If your ORs produced 500,000 pounds of waste last year, you probably spent about $25,000 to dispose of it. That's twice what it need be, and not because you didn't get the best deal with the trash hauler, but because you weren't environmentally responsible enough. Here's how two activities - converting red-bag waste into clear-bag waste and recycling clear-bag waste - can save your facility thousands of dollars.

Red bag to clear bag
Our hospital generates more than 6,000 tons (that's 12 million pounds) of waste each year. Our 42 ORs were responsible for about 30 percent (788,000 pounds) of it. You can sterilize and shred much of what would otherwise be regulated medical waste to dispose of it as clear-bag waste, which usually costs at least five times less per pound to dispose of than red-bag waste (about 5 cents per pound versus about 30 cents per pound). Of course, you can't recycle this converted medical waste, but you'll save big on disposal costs, because this processed waste is safe to dispose of in a landfill.

Here at Brigham and Women's Hospital, we're lucky enough to have a service center that works with environmental services to sterilize our regulated medical waste. That department ensures our regulated medical waste meets the requirements that let it be accepted for disposal in a landfill:

• All infectious waste must be treated (sterilized or autoclaved, for example) to make it non-infectious.
• The waste must be deemed and labeled non-infectious.
• Sharps must be ground up or their physical hazards otherwise eliminated.

Now, if you wanted to send regulated medical or chemical waste to an incinerator instead, you'd have to place all waste in rigid, leak-resistant containers and label it with the facility's name, address and phone number. You must label untreated waste with the international biohazard symbol. It must then travel with an infectious waste manifest.

A sorted affair
Surgical services produces the largest percentage of hospital waste, consisting generally of solid waste including paper, metal, glass and plastic, which makes up the largest portion of a healthcare facility's waste - 70 to 80 percent. About half a facility's solid waste is paper and cardboard, which can be easily reduced and recycled.[1]

Much of what gets tossed into clear bags is recyclable: paper, cardboard, plastic packaging from sterile supplies and so forth. Adding recycle bins to your facility can make a huge difference. Here are simple steps to launch a recycling campaign.

• Start with what you buy. Paper should be chlorine-free and 30 percent or greater post-consumer recycled. Reduce your purchase of polyvinyl chloride products, which can have harmful effects when used in patient products and can damage the environment when incinerated as medical waste.
• Introduce separate bins for recyclables to the staff lounge first. This lets staff get in the habit in a more informal environment, even if they're only tossing morning newspapers in the paper bin and soda cans in the aluminum bin.
• Market your recycling program. Put together a presentation on what you're doing and, more importantly, why you're doing it. Get the facility's administrators on board, too. Our hope was that we could convince our perioperative colleagues to at least try the recycling program - but, much to our delight, the presentation was so well received that everyone jumped on board.
• Hit the perioperative area. Next, introduce paper and cardboard and plastic bins for pre-op, PACU and the ORs. Our hospital already recycled about 400 tons of cardboard per year, but we stepped up our efforts to keep clean cardboard out of red-bag trash. Stress two main activities with your staff. First, only open necessary supplies and equipment in the ORs. Second, meticulously sort all trash. Remind your nurses that they won't have to make special trips to the bins. Eventually, at some point in every case, they'll have to leave the room to get something - when leaving, they can gather plastic wrappers and drop them in the plastic recycling container right outside the OR door. Our patient care assistants are instrumental in making this project work; they also assist staff in the recycling effort by transporting the plastics and cardboard to the recycle bins when the need arises. In PACU, toss those unused lab slips and requisitions into a recycle bin specifically for paper next to the nurses' station.

A small FYI: No. 1 and No. 2 plastic represent the largest volume of plastic in the OR. They're used for packaging items such as cement systems, staplers and reloads, to name only a few.

• Educate non-nursing disciplines. Our anesthesia pro-viders were throwing everything in biohazard trash, including saline IV bags and pourable sterile saline and water bottles. The CDC's rule of thumb: You can dispose of items that aren't dripping or saturated with blood and body fluids, even if they've been used in the OR, in the solid waste stream.
• Who's handling the back end of the program? Whether it's environmental services or a maintenance person, make somebody responsible for providing the bins and routinely emptying them. At our hospital, plastic, cardboard and paper are collected and taken to the service center, where they're baled for pickup by our recycling hauler. We are reimbursee for plastic, but it's just enough to cover the costs of the baling efforts, making the endeavor a break-even proposition. Still, it doesn't end up in a landfill. Since our program began in August, BWH's ORs have baled and recycled about 1.5 tons of plastic - and we're doing more every month.

Doing your part
AORN calls for nurses to conserve supplies, reprocess where possible and recycle in its 2006 position statement on environmental responsibility. The Ameri-can Hospital Association and EPA have joined to form H2E or Hospitals for a Healthy Environ-ment and the movement is picking up momentum. Further, more states are cracking down on institutions that discard of cardboard rather than recycling it. Professionally, ethically, monetarily and practically, you've every reason to get involved and start making a difference.

References
1. Fenwich R. American Hospital Association Conference on Hospitals and the Environment, 1991.