Sustainability: The Green OR: Swim Upstream

Sustainability isn’t just recycling. It’s having less to recycle in the first place.

In the Nov./Dec. 2024 issue of this magazine, I provided a list of 10 best practices your ASC can implement to become more environmentally sustainable. Here, I’ll dive more deeply into a topic that should be on the radar of ASC leaders who appreciate that sustainability is not only good for the environment, but also for their surgery center’s bottom line.

Address the source

Many people think of recycling when they hear “green” or “sustainable,” but a sustainable ASC goes beyond that. The most effective sustainability programs account for “upstream” and “downstream” impacts from daily operations. Repurposing, donation and recycling help reduce downstream waste, while upstream actions center around reducing demand for materials by purchasing fewer single-use items. This source reduction approach not only reduces downstream impacts associated with waste disposal, but more significantly reduces the upstream factors associated with production and manufacturing: natural resource extraction, energy usage, chemical additives, and oil and gas used during transportation and distribution.

I use the analogy of our kitchens. We all know it’s more cost-effective to use reusable plates and utensils. Otherwise, we’d be purchasing, using and throwing out plastic knives, forks, spoons and disposable plates left and right. Most of us use plastic utensils and disposable plates by exception.

Surgery centers should adopt this same principle with supplies used for patient care when and where feasible and appropriate. Review opportunities in your ORs such as reusable patient positioning devices, pulse oximetry probes, EKG cables, blood pressure cuffs and transfer devices with your infection prevention colleagues, cleaning and disinfection policies and manufacturer instructions for use (IFUs). There can be no compromise with patient safety. Making smart choices about reusable devices and supplies for general use will lower both your supply costs and overall waste, and deliver environmentally beneficial returns on investment.

Impacts far beyond the ASC

Sustainability makes even more sense when viewed through a much wider lens. One of the most pressing issues we face in health care is the proliferation of single-use medical plastics. Globally, 6% of all oil extraction is used to produce plastic, which can contain petrochemicals that are known endocrine disruptors. There is significant demand for disposable supplies made of plastics, which perpetuate greenhouse gas emissions from upstream and downstream impacts, contribute to air and water pollution, and increase bioaccumulation of microplastics inside all marine mammals and humans.

We can reduce the amounts and impacts of plastic in health care by opting for reusable supplies and materials when and where feasible and appropriate. Examples include reusable sharps containers, reusable sterilization containers that reduce use of plastic “blue wrap,” and fluid management systems that replace disposable plastic suction canisters.

Single-use plastic laryngoscope handles are 16 to 18 times more carbon-intensive than reusable stainless steel handles, and single-use laryngoscope blades generate five to six times more carbon dioxide equivalent emissions than reusable steel blades, even when water and energy used for cleaning and disinfection are included. Reusable blood pressure cuffs are environmentally preferable to disposables in some cases by a factor of 40.

Enhance your bottom line

I recently examined life cycle assessments around reusable pulse oximetry probes, which can easily be cleaned with the same disinfectant wipes used to clean OR tables and furniture. In one example, the average cost for single-use disposable probes was $240,000 a year. Over a five-year period, a shift to reusable probes would decrease equipment costs by about $1 million.

ASC owners and operators opting for reusable devices not only can reduce supply and waste costs, but also insulate their centers from inventory shortages and price hikes due to supply chain disruptions. For example, reusable isolation gowns can offer a 50% supply cost reduction versus disposable gowns (osmag.net/gowns), with the added benefit that they also protect your facility from the kinds of price shocks and supply shortages we experienced during the COVID-19 pandemic. In some cases, there was a 2,000% price increase on disposable gowns (PDF) because supplies were unavailable. Hospitals that had reusable isolation gowns in place were not exposed to those price increases or back orders, and were able to maintain the same level of care.

A couple things to keep in mind regarding a shift away from disposables to reusables: Involve frontline staff and leaders from across all affected departments, as interdisciplinary collaboration is essential for reviewing, designing and testing changes in work processes. Also, assess the resources you’ll need, such as cleaning, disinfection and sterilization supplies, capital equipment and full-time employees, to successfully and efficiently reprocess reusable devices. OSM