Source reduction vs. recycling
Source reduction is the elimination of waste at the source. A simple example would be using a washable porcelain cup instead of a disposable paper one for drinking water. Recycling, while a good strategy when waste is inevitable, is not source reduction — it's a method of waste management.

To illustrate the difference between source reduction and recycling in the OR, consider a common source of surgical waste: blue wrap. Recycling blue wrap is good because, rather than sending it to a landfill or incinerator, you're letting it be made into something else, such as laundry detergent bottles. But in this system, the loop is not "closed." Additional resources, such as water and energy, are used to make more blue wrap and detergent bottles from the blue wrap waste. Reducing or eliminating your use of blue wrap in the first place by purchasing reusable sterilization containers is an even better solution for the environment because you're reducing the resources, such as petroleum-based plastics, water and energy, needed to manufacture and recycle the material.

Just as it makes more sense from an environmental standpoint, source reduction is also even better for your bottom line than recycling because it saves money on the purchase and storage of supplies as well as waste management costs. To go back to the blue wrap example, by recycling blue wrap instead of trashing it, your facility may save a penny per pound on disposal costs. But if you reduce or eliminate the need for blue wrap altogether, you can save as much as $10 per pound.

Keeping tabs on waste
Identify the waste that you generate and set up a mechanism to track that waste so you can identify and target the largest quantity areas for reduction. Assemble a green team composed of staff from various areas of your facility — nursing, anesthesia, environmental services, physicians — to gather suggestions and ideas for how best to tackle the problem. For example, your business staff can provide purchase and cost data, such as the amount and cost of blue wrap purchased in the last year, to help you identify the greatest opportunities for cost savings.

Ask the companies that haul your hazardous, infectious and solid waste and recycling to provide you with spreadsheets and invoices detailing your waste levels from the previous months. You'll need to know the baseline weight of your waste so you'll know how much you're able to reduce once your green program is up and running. Without this concrete data to work with, getting support for sustainable purchasing will be more difficult and tracking the success of the program will be impossible.

When you begin to critically examine your supplies and look for areas of unnecessary waste, you'll see that some source reduction is easy to do and fairly obvious. Some common opportunities for source reduction include:

• Medication vials. A number of pharmaceuticals come in 50cc vials, but only 10cc is typically used. Substituting a smaller-sized vial will reduce 40cc of waste and, of course, save you money.
• Skin preps. Are half-full bottles of surgical prep being discarded after a case because you only needed half the solution? Because surgical preps are often alcohol-based, the waste is considered hazardous and is expensive to discard. Using preps that come in smaller containers or dispensers can reduce hazardous waste and costs. For example, a surgery center in Minnesota switched from a 26ml surgical prep product to a 10ml product while still providing adequate asepsis. The move has saved the facility almost $60,000 annually.
• Procedure packs. Surgical packs often contain items that are not needed or used, such as light handles, emesis basins or suture. Consult with your OR nurses — they're most familiar with usage patterns and can easily identify wasted items that should be removed from the packs.
• Packaging. With respect to supplies, the largest waste stream is often packaging. Let vendors know your facility is working on environmental improvements and prefers products with less packaging and waste. Even better: Ask for reusable shipping containers and boxes.

Environmentally preferable purchasing
After you've eliminated the low-hanging fruit like excess packaging and unused supplies, take a closer look at the remaining products you're using to see if there are environmentally preferable alternatives. You'll want to consider how the products are made, what they're made of and what can be done with them after they're used. Again, keep in mind that sustainability goes beyond recycling; just because an item is identified as "recyclable" doesn't necessarily mean it's better for the environment. Better selection criteria include items that reduce, are reused, can be repaired and then are recycled.

Take surgical gowns, for example. Gowns that can be washed and reused, usually about 50 times before they need to be discarded, are environmentally preferable to disposable gowns that are used only once. Although the washable gowns use water, detergent and energy for cleaning, this resource consumption is less than that required to manufacture and transport 50 new disposable gowns.

It's not always easy to tell an environmentally preferable product from a less eco-friendly one. If you purchase your supplies through a group purchasing organization, ask if they have an environmentally preferred purchasing (EPP) program and how you can get enrolled. Several of the major GPOs offer EPP to help take the guesswork out of purchasing sustainable supplies. If your GPO doesn't have an EPP program, or if you purchase supplies outside of a GPO, you should:

• Avoid products that contain hazardous materials such as mercury, heavy metals, or the perfluorinated compounds often found in foaming hand rubs and plastics made of polyvinyl chloride (PVC).
• Look for items that have reliable certification such as Green Seal (www.greenseal.org), Energy Star (www.energystar.gov) or Blue Angel (www.blauer-engel.de/en).
• Consider washable, reusable products for your emesis and wash basins, drapes and gowns, over disposable options.
• If an item is not reusable, ask your vendor to assist you with reprocessing or recycling it.

Why sustainability makes sense
Reducing pollution and preserving natural resources are worthy goals from an environmental standpoint, but also from a healthcare perspective. By considering the environmental impact of the supplies and equipment used in your surgical facility, you'll be improving the health of the community you serve and the health of your business.