant
 Single-stream recycling in OR’s
 Education on proper waste disposal and
segregation
 Waste audit – over 900 lbs of RMW from the OR
daily!
(15% RMW industry best practice)
• Results:
 Re-analyzed waste 6 months later
• 19% reduction
• Decreased over 1 million pounds of RMW from
2009-2010
• Cost savings of over $200,000
Medical Plastics Recycling
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Clean, recyclable plastics
Rigid trays/packaging
Overwraps
Blue sterile wrap
Saline pour bottles
More…
Fluid Management Systems
Case Study: Fluid Management in the
OR
• North Suburban Medical Center
 157-bed acute care hospital
 6 operating rooms + surgical services expansion
• Problem:
 The OR will perform fluid suction in 90% of
surgeries
 Wall suction canisters – canisters only
available in limited sizes
 Exposure risk to splashes and chemicals
 Poor suction strength
 Time consuming and add to RMW stream
• Strategy:
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Needed safer, more precise fluid management
Reduce RMW waste disposal
Decision making team
Key Criteria:
• Ease and versatility of use (mobile)
(empties and cleans in 3-5 minutes)
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Capacity and handling requirements
Evacuation and disinfection method
Likelihood of spills
Precise measurements
• Outcomes
 Purchased 3 new systems
 Zero staff exposure, slips from spills or
electrical hazards
 More volume capacity, precise measurements,
smoke evacuator and smoke detector,
self cleaning, reduces RMW related waste
 Quicker turnover time between surgeries
 4 year payback period
“Single Use Device” Reprocessing
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Arthroscopic shavers
Blood pressure cuffs
Soft tissue ablators
External fixation devices
Electrophysiology catheters
Scissors and staplers
Biopsy forceps
Laparoscopic scissors and forceps
Clamps and dissectors
Compression sleeves (DVT)
Phaco tips
Pneumatic tourniquet cuffs
Pulse oximeter sensors
Orthopedic drill bits and burrs
Tracers and Trocars
www.amdr.org
Case Study: Reprocessing of Single
Use Medical Devices
• Metro Health Hospital
 208 bed facility
 10 operating rooms
 12,740 surgeries in 2010
• Problem:
 Disposable medical products make up large portion of waste
 OR utilize expensive devices
• Estimates saying 50% OR budget on supplies
• Strategy:
 Key implementation leaders developed program
 Executive approval and Physician’s Chief of Staff signed
making mandatory
 Education, infection control procedures, quality assurance
process
 Identify collection container placement, pre-cleaning and
packaging
• Results:
 $235,803 from purchasing SUD’s (2008-2010)
 1.84 tons waste avoided in 2010
 Avoided $900 in RMW disposal
Medical Supply Donations
• Clean, unused or expired
medical supplies
• Donated through third party
non-profit
• Facilities in need in
developing countries
Supply Chain
• Move to reusable surgical gowns and linens
• Reformulate OR kits to reduce overage
• Purchase FDA-approved reprocessed medical devices
• Replace blue wrap with rigid sterilization containers
• Transition to reusable medical supplies such as
grounding pads, anesthesia circuits or patient
warming devices
Reusable Surgical Linens
• Increased comfort
• Comparable barrier protection
• Decreased waste
• Increased instrument recapture
with third party reprocessor
• Cost-savings
Case Study: Reusable Textiles in the
OR
• University of Maryland Medical Center
 757-bed facility
 31 operating rooms
 21,500 surgical procedures in 2010
• Situation:
 Using reusable gowns and basins for 15 years
 Performed waste audit
• 10 million pounds of waste annually
• $1.35 million on waste disposal
 Shift to disposables - gowns, basins, towels,
bluewrap, canisters get thrown away
• Strategy:
 Green team
 LCA of reusables vs. disposables
 Reviewed purchasing
• Reusable gowns, drapes, table covers, basins
• Avoided cost of waste disposal and savings from return of
discarded instruments – essentially same expense
 Reviewed staff preference, quality and safety
 Uses third party company
• provide reusable products, collects, sterilizes and
repackages custom made OR packs daily
• Outcomes:
 138,748 pounds of waste diverted in 2010
 1.5 million pounds diverted since 2000
 $38,000 savings in avoided waste disposal costs in
2010
 $722,250 in avoided waste disposal costs since 2000
 Average $39,000 in returned instruments yearly
 Staff satisfaction
Reformulate OR Kits/Procedure Packs
• Review packs
• Take out excess supplies
• Reduce supply cost
• Reduce waste volume and
cost
Case Study: OR Kit Reformulation
• University of Minnesota Medical Center,
Fairview
 2,000 – bed academic medical center
 21 operating rooms
 6,135 surgeries in 2010
• Problem:
 Huge volume of waste from the operating room,
much of it unnecessary - unused, disposable items
 Packaged surgical kits for various procedures
contain a number of supplies and equipment
• Physician preference
• Unnecessary for procedure
 Once opened, unused items no longer considered
sterile, thrown away
• Strategy:
 Surgeon leader
 Reviewed disposable items in OR kits
• Port placement procedure kit for chemotherapy
 44 items to 27
 1 pound of waste per case, $50
• Waste reduction strategies
 Smaller bottles for prep solution
 Smaller bottles for saline
 Another pound of waste per case
 Presented information to OR staff, developing hospital’s
Green Team
• Reviewed another 38 OR kits, identifying unnecessary items
 Gauze dressings, plastic basins, styrofoam trays, plastic cups,
syringes
 Collaborated with vendors to remove items
• Results:
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Reviewed 39 OR kits
Waste reduced by 10,553 pounds
$116,215 savings in supplies
More than $2,000 savings in avoided RMW
disposal costs
Reusable Sterilization Containers
• Decrease supply costs
• Decrease waste
• Reduce rewrapping and flash
sterilization
• Reduce ergonomic wrapping
injuries for SPD staff
• Short payback period
Chemicals
• Transition to PVC-free and DEHP-free medical
supplies
• Eliminate worker exposure and climate change
impacts from waste anesthetic gases
• Minimize worker and patient exposure to laser
generated air contaminants (LGACs)
• Green cleaning equipment
Energy
 Economizer Operation of Air Handling Units
 Utilize Low Energy Dehumidification Systems
 Timely Replacement of HEPA Filters (when required)
 HVAC Setback Programs for Unoccupied ORs
 Occupancy Sensors for Lighting
 Transition to LED Surgical Lighting
Case Study: Energy Efficiency in the
OR – HVAC Setback Program
• Providence St. Peter Hospital
 340-bed
 11 operating rooms
 8,300 surgeries in 2010
• Problem:
 OR is incredibly energy intensive
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Highest air change requirements (15) of any area in hospital
High level filters to reduce particulates
Electricity and natural gas costs through HVAC system
Equipment such as medical gas vacuum pumps, diagnostic and
monitoring equipment, and surgical lighting
 Most OR’s empty between late evening and early
morning, but same number of air changes still occurring
• Strategy:
 Review staff needs, comfort level, education
 Installed occupancy sensors tied to HVAC system
• No motion for 60 minutes, HVAC to unoccupied – 6
changes/hour
• Two ceiling mounted, infrared, independent sensors set
at high sensitivity
• 3 minute delay for start-up, red flashing light outside
indicating “Unoccupied Mode”
 Received grant funding for portion of project
• Results:
 60% setback in the two OR’s
 Reduce air by 60% when unoccupied 47% of the
time
 25,000 kWh energy savings
 2,460 therm energy savings
 $4,091 cost savings
 OR’s energy usage now 1% of total energy usage
Built Environment
• Utilize epoxy-free wall and surface coatings
• Purchase urea-formaldehyde-free casework and
cabinetry
• Transition to PVC-free and phthalate building finishes
and materials
• Rubber flooring reduces slips, staining and improves
ergonomics
Greening the OR can save $$$ annually
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$86,460 saved on fluid management
$400,000 on SUD reprocessing
$15,000 on RMW minimization
$6,000 on recycling in the OR
$16,186 on rigid sterilization containers
$116,000 through OR kit reformulation
*Savings incurred in individual hospitals over a
one year time-frame
Learning Community
• Sharing best practices
• Piloting new initiatives
• Research and data to support initiatives
• Ways to help hospitals make the business case
What We’re Learning
Communications lacking
among stakeholders .
Education and training
is a continuous process.
Need to figure out what
needs to be measured –
then baseline, collect
data and continuously
report.
Vendors can play a
significant role.
Overarching Themes
1. Understand the environmental impact of the OR.
2. Recognize best practices.
3. Engage stakeholders and facilitate collaboration.
4. Communicate successes and share data across the
sector as mechanism to build momentum for this
work.
Resources include:
• Greening the OR Webinar Series
TM
• Business Case for Greening the OR
TM
• Greening the OR Checklist Tool
TM
• Implementation Modules for Best
Practices
• Case Studies
• Council for Environmentally Responsible
Surgery
Virtual Tour of Green OR
How to Participate!
• Hospitals and ambulatory surgery centers can participate
by signing a Commitment Form
• Participation and resources are FREE*.
• Menu of options allows organizations to choose how they
will participate.
• 137 hospitals are participating as of October 2011.
Download Commitment Form at:
www.greeningtheor.org
Suppliers, service providers and other
business partners are key to the
conversation--this initiative is about
reaching across company lines and
innovating sustainable strategies to
address today’s OR challenges.
For more information on how businesses can participate, contact:
Bob Jarboe,
Executive Vice President of Business Development
Ph: 502-727-8658
Email: bjarboe@practicegreenhealth.org
Sponsoring Organizations
SAVE THE DATE
April 30–May 2, 2012 • Denver, Colorado
Colorado Convention Center & The Hyatt Regency Denver
The premiere national environmental conference for leaders in healthcare sustainability.
Questions?
Practice Greenhealth:
Kaeleigh Sheehan
Project Manager
888.450.7707 | ksheehan@practicegreenhealth.org