Look around your ORs at all the equipment and supplies you use each day. Every item, from the lights and monitors to the gowns and IV bags, has its own environmental footprint, from design and manufacture to use and disposal. Sometimes it's easy to spot a "green" product by such telltale signs as the recycling symbol or Energy Star rating. But what you may not realize is that many surgical vendors are taking steps to reduce the environmental impact of their products and services in ways you, their customers, can't see. They're doing so by adopting more sustainable design, manufacturing, distribution and waste management practices.

Greener products
One of the most obvious and visible efforts surgical supply companies are making to go green is introducing more earth-friendly products for the OR and beyond. Medical device manufacturers are largely constrained by FDA regulations and other guidelines for patient safety and infection control, but internal and external pressures on the industry are prompting them to come up with ways to make their products more sustainable. Some recent trends include:

• A move from single-use to reusable supplies. Due to infection control concerns, disposable supplies are often preferable in surgery. And since reprocessing can be expensive and environmentally problematic, it's not always correct to view reusable products as more sustainable than disposables, says Chris Kadamus, principal engineer at Massachusetts-based Cambridge Consultants. However, he notes that manufacturers can help reduce the environmental impact of surgical supplies while also creating more robust and complex devices by designing durable/disposable, hybrid devices. For example, instead of having an entirely disposable surgical stapler, which would yield a large amount of hazardous waste each time you open a new device, manufacturers can make staplers that feature reusable handpieces and disposable tips, says Mr. Kadamus.
• Reductions in package waste. Ensuring sterile supplies means a lot of individual packaging on everything from surgical instruments to gowns and gloves. Many companies are looking at ways to reduce packaging waste by single-wrapping rather than double-wrapping (where possible and appropriate), eliminating heavy plastic items such as trays used in procedure packs and using recycled and more eco-friendly materials in packaging. For example, Kimberly-Clark developed a new packaging system for gloves that lets the company fit more gloves in a single box, thereby saving both storage space and packaging waste.
• Elimination of hazardous chemicals and toxins. Companies are making more medical devices and supplies that are free of lead and mercury (blood pressure cuffs, cleaners), PVC and DEHP (IV systems and tubing), latex (gloves) and other materials that may be harmful to patients, staff or the environment upon disposal.
• Energy-efficient equipment. As energy costs continue to climb, Mr. Kadamus says he expects this to become a higher priority in medical device design. For now, LED lights and cleaning and sterilizing machines that use less water per cycle are examples of energy-saving innovations.

Greener processes
Sustainability means looking beyond the finished product and focusing on the entire life cycle of a device or supply. In this respect, products that don't seem environmentally friendly on the surface may be considered "green" if you look at how they are manufactured. "A lot of companies have green, sustainable products that they sell, but they also walk the walk," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. "When we do an RFI, we ask suppliers to let us know what kinds of corporate programs they have." Manufacturers with corporate sustainability programs typically set tangible goals, such as reducing carbon emissions from their factories and earning LEED certification for their buildings, and publish reports of their progress toward fulfilling those goals. Common sustainability targets on the manufacturing end include:

• Waste reduction. Companies are coming up with innovative ways to reprocess and reuse excess materials and manufacturing waste rather than sending them straight to the landfill.
• Water usage. Reducing the amount of water used in manufacturing processes, reclaiming and reusing water where possible and properly processing wastewater before it's discarded.
• Energy efficiency and emissions reduction. Using solar panels, reprocessed waste and outdoor temperatures to generate power and to heat and cool the water used in manufacturing.
• Raw materials. Choosing materials that have less harmful environmental impacts and buying them in bulk to reduce packaging and distribution waste.
• Transportation efficiency. Making smarter decisions about where to place distribution centers and how to map shipment routes to reduce unnecessary mileage and fuel consumption. Some companies, such as Johnson & Johnson, are adding hybrid vehicles to their distribution fleets.

Cooperation with customers
In addition to cleaning up their own houses, many surgical vendors are reaching out to their customers and offering assistance with their efforts to go green by setting up informational Web sites about eco-friendly products and practices, working with GPOs that have environmentally preferable purchasing (EPP) programs and teaming up with organizations like Practice Greenhealth (www.practicegreenhealth.org) and Medshare International (www.medshare.org), which helps healthcare facilities donate their unused items to developing countries. It's all about raising awareness, says David Lauer, environmental, health and safety manager for B. Braun. His Green Team initiative seeks to involve all the company's employees in the effort to reduce waste. "As we start to mature with our green initiative, we're raising our awareness level and passing that off to the customer as well," says Mr. Lauer. B. Braun offers customers an online "Waste Calculator" to show them how they can reduce their landfill waste by using the company's PVC- and DEHP-free infusion therapy products.

Surgical suppliers may be taking initiatives, but if you identify an opportunity for waste reduction or more sustainable materials management, you don't have to wait for your vendors to catch up. Mr. Kadamus encourages surgical decision-makers to keep driving the green movement: "If they ask for more sustainable products, the medical device companies will develop more sustainable products."