Going Green for the Greater Good


Surgical tech Veronica Marella's idea to turn blue wrap into sleep mats for the homeless inspired a nationwide movement.

Veronica Marella was setting up an OR with a coworker when 10 instrument trays arrived from sterile processing. Ms. Marella, a certified surgical technologist at Providence Little Company of Mary Medical Center in Torrance, Calif., began to remove blue wrap from the trays, checking for holes and strikethroughs. She happened to glance over at her colleague as he was tossing mounds of the used material into the trash.

"I thought, if all this wrap is being wasted, maybe I can do something with it," she recalls.

Ms. Marella rubbed a piece of the soft polypropylene plastic between her fingers. She knew the material repels water, is durable and retains heat, and thought back to her past career as a deputy sheriff when she saw homeless people with nothing between them and the hard ground except newspaper or cardboard.

The flicker of an idea danced in her head. Ms. Marella set aside two pieces of wrap and took them home later that night. A plan began to take shape as she held the four-foot squares out in front of her. She carefully folded the two pieces in half, sandwiched one inside the other and stitched the edges together around all four sides. In a matter of minutes, she'd produced the prototype for a blue wrap sleeping mat that would eventually be handed out to thousands of homeless individuals across the country. To make the mat easier to carry, she attached elastic loops on one end so it could be rolled up like a yoga mat. (See how Ms. Marella creates the sleeping mats by watching her instructional video: osmag.net/xH9qUQ.)

FORM OF FLATTERY Surgical teams across the country have launched their own wrap-to-mat programs.

Ms. Marella brought the mat to work the next day, pitched her OR director on making more for the homeless and got permission to take as much wrap home as she'd like. Providence liked the idea so much that it worked with her to expand it to several of its other facilities across the country.

Ms. Marella remains ?on a mission. She has established a nonprofit with two partners called du cOeuR Project, which distributes the mats to homeless individuals across the country. The French term means "from the heart," and the capitalized O and R are a nod to her OR coworkers who help her collect wraps for upcycling.

The project started out focused on providing mats to homeless populations in Southern California, but has since extended its efforts nationwide.

"I'm helping other hospitals start their own projects," says Ms. Marella. A lot of nurses and techs email her, asking how to start such a project at their own facilities. News stories of her efforts have gone viral on social media, inspiring countless surgical staff across the country to make and distribute mats of their own.

"It's a great feeling to know there are other people out there that are taking my idea and doing the same thing to help out those in need," says Ms. Marella. "I just hope it continues."

Through email and other encounters, she and other blue wrap enthusiasts point each other to new sewing patterns. Others around the country have created tote bags, sleeping bags and more out of the stuff.

Ms. Marella still sews the mats herself, with some help from local Girl Scouts and other clinicians. They only take about five minutes to make, and she's produced around 3,500.

Ms. Marella believes reusing blue wrap saves facilities money. "When surgical teams collect wraps for me, 10 or 15 in one bag weighs a lot," she says. Since many facilities pay their waste vendors based on weight, throwing blue wrap out can be costly as well as wasteful.

The U.S. healthcare system generates billions of pounds of waste every year, and ORs produce about a third of that waste. A blue wrap project could kick off larger green efforts at your facility. "I see this as a stepping-stone to launching a recycling and a repurposing program," says Ms. Marella. "This is an easy way for you to get started, and then ask, 'What else can we do?'" OSM

10 Sustainable Solutions for Your ORs
CHAMPION FOR A CAUSE Polly Woodworth, RN, recycles packing material during a procedure at Boston Medical Center.   |  Boston Medical Center

There are many possibilities for greening a surgical facility, ?ranging from large, sweeping, expensive projects to small, focused, virtually free workplace hacks. Whether you spend hundreds of thousands of dollars, or a whole lot less, there are many things you can do to reduce your facility's carbon footprint.

1Add LED lighting. Back in 2011, Boston (Mass.) Medical Center was launching a campus consolidation project that involved a lot of renovation and rethinking. Becoming more sustainable in every area possible was a priority. Green energy savings were accounted for when the campus consolidation was costed out. As part of the project, BMC converted almost completely to energy-saving LED bulbs, which are more expensive, but last longer and are more efficient. BMC installed 30 LED lights in its new hybrid operating room, and 30,000 LED lights all told throughout campus.

2Change anesthetic gases. BMC, like a growing number of surgical facilities, has moved away from desflurane in favor of sevoflurane because of the former's relatively huge carbon footprint. Dave Maffeo, BMC's senior director of support services, says using desflurane for a two-hour surgery has the same environmental impact as driving a car 756 miles, as opposed to 16 miles using an equivalent dose of sevoflurane. "It's huge for organizations that want to go green to make the change," he says.

3Capture waste gases. BMC installed wall-mounted canister systems in its ORs that capture all of the CO2 patients exhale. The carbon is absorbed in pellets that are safe to throw away with other medical waste. "In a lot of facilities, that waste reaches the outside environment as greenhouse gas emissions," says Mr. Maffeo.

4Reprocess disposable devices. BMC works with a vendor that reprocesses single-use devices, says Mr. Maffeo. Not only does this prevent single-use devices from going directly to a landfill, it also limits the need for BMC to buy reusable instruments and use resources to endlessly reprocess them.

5Trace the waste. Go on a "waste walk" to make sure the items you recycle aren't ending up in the regular trash, suggests Stephanie Barman, BSN, BA, RN, CNOR, staff circulating nurse and GYN surgery coordinator at UnityPoint Health — Meriter, a partner of UW Health in Madison, Wis. During her walk, Ms. Barman was surprised to learn the items her team sorted into recycling bins in the ORs were being thrown in a dumpster. She says following the waste stream through your facility to see the different steps in the process will reveal where problematic areas might be.

6Segregate at the point of use. Ms. Barman says recycling begins at the point of use. "As soon as packaging becomes garbage, when you open the item onto the sterile field, that's when you should sort it," says Ms. Barman. The onus is on the OR staff to know what is and what isn't recyclable, but you can help their efforts by placing recycling bins in convenient locations next to trash receptacles and hanging signage that displays the items that should be recycled.

7Understand the rules. A key aspect of getting a recycling program off the ground is knowing what's recyclable and what isn't — which varies depending on your individual waste vendor. "I've learned that even if an item is marked recyclable, your vendor may or may not have the capability or the market to recycle that item," says Ms. Barman. "We found that out through a few meetings with our waste vendor representative. Based on those consultations, nurses and techs received educational tools and information about what they can and cannot recycle.

8Always look for additional opportunities. It was during meetings with the waste vendor that Ms. Barman found out the vendor was able to recycle plastic wrap. Meriter OR staff began saving plastic wrap for recycling by placing it in a large hamper provided by the vendor. When a bag is full, it's tied off, letting the evening housekeeping staff know it's ready to be moved to a designated spot on the hospital's loading dock.

The results were mind-blowing. "After three months, I did the math on how many of the big bags we had gone through, and a friend who's a math teacher helped me determine the area of it," says Ms. Barman. She calculated the plastic wrap they collected over three months would have filled 157 garbage trucks.

9Challenge vendors. Ms. Barman was frustrated she couldn't recycle the Styrofoam trays in her facility's custom packs, even though the trays had recycling numbers on them. A process improvement engineer suggested Ms. Barman talk to the vendor who created the custom packs to find out if they had an alternative to Styrofoam. They did and as a result of Ms. Barman's willingness to ask, the packs began arriving with recyclable cardboard trays. "You can actually feel empowered as the person who uses the product to talk to the vendor selling it and say, 'How can we do this differently?'" she says.

10Make it easy. Every custom pack at Meriter comes in a plastic bag, so Ms. Barman's team hangs the bags on hampers in the OR as they open the pack's supplies. The team members toss the recyclable items from the packs into the bags in which the packs were shipped. It's full-circle recycling.

When done right, recycling becomes second nature. "We realized recycling has to be easy to do," she says. "Eventually, staff will do it without thinking. It's part of their muscle memory." Creating awareness among staff is key. That mindset could produce more epiphanies like those experienced by Ms. Barman, who challenges you to think differently about surgical waste: "When you open something and don't use it and it's still clean, always try to determine if there's a way to upcycle or recycle it."

— Joe Paone

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