Surgical instruments that are of poor quality or improperly maintained can fail during procedures, an alarming occurrence that jeopardizes outcomes...
When Memorial Hospital in York, Pa., set out to reduce its environmental impact a few years ago, members of its "Green Team" toured the local waste management company handling their output to see what really happens to the trash when it leaves the hospital. "This awareness was key to getting everyone on board with going green," says Pam Neiderer, RN, BSN, CNOR, director of surgical services. You don't have to go as far as Memorial Hospital's staffers did to go green. Here are some readers' suggestions for simple ways any facility can reduce waste.
Several sources have named the surgical industry as one of the nation's leading generators of waste. While much medical refuse is unavoidable, bound for the landfill or incinerator, a broad recycling program can reduce a facility's footprint and benefit its bottom line.
"We separate our clean recyclable waste in clear green trash bags. We are able to place this and all our cardboard boxes into the recycling dumpster," says Dallas Freyer, RN, CASC, administrator of the Corpus Christi Outpatient Surgery Center and Surgicare of Corpus Christi, in Texas. "It has not only provided us a 'going green' opportunity, but also a savings opportunity as this is a cheaper pickup and we were able to reduce the number of regular pickups."
A facility's recycling options aren't limited to paper, plastic and aluminum, though. Some readers separate supply wrappers, batteries and even device components out of their waste streams. "We send shaver blades, wands and cannulas out as part of a recycling program," says Linda Mae Ruterbories, ANP, the surgical center director at the OA Centers for Orthopaedics in Portland, Maine. At Minnesota Valley Surgery Center in Burnsville, Minn., staff "save used cautery cords containing copper and recycle them for cash," says Sonja Wilcox, RN, CNOR, operating room supervisor. "We donate the proceeds to our favorite charity." Contact your municipality, local waste management businesses and vendors to determine what's possible in your area.
Make it easy
With environmental efforts, as with any practice changes, making it easy to do the right thing will get it done right, and keep clean recyclables out of conventional and medical trash.
One solid starting point is visibility and accessibility. "Purchase the blue plastic recycle bins and place them in each area of your workplace. They are very inexpensive, highly recognizable and easy to clean," says Henry Rey Jr., RN, the nurse manager at Schulze Surgery Center in Savannah, Ga. "Our clean and sterile rooms utilize distilled water, so we have several of the blue bins there for employees to place the plastic jugs in. The same blue bins are at the front desk area for paper products."
Automation also works to help reduce waste. For example, one of the primary draws of closed, direct-to-drain fluid waste management— be it a portable suction unit, stationary room suction or a no-contact, canister-emptying system — is that it keeps the weight of solidified fluid out of red bags. This eliminates a large amount of high-cost biohazard waste, notes Kathleen Allman, RN, MSA-HCM, CASC, the CEO of Millennium Surgery Center in Bakersfield, Calif.
Electric eyes can keep your facility's utility costs as low as practical without assigning staff to light-switch-monitoring duty, says Sharon Dillon, RN, CNOR, CRNO, CASC, administrator of the Eye Surgery Center at the Biltmore in Phoenix, Ariz. "We have lights with motion sensors and thermostats that are set to increase or lower during times of non-occupancy," she says.
Inhalational anesthetics play a significant role in the U.S. healthcare industry's carbon footprint, but one hospital saw an 11-fold reduction in greenhouse gas emissions simply by avoiding the use of desflurane and nitrous oxide.
According to research presented at the American Society of Anesthesiologists' annual meeting in October (tinyurl.com/qakspwp), the 2 gases have the highest amount of associated carbon dioxide emissions among inhalational agents. In contrast, sevoflurane and isoflurane are 20 times less polluting, and propofol 4 times less so.
"Inhaled anesthetics are a really low-hanging fruit to target for significant reduction in greenhouse gas pollution," says Jodi Sherman, MD, an assistant professor of anesthesiology and the environmental compliance officer at Yale University's School of Medicine, who led the study at Yale-New Haven Hospital. In addition to switching agents, Dr. Sherman recommends adopting low-flow techniques, recapturing waste gases and using regional anesthesia when practical.
Reusing is recycling
In addition to encouraging recycling throughout the facility, Ms. Neiderer's hospital also participates in a single-use device reprocessing program. Many facilities have found dual advantages in such partnerships with FDA-approved companies. "This allowed us to decrease our red-bin usage and purchase reprocessed items back at a fraction of the original cost," says Jered E. Beaird, RN, BSN, CNOR, OIC, who manages OR logistics at the Keesler Air Force Base Medical Center in Biloxi, Miss.
Reuse is also recycling when surgical supplies that went unused find new purposes. A sterile drape that was opened but did not make contact with the patient can be saved for use as a stretcher sheet, for instance. Or "use gowns and gloves from packs that were opened prior to the patient coming in the room, that are not needed (wrong size or extra), in the endoscopy procedure room," says Patricia S. Mayo, RN, BSN, CNOR, CAPA, director of perioperative services at Taylor Regional Hospital in Hawkinsville, Ga.
One frequently cited concern among the environmentally minded is the problem of blue wrap. "Sterile tray wrap is a big waste of material," says Ed Harrich, RN, director of surgical services for Pullman (Wash.) Regional Hospital. It's even stumped Ms. Neiderer's Green Team. "To be honest, the only thing we haven't found a recycling source for is our blue wrappers," she says.
But blue wrap has a silver lining in reuse. "We use our used blue wraps (removed from the room before the patient arrives) to cover the working table for endoscopy," says Marla Holmes, RN, CNOR, a surgical nurse at ProMedica Fostoria (Ohio) Community Hospital. "This is a second use before they go in the trash."
Ms. Mayo adds that uncontaminated wrap can also be used to line supply and instrument shelves, keeping the surfaces clean and protecting the wrappings of other items. Many readers also donate used blue wrap to local animal shelters or veterinary clinics, which use it for bedding material in their cages.
Alternatively, you can sidestep the blue wrap issue by going without it, like the Bayshore Medical Center in Pasadena, Texas. "We are currently converting all of our instrument sets from wrappers to an instrument pan system," says supervisor Robin Webb, RN, CNOR.
In addition to adopting rigid containers for reprocessing, you've got many options for using less stuff that soon becomes waste. "Look at the things you use in large quantities. Is there a substitute that is reusable?" asks Joyce Mackler, RN, MSN, CASC, manager of the Seaford (Del.) Endoscopy Center. "For example, we use bins instead of plastic bags for patient belongings."
"We have a water-filtration station and an ice machine with filtered water, so no plastic water bottles," says Ms. Allman. "Our staff brings coffee cups from home to reduce the use of throwaway cups," adds Kim Loew, RN, CASC, director of nursing at the Laser Spine Institute in Oklahoma City, Okla.
"All of my binders (for example, risk management and infection control) are now digital," says Stacy Daugherty, RN, endoscopy nurse manager for Gastro-enterology Associates in Canton, Ohio. "Everything is electronic with a backup in a fireproof safe. No more paper!"
Overall, the best replacements are those that deliver benefits on multiple levels. "Look for environmentally friendly cleaning options. They are out there," says Rena Carney, RN, BSN, clinical coordinator for the Dublin (Ohio) Surgery Center. "Not only are they good for the environment, but they are safer for our employees. We recently switched the chemical used in our endoscope washer to a hydrogen-peroxide-based solution. It is less toxic for the employees and the environment. The bottles are also larger, and we use less of them per solution change, so this is a trash savings."