You, Too, Can Go Green

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Simple solutions lead to cost savings and sustainable care.


Approach greening your facility as a strong and steady tortoise would, rather than a hare sprinting out of the box. “Build a strong foundation,” says Kaeleigh Sheehan, a sustainability strategy manager at Practice Greenhealth, which offers resources to develop proactive frameworks for undertaking “Greening the OR” strategies. “Make sure staff is on board, and that you have a culture that’s fostering environmental stewardship as part of everyday work rather than trying to do it overnight, because those are often the programs that burn hot and bright, and then fizzle.” 

Susan R. Pepin, RN, BA, CNOR, service line supervisor at Regions Hospital in St. Paul, Minn., says it’s vital to get both your organization’s leadership and staff on board with greening goals. “You need to have all the players in place,” she says. “If you’re the only one doing it, you have no place to take it.”

Ms. Sheehan urges you not to view sustainability as an add-on, and to reflect on things you’re already doing that you might not have considered as green or sustainable. She lists a wide variety of entry points to move in a greener direction at your facility. One, some or all of these low-impact projects are great places to start and might lead to even more exciting opportunities.

HVAC and lighting setback. The goal is to consume energy resources only when needed. Outpatient facilities can take advantage of their off hours to generate huge cost and environmental savings. “They can set back air exchange rates and lighting into unoccupied mode, and make sure all of their devices and equipment are powered down at the end of each day,” says Ms. Sheehan. “That seems basic, but you’d be surprised by how many places leave them on and running. When your ORs are shut down for 12 hours a day, that’s an opportunity for substantial savings.”

Regions Hospital’s surgery center ensures energy savings are realized when the building is not in use. Ms. Pepin says staff there turns off lights and reduce air exchanges at the end of each day. At the health system’s inpatient hospital, ORs not in use automatically shut down when sensors detect no activity in the room, turning air exchanges to lower flows and all lights off.

MULTIFACTORIAL SAVINGS Practice Greenhealth lays out median cost savings per OR based on its annual Environmental Excellence Award application responses. “The savings highlighted are extremely conservative but a great way to highlight financial savings opportunities,” says Practice Greenhealth Sustainability Strategy Manager Kaeleigh Sheehan.  |  Practice Greenhealth

Custom packs. Look at opportunities to reduce waste through your procurement practices, including reviewing your custom packs, says Ms. Sheehan. Often, items in those packs are routinely thrown away because they’re not needed. That’s an added cost upfront and it adds to disposal expenses. Ms. Sheehan recommends that a surgeon, nurse or other clinical staffer perform an inventory analysis to eliminate routinely unused items, or items that typically go past their expiration dates, and have your vendors remove them from future packs.

Rigid sterilization containers. Eliminating as much blue wrap as possible should be the goal. 

“OR nurses often tell me, ‘What do we do with all this blue wrap? It’s everywhere!’” says Ms. Sheehan. “Rigid containers reduce blue-wrap usage.”

Many centers have also taken to turning blue wrap into garments and sleeping materials for homeless populations. In addition to Regions Hospital’s use of reusable containers — over 75% of its facility’s instrument sets are in them now, estimates Ms. Pepin — its health system’s green team has contracted with a company that makes reusable shopping bags out of its blue wrap.

Additionally, Ms. Sheehan says some vendors even accept blue wrap for recycling, because it’s a polypropylene number five plastic, and turn it into little pellets used to construct park benches, building material blocks and more.

Reusable instruments. The sterilization process uses chemicals such as ethylene oxide, which are problematic for the environment, points out Ms. Sheehan. “But we’re trying to get away from single-use disposables because of their impacts in natural resource extraction, manufacturing and disposal,” she says.

Ms. Sheehan notes that it’s possible to sterilize and reuse single-use items. “We advocate for reusables, first and foremost, but if you’re going to use a single-use disposable instrument, reprocessing it through an FDA approved third-party reprocessor has a place,” she says. 

Environmentally friendly anesthesia. Low flows of anesthetic gases that produce the least environmental burden possible are an easily achieved, low-impact goal. “Nitrous oxide and desflurane have high global warming potential in terms of their emissions, and desflurane is the most expensive anesthetic gas in health care,” says Ms. Sheehan. “Using an alternative such as sevoflurane or isoflurane is a great strategy. Because gases are mostly unmetabolized by the patient, you don’t need to use high flow rates throughout a whole case. It’s another scenario where more isn’t necessarily better.”

Fluid management. The goal should be to eliminate single-use disposable canisters. “Direct-to-drain systems are great investments, and a couple are designed specifically with ASCs in mind,” says Ms. Sheehan. “They’re smaller and hardwired into the plumbing.” As a bonus, these systems minimize exposure to blood and bodily fluids for staff, and several options can also provide surgical smoke evacuation to enhance the safety of OR staff and patients.

Waste segregation. While not flashy, Ms. Sheehan says this basic step can significantly reduce your environmental footprint, provided staff complies and everyone breaks old habits. Make sure recycling receptacles are placed in strategic locations throughout the facility, focusing on areas where staff dispose of recyclable items. “Staff are prone to fill up the closest waste bin,” she says. “Conduct proper education and hang signage near recycling receptacles to ensure materials that can be recycled are recycled.”

At Ms. Pepin’s facility, recyclable materials in the OR often ended up in general trash bins. Housekeeping now supplies one or two tall blue recycling bins for every suite. “We recycle paper, clean plastics such as water or saline bottles, and acceptable rigid packaging,” she says. “At the end of every case, it’s all taken and put into another area where we collect all recyclables, and housekeeping takes it down and puts it in the proper receptacles for collection.”

Ms. Pepin says exactly what can be recycled at any given time can be a moving target, making a strong relationship with your waste management vendor important. “We used to recycle more plastics than we are now, but we still do a fair amount,” she says. “Our contracted waste management company constantly tells us which plastics we can recycle and which we can’t.”

Asking for input from staff about these strategies is important because you might get pushback on any number of them, according to Ms. Sheehan. “Getting a couple wins under your belt to begin can be powerful,” she says. “Having a green team and leadership structure in place to solicit ideas and get support involving key stakeholders is really important.”

Plenty of perks

GOOD CAUSE Merrick, an organization that empowers adults with disabilities, regularly collects Regions Hospital’s blue wrap for recycling.  |  Regions Hospital

Saving the earth is one aspect of greening. Saving money is another. There can be additional perks, however. Ms. Sheehan notes that many patients want to patronize businesses that reflect their values. “If they enter a facility that has invested in a sustainability program and commits to their local community, it shows them where their values are,” she says.

Another winning element of environmental stewardship programs is the ability to attract staff who are interested in green initiatives, an important factor during the current staffing shortages. “Sustainability initiatives tend to benefit staff retaining and recruitment efforts, especially among younger generations,” says Ms. Sheehan. “They want to work for employers that have a mission, and whose values align with their own — with sustainability being one of them.”

Ms. Pepin notes that persistent monitoring and education is crucial for green efforts to succeed. She floats around during the day and has appropriate conversations when she witnesses noncompliance. “Work on keeping staff engaged with your efforts,” she says. “I tell them this is something that the organization is interested in. It should be an ongoing process.” OSM

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