OR Excellence Awards: Environmental Sustainability: A Win-Win for the Planet and the C-Suite

While Memorial Sloan Kettering Cancer Center reduces energy usage and waste in its ORs, it’s also saving significant money.

Memorial Sloan Kettering Cancer Center (MSKCC) in New York City proves that going green doesn’t automatically mean you will lose green. In fact, quite the opposite can be true. As a result, MSKCC is the 2024 OR Excellence Award winner for Environmental Sustainability.

• Single-use device reprocessing. MSKCC participates in a third-party reprocessing/recycling program that collects nearly two dozen types of its used single-use devices. At 20 cents per pound in avoided waste costs, it realized a financial savings of $341,164 in 2023 through this program. It is not using detergent and chemicals at its site to reprocess the devices, and gets up to 10 uses out of these single-use devices, reducing the number it sends to landfills.“We place them in a special container, and they are reprocessed or recycled by the third-party company, which follows FDA-regulated testing and validation processes that meet the original manufactutrer’s specifcations and are safe for patient use,” says Kathleen Gaul Burke, MSN, RN, nursing director, perioperative services. While there’s no such thing as zero-waste surgery, MSKCC is focused on reducing OR waste however it can.

• Blue wrap recycling and reusable sterilization containers. MSKCC contracts a third party to haul uncontaminated blue wrap to another company that recycles it into other healthcare products. In 2023, it diverted 7,440 pounds of it for recycling, accounting for 43% of its total purchase. Blue wrap is recovered from ORs, checked for contaminants by staff and, if uncontaminated, folded and placed in a clear bag inside a designated hamper signed “blue wrap only.” Full bags are transported to a dedicated EVS cart, and then make their way to the recycling company.

Ms. Burke says OR staff has become conditioned to place blue wrap in the proper bucket. “I once watched someone take blue wrap out of the garbage and put it into its specific bucket,” she says. The goal is to not use blue wrap at all wherever possible in favor of rigid sterilization containers, which are safer for the instruments and, by extension, patients. “You could have 10 trays for a case stacked on top of each other, and it all remains very compact and the integrity stays completely sterile,” says Ms. Burke. Of MSKCC’s 204,102 instrument trays in 2023, 142,872 were sterilized in reusable containers, generating cost avoidance and savings of $246,979 that would have been spent on blue wrap.

• Energy management. HVAC setback and LED surgical lighting have saved MSKCC both energy and money. By reducing OR air exchanges from six to four per hour during off-hours when ORs are unoccupied, and installing a ventilation control system in its 28 ORs, it realized 1,962,229 kWh in energy savings in 2023, equivalent to $448,259. MSK sets the exhaust volume to a flat 300cfm and sets supply volume to vary enough to keep the room positive.

High-intensity discharge lamps were replaced with more energy-efficient LED surgical lights in all ORs, leading to over 46,124 kWh in energy savings or $7,010 in avoided costs. The lighting system is equipped with occupancy sensors, and sensors for daylight harvesting, with user control provided for customization if needed. A greater number of LED light fixtures can be powered from a singular electrical panel, generating further cost and energy savings by cutting energy use and demand nearly in half.

Environmental sustainability is an all-hands-on-deck effort at MSKCC. Nurses, surgeons, anesthesia providers, EVS, facilities management, supply chain and surgical support staff are all tuned in and engaged. A “Greening the OR” committee meets quarterly, and its chair participates in monthly MSK Sustainability Steering Committee meetings. A manager of sustainability and energy looks at all MSK facilities and identifies areas of opportunity that others might not see, replicating ideas across multiple sites. “Sustainability is entrenched in our culture, and we’re benefiting from it,” says Ms. Burke. OSM

Honorable Mention: No Laughing Matter

Prioritizing Nitrous Oxide Waste Reduction

ACCESS DENIED Dr. Martin van der Vyver, site chief anesthesiologist at Sunnybrook Health Sciences Centre Holland Campus and co-chair of its OR Green Team, holds a nitrous oxide tank as he points to the capped wall outlet labeled “Do Not Use” that once supplied the gas from a central system.

An orthopedic surgery team at Toronto’s Sunnybrook Health Sciences Centre had a vexing problem. Nitrous oxide (N₂O) anesthestic was provided to its ORs via a centrally-piped wall system, but it was being consumed at a much higher rate than it was used intraoperatively.

Sunnybrook’s Clinical Operations Green Task Force engaged plant operations and maintenance to analyze the situation. Purchasing data showed Sunnybrook had bought 32,600 Kg of the gas over five years but used extremely little of it clinically. “We weighed the tanks at our central manifold to determine the amount of N₂O leaving the tanks and compared this to our clinical usage using our electronic medical record,” says Patient Care Manager Barbara McArthur, RN, MN, CPN(c). They discovered a startling 99% wastage rate. A pipe was leaking somewhere at the facility, but engineers couldn’t pinpoint exactly where.

The team resolved to rectify the situation due to the staggering environmental impact of the gas. N₂O represents 75% of the carbon footprint of anesthetic gases, has 300 times the global warming potential of carbon dioxide and persists for over 100 years in the atmosphere.

The gas could not be removed entirely, as it is used to provide safe sedation for patients with respiratory problems and is standard of practice in the obstetrical unit. With anesthesia providers joining the team, the solution was to decommission the central system while switching to small tanks of N₂O that easily connect to anesthesia machines, while capping the wall outlets and clearly labeling them “Do Not Use.” Doing so reduced N₂O waste by 80%.

“We saved the annual equivalent of planting 1,450 trees and letting them grow for 10 years,” says Ms. McArthur. Now Sunnybrook is working to do the same at its main campus.

– Joe Paone