The surgical services department is one of the largest generators of waste in a hospital. And as the number of cases pile up at ambulatory surgical centers, so does the waste. Even a minor case like an abscess drainage can leave the trash cans overflowing with non-contaminated waste. Here are 11 waste minimization and energy conservation initiatives your colleagues have embraced that can have a considerable impact on your bottom line and soften the environmental footprint your facility leaves on your community.

1 Start by Recycling Blue Wrap
A good way to kickstart your recycling program is to designate a recycling bin in each OR for the blue wrap from procedure packs and trays. This is an easy first step because the wrap is removed when the room is being set up, before the patient and physician arrive and things get busy. Once staff gets accustomed to recycling the wrap, add another bin for mixed items — clean paper and clean plastic. Make sure that the recycling bins are well marked and a different color from regular waste bins. In areas where a lot of contaminated waste is generated, recycling bins should have a lid in order to discourage nurses from throwing random contaminants in them. The lids may discourage recycling when first introduced, but as buy-in increases, so too will recycling. Eventually, recycling will be part of everyday business in your ORs. It is in ours. Each day our 21 operating rooms recycle about 300 pounds of uncontaminated paper and plastic.

Juliana E. Hansen, MD, FACS
Chief, Division of Plastic and Reconstructive Surgery
Associate Professor, Oregon Health and Science University
Portland, Ore.
[email protected]

2 Reduce Paper Consumption
We probably won't save many trees, but our efforts to reduce our paper consumption are simple and satisfying. If paper from the copying machine is printed on a single side but has no patient data on it, we flip it over and use it again. We rip memos and such that don't contain patient information into quarters for use as scrap paper. Whenever possible, instead of displaying or sending paper notices, we send e-mail messages.

Jeanne Goodrich, RN
Ambulatory Care Unit
Mid Coast Hospital
Brunswick, Maine
[email protected]

3 Let Patients Take Their Pillows Home
Our hospital uses disposable pillows. In an outpatient surgery department, this can quickly fill a trash can with pillows that have been used for a very short period of time. Our department now places the disposable pillows in patients' belongings bags at the time of discharge. Most patients love the souvenir pillow and it cuts down on our waste.

Jack Draper, RN, CNOR, RNFA
Manager, Perioperative Services
Bear Valley Community Hospital
Big Bear Lake, Calif.
[email protected]

4 Follow the 3 R's: Reduce, Reuse and Recycle
We shut down our incinerator, use micro-fiber mops, have water-reducing sinks and seek environmentally-friendly building materials. Here are a few of our other simple tips for going green:

• Work with vendors to trim your procedure packs. If 75 percent of your surgeons don't use an item 75 percent of the time, alter your packs. The less you have to throw away, the better off you are.
• Make recycling easy. Put collection bins in convenient spots and be sure you have plenty of them. Don't expect a nurse to walk 100 feet to recycle. In addition to plastic, glass and paper, we recycle batteries, fluorescent lights and printer cartridges.
• You know all the Styrofoam peanuts, bubble-wrap and other packing materials your supplies come in? Some of our vendors pay for us to return those to them.
• Conserve electricity. Make sure you turn off lights, blanket warmers and computers when they're not in use.
• Don't put things that can be recycled into red bag waste, which is very expensive to haul away from your facility.

Connie Archer Sargent, RN, BC, BS, CNOR
Bronson Methodist Hospital
Kalamazoo, Mich.
[email protected]

5 Don't Forget the Break Room
There's much you can recycle in your break room: paper, plastic, glass. That's where we placed a 50-gallon container for recycling products.

Marcus Wilson
Surgical Technician
San Joaquin General Hospital
French Camp, Calif.
[email protected]

6 No Paper in the Staff Lounge's Cupboard
I have a staff of about 35 employees. Since we have a dishwasher in the staff lounge, I went to WalMart and Sam's Club to purchase plates, bowls, coffee cups, plastic drink glasses and silverware to eliminate purchasing paper products. This saved the facility money and has cut down on the amount of daily trash we produce. The staff loves that we're helping the environment and our bottom line.

Deborah Roe, RN
Clinical Manager
OrthoArkansas Surgery Center
Little Rock, Ark.
[email protected]

7 Curbside Pickup
We recycle all the plastic bottles from irrigation fluids by bagging them and taking them home to put out for pick up at the curb. We also collect all the soda cans by having staff place them in specially marked cans throughout the surgery center.

Susan Weaks, RN, CNOR
Nurse Manager
Hyatt Surgery Center
Tipp City, Ohio
[email protected]

8 Recycle Recycled Products
Use recycled paper towels, toilet paper and cups, and then recycle them.

George Ferraioli
Director of Purchasing
Lakeland Surgical and Diagnostic Center
Lakeland, Fla.
[email protected]

9 Beware of Recycling Landmines
Our OR recycling program was going along just great — until we got the $600 bill from the company that empties our hospital's only outdoor recycling receptacle. Before our 40-bed hospital started recycling OR waste, our receptacle collected mostly tin cans and plastic bottles from the kitchen. It cost the hospital $100 a month to have the receptacle on site and another $600 to empty it every 6 months. Once we started recycling waste from cases that our orthopedic specialty generates, we were filling the receptacle every 6 weeks. We were so efficient that the program became economically unviable. So before we can resume recycling our clean OR waste, we need to negotiate with our county's waste facility to add a dedicated bin for our OR waste. The upshot: Consider the cost of handling recyclables when you plan your program.

At the same time, I discovered that our hospital was paying $2.50 a pound to dispose of red sharps containers. Trouble was, our staff was throwing glass vials into the sharps containers. Our solution was to buy separate bins for glass vials and educate our staff. We're now recycling 45 pounds of glass each month, a direct savings of $1,350 per year.

Tyler Bemont, RN
Operating Room Nurse
Community Memorial Hospital
Hamilton, N.Y.
[email protected]

10 Donate Unused Items to Schools
We donate all clean plastic items, giant plastic bags, unused towels and drapes and items from our procedure packs to schools (those blue bowls and plastic measuring cups that come out of our cataract packs are great for art classes) and to the local kids resource center, which makes crafts with the items and then sells them to raise money for charitable organizations. It's a winning formula: less plastic in the trash or recycling bin; more items for our schools to use at no cost.

Carrie L. Frederick, MD
Anesthesiologist
Portland, Maine
[email protected]

11 Turn Off the Lights in Unexpected Places
We performed an energy audit and learned that the dozens of soft drink vending machines around the hospital — essentially big refrigerators — were consuming large amounts of electricity. We removed several and turned off the lights in the remaining machines. This will save us more than $10,000 a year.

Office computers sap a lot of energy. We encourage everyone to turn off their computer and any peripherals — printers or scanners — when they leave at day's end. Use Smart Strips power strips ($40 each) that automatically turn off peripherals and monitors once they sense a computer is off. The return on investment will take just a few months.

Ravindra Gupta, MD
Hospitalist and Co-Chair of Inova Health System's Sustainability Committee
Inova Health System
Falls Church, Va.
[email protected]