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Overview:

A large quantity��of any hospital’s environmental footprint is produced by its operating rooms. Studies estimate that between 20-30 percent of the total waste volume generated by a hospital comes from ORs. Operating rooms are one of the largest users of supplies within a hospital. Surgical kits are often wrapped with plastic after sterilization and boxed, and many instruments are individually wrapped. This packaging ends up in the waste stream. Halogenated anesthetic agents are released into the environment during use and present significant climate harm potential. To address these issues, SBUH continues to explore environmentally sustainable ways of managing operating room.

Goals 2025:

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1. Reduce the use of halogenated anesthetic agents by an additional 20% over 2024
2. Convert to reusable gowns in the endoscopy unit
3. Establish set back program for main ORs
4. Conduct peri-op grand rounds on sustainability
5. Remove anesthesia machine from ACP endo
6. Continue reviewing OR material packets to reduce waste, identifying items for removal that are not used

Highlights:

Inhaled anesthetic gases are a significant source of greenhouse gas emissions from a hospital. SBUH has worked to reduce the total amount used and to specifically reduce the quantity of desflurane used in the ORs. Desflurane is similar in clinical action to several other drugs, but has a much larger environmental impact. It is still available for use, but only with special arrangements.

To increase recycling, ��efforts are being made to ensure appropriate used OR medical supplies are placed into correct recycling bins. In addition, we encourage the purchase of upcycled medical devices wherever feasible.

We have cut back on our use of blue wrap, the plastic material used for wrapping boxes of sterilized surgical instruments. We switched to reusable stainless steel containers, and sterilize the instruments inside them. This not only cuts back on blue wrap, but it is also a more effective way of keeping instruments sterile in storage until they are needed in surgery. Metal containers hold instruments more securely and keep them from getting jostled and potentially breaking their wrapping which affect sterility.

SBUH is also focused on improving OR efficiency. Our “Greening the OR” team collaborates with clinicians to review surgical case packs (kits of supplies organized by surgical service). The annual accounting and reporting process identifies instruments not being used, so we can remove them from the packs reducing waste. We are working with our primary implant vendors to reduce tray weights and shift to validated containers whenever possible.

In 2024 we re-launched our Reprocessing program. A new contract was awarded that allows for the purchase of additional reprocessed devices. With the change in contract and an education campaign, ��we saw an increase in purchases, from just over $10,000 in 2023 to $174,000 in 2024. We are continuing to target areas and expect 2025 total to be well over $250,000. Collections and additional purchases are also being reviewed, especially in the Cardiac and OR areas, with the help of clinical stakeholders.

We have a 10-OR ambulatory surgery center (ASC) on our Hospital campus. We conduct about 10,000 surgeries a year, with all surgical specialties and case types from breast reconstructions to sports medicine. As of November 2024 the ASC formally disconnected the centralized, piped nitrous oxide and all lines were capped. The center has exclusively moved to E-cylinders on the anesthesia machines in each OR, greatly reducing the amount of nitrous that is released into the atmosphere.

Recognition:

Practice Greenhealth has recognized the work of this group with��Greening the OR��awards in 2018, 2019, 2020, 2022, and 2024.

Our Central Sterile Department was named a runner-up for the Central Sterile/Sterile Processing Department of the Year national award from Healthcare Purchasing News.����

Team:

*Ally Silver, Mike DeMasi, Cynthia Jorgensen, and Martha Houlihan

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