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Greening the Operating Room

Greening the Operating Room. TM. Janet Brown for Kaeleigh Sheehan Project Manager Practice Greenhealth. Is this sustainable?. Why is the OR Important?. “Generates ~ 40% of patient-related revenue…high dollar, high impact cost centers”

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Greening the Operating Room

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  1. Greening the Operating Room TM Janet Brown for Kaeleigh Sheehan Project Manager Practice Greenhealth

  2. Is this sustainable?

  3. Why is the OR Important? • “Generates ~40% of patient-related revenue…high dollar, high impact cost centers” • Healthcare organization’s reputation often tied to surgical outcomes.

  4. Is this Sustainable? Within the OR, supplies are 47% - 56% of OR budget. OR typically largest generator of waste (20-33% facility total) and largest generator of regulated medical waste (RMW) One of most energy-intensive departments within hospital Energy, waste and waste anesthetics = large carbon footprint • OR represents 1/3 or more of total hospital supply expense • Materials In  Waste Out

  5. Operating Room Fast Facts • Stressful, high-paced environment • Multiple surgical services and critical stakeholders – from world-class surgeons, anesthesiologists, nurses, techs to environmental services staff. • 54,000 ORs in North America • Studies show that over 50% of budget can be supply costs • Department often not integrated with rest of hospital—closed system

  6. OR Environmental Footprint ©Brandon Medical, 2011. © Woods, 2010. © Seabrook, 2010. © Nussbaum, 2010.

  7. A Few Waste Stats • Almost 80% of packaging waste from procedure generated before the patient enters the OR • Approximately 20% of surgical waste is blue wrap • Approximately 40% of waste is fluid canisters

  8. Environmental Responsibility

  9. What are the Opportunities? • Increase efficiency. • Protect or IMPROVE worker & patient safety. • Reduce environmental impact. • Improve staff satisfaction. • Reduce cost! • Support healthcare’s goal to reduce environmental footprint.

  10. Biggest Perceived Challenges to Implementing Green Practices in the OR Practice Greenhealth’s Greening the OR Survey, 2011.

  11. The Greening the ORTM Initiative is designed to coalesce and build the body of knowledge around environmental best practices in the OR that can also improve patient safety, worker health and the bottom line.

  12. Waste • Reduce RMW through effective segregation • Recycle medical plastics and other recyclables • Reduce suction canister waste (RMW) through fluid management system • Send appropriate devices for third party reprocessing • Philanthropic donations of clean, unused medical supplies

  13. Regulated Medical Waste Reduction • Up to 60% of RMW comes from ORs • Segregate non-infectious waste • Virtually all pre-op waste in NOT RMW

  14. Case Study: Regulated Medical Waste Reduction and Minimization • INOVA Fairfax Hospital • 900 bed Trauma 1 hospital • 29 Operating Rooms • 19, 402 inpatient surgeries, 16,362 outpatient surgeries in 2010

  15. Problem: • Not recycling, no waste segregation, non-infectious items ending up in RMW stream • Strategy: • Clinical leader, senior leadership, sustainability consultant • Single-stream recycling in OR’s • Education on proper waste disposal and segregation • Waste audit – over 900 lbs of RMW from the OR daily! (15% RMW industry best practice)

  16. Results: • Re-analyzed waste 6 months later • 19% reduction • Decreased over 1 million pounds of RMW from 2009-2010 • Cost savings of over $200,000

  17. Medical Plastics Recycling • Clean, recyclable plastics • Rigid trays/packaging • Overwraps • Blue sterile wrap • Saline pour bottles • More…

  18. Fluid Management Systems

  19. Case Study: Fluid Management in the OR • North Suburban Medical Center • 157-bed acute care hospital • 6 operating rooms + surgical services expansion

  20. Problem: • The OR will perform fluid suction in 90% of surgeries • Wall suction canisters – canisters only available in limited sizes • Exposure risk to splashes and chemicals • Poor suction strength • Time consuming and add to RMW stream

  21. Strategy: • Needed safer, more precise fluid management • Reduce RMW waste disposal • Decision making team • Key Criteria: • Ease and versatility of use (mobile)(empties and cleans in 3-5 minutes) • Capacity and handling requirements • Evacuation and disinfection method • Likelihood of spills • Precise measurements

  22. Outcomes • Purchased 3 new systems • Zero staff exposure, slips from spills orelectrical hazards • More volume capacity, precise measurements, smoke evacuator and smoke detector,self cleaning, reduces RMW related waste • Quicker turnover time between surgeries • 4 year payback period

  23. “Single Use Device” Reprocessing • Arthroscopic shavers • Blood pressure cuffs • Soft tissue ablators • External fixation devices • Electrophysiology catheters • Scissors and staplers • Biopsy forceps • Laparoscopic scissors and forceps • Clamps and dissectors • Compression sleeves (DVT) • Phaco tips • Pneumatic tourniquet cuffs • Pulse oximeter sensors • Orthopedic drill bits and burrs • Tracers and Trocars www.amdr.org

  24. Case Study: Reprocessing of Single Use Medical Devices • Metro Health Hospital • 208 bed facility • 10 operating rooms • 12,740 surgeries in 2010

  25. Problem: • Disposable medical products make up large portion of waste • OR utilize expensive devices • Estimates saying 50% OR budget on supplies • Strategy: • Key implementation leaders developed program • Executive approval and Physician’s Chief of Staff signed making mandatory • Education, infection control procedures, quality assurance process • Identify collection container placement, pre-cleaning and packaging

  26. Results: • $235,803 from purchasing SUD’s (2008-2010) • 1.84 tons waste avoided in 2010 • Avoided $900 in RMW disposal

  27. Medical Supply Donations • Clean, unused or expired medical supplies • Donated through third party non-profit • Facilities in need in developing countries

  28. Supply Chain • Move to reusable surgical gowns and linens • Reformulate OR kits to reduce overage • Purchase FDA-approved reprocessed medical devices • Replace blue wrap with rigid sterilization containers • Transition to reusable medical supplies such as grounding pads, anesthesia circuits or patient warming devices

  29. Reusable Surgical Linens • Increased comfort • Comparable barrier protection • Decreased waste • Increased instrument recapture with third party reprocessor • Cost-savings

  30. Case Study: Reusable Textiles in the OR • University of Maryland Medical Center • 757-bed facility • 31 operating rooms • 21,500 surgical procedures in 2010

  31. Situation: • Using reusable gowns and basins for 15 years • Performed waste audit • 10 million pounds of waste annually • $1.35 million on waste disposal • Shift to disposables - gowns, basins, towels, bluewrap, canisters get thrown away

  32. Strategy: • Green team • LCA of reusables vs. disposables • Reviewed purchasing • Reusable gowns, drapes, table covers, basins • Avoided cost of waste disposal and savings from return of discarded instruments – essentially same expense • Reviewed staff preference, quality and safety • Uses third party company • provide reusable products, collects, sterilizes and repackages custom made OR packs daily

  33. Outcomes: • 138,748 pounds of waste diverted in 2010 • 1.5 million pounds diverted since 2000 • $38,000 savings in avoided waste disposal costs in 2010 • $722,250 in avoided waste disposal costs since 2000 • Average $39,000 in returned instruments yearly • Staff satisfaction

  34. Reformulate OR Kits/Procedure Packs • Review packs • Take out excess supplies • Reduce supply cost • Reduce waste volume and cost

  35. Case Study: OR Kit Reformulation • University of Minnesota Medical Center, Fairview • 2,000 – bed academic medical center • 21 operating rooms • 6,135 surgeries in 2010

  36. Problem: • Huge volume of waste from the operating room, much of it unnecessary - unused, disposable items • Packaged surgical kits for various procedures contain a number of supplies and equipment • Physician preference • Unnecessary for procedure • Once opened, unused items no longer considered sterile, thrown away

  37. Strategy: • Surgeon leader • Reviewed disposable items in OR kits • Port placement procedure kit for chemotherapy • 44 items to 27 • 1 pound of waste per case, $50 • Waste reduction strategies • Smaller bottles for prep solution • Smaller bottles for saline • Another pound of waste per case • Presented information to OR staff, developing hospital’s Green Team • Reviewed another 38 OR kits, identifying unnecessary items • Gauze dressings, plastic basins, styrofoam trays, plastic cups, syringes • Collaborated with vendors to remove items

  38. Results: • Reviewed 39 OR kits • Waste reduced by 10,553 pounds • $116,215 savings in supplies • More than $2,000 savings in avoided RMW disposal costs

  39. Reusable Sterilization Containers • Decrease supply costs • Decrease waste • Reduce rewrapping and flash sterilization • Reduce ergonomic wrapping injuries for SPD staff • Short payback period

  40. Chemicals • Transition to PVC-free and DEHP-free medical supplies • Eliminate worker exposure and climate change impacts from waste anesthetic gases • Minimize worker and patient exposure to laser generated air contaminants (LGACs) • Green cleaning equipment

  41. Energy • Economizer Operation of Air Handling Units • Utilize Low Energy Dehumidification Systems • Timely Replacement of HEPA Filters (when required) • HVAC Setback Programs for Unoccupied ORs • Occupancy Sensors for Lighting • Transition to LED Surgical Lighting

  42. Case Study: Energy Efficiency in the OR – HVAC Setback Program • Providence St. Peter Hospital • 340-bed • 11 operating rooms • 8,300 surgeries in 2010

  43. Problem: • OR is incredibly energy intensive • Highest air change requirements (15) of any area in hospital • High level filters to reduce particulates • Electricity and natural gas costs through HVAC system • Equipment such as medical gas vacuum pumps, diagnostic and monitoring equipment, and surgical lighting • Most OR’s empty between late evening and early morning, but same number of air changes still occurring

  44. Strategy: • Review staff needs, comfort level, education • Installed occupancy sensors tied to HVAC system • No motion for 60 minutes, HVAC to unoccupied – 6 changes/hour • Two ceiling mounted, infrared, independent sensors set at high sensitivity • 3 minute delay for start-up, red flashing light outside indicating “Unoccupied Mode” • Received grant funding for portion of project

  45. Results: • 60% setback in the two OR’s • Reduce air by 60% when unoccupied 47% of the time • 25,000 kWh energy savings • 2,460 therm energy savings • $4,091 cost savings • OR’s energy usage now 1% of total energy usage

  46. Built Environment • Utilize epoxy-free wall and surface coatings • Purchase urea-formaldehyde-free casework and cabinetry • Transition to PVC-free and phthalate building finishes and materials • Rubber flooring reduces slips, staining and improves ergonomics

  47. Greening the OR can save $$$ annually • $86,460 saved on fluid management • $400,000 on SUD reprocessing • $15,000 on RMW minimization • $6,000 on recycling in the OR • $16,186 on rigid sterilization containers • $116,000 through OR kit reformulation *Savings incurred in individual hospitals over a one year time-frame

  48. Learning Community • Sharing best practices • Piloting new initiatives • Research and data to support initiatives • Ways to help hospitals make the business case

  49. What We’re Learning

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