By Don Sadler
When it comes to sustainability, healthcare is lagging behind many other industries. The health care industry accounts for about 10% of all greenhouse gas emissions in the U.S.
Operating rooms are considered to be the main energy consumers and waste producers within hospitals, using up to six times more energy than the rest of the hospital and generating more than half of a hospital’s waste.
The good news is that awareness of the importance of sustainability seems to be increasing among perioperative professionals. A study published in the Journal of the American College of Surgeons detailed how rethinking the delivery of surgical care to focus more on sustainability interventions could substantially decrease the ever-growing carbon footprint of ORs while also reducing costs.
An Opportunity for Leadership
“Surgeons have an opportunity to really be leaders in this space, mainly because the single biggest producer of waste is indeed the operating room,” said study coauthor Mehul V. Raval, MD, MS, FACS, a pediatric surgeon at the Ann & Robert H. Lurie Children’s Hospital in Chicago, in an article published at facs.org.
“The opportunity to reduce our carbon footprint falls squarely on us,” said Raval. “I see surgeons taking a prominent role in leading efforts, not just locally with their green implementation teams, but in setting national standards and policies that will move this effort forward for an overall sustainable way of approaching healthcare delivery. There’s a lot of enthusiasm around this topic.”
According to Jeff Kremer, senior director of business development for Henry Schein Medical’s ASC Division, if the healthcare sector were a country, it would be the world’s fifth-largest emitter of greenhouse gases.
“By adopting sustainable practices, healthcare organizations can reduce costs, improve efficiency and enhance their environmental impact,” says Kremer. “This benefits patients by ensuring access to quality care and contributes to a more sustainable future.”
Reducing the OR’s Environmental Footprint
Sarah Ripley, RN, is an experienced perioperative nurse, sustainable health care consultant and climate change advocate in Adelaide, South Australia. She is dedicated to promoting ecological responsibility and health equity by integrating sustainability into health care practices, with a dual focus on people and the planet.
In 2023, Ripley was appointed South Australia’s first Environmental Sustainability Project Officer within SA Health. In this role, she developed and implemented SA Health’s inaugural Environmental Sustainability Strategy.
“To me, OR sustainability means supporting and implementing practices that actively reduce the OR’s environmental footprint and contribute to the global reduction of greenhouse gas emissions,” says Ripley. “While patient care is my top priority, I also recognize my responsibility to integrate environmental and sustainable practices into my work to protect the health of future generations and care for our planet.”
According to Ripley, OR sustainability is crucial because the OR is one of the most resource-intensive areas of a hospital. “The OR uses large quantities of single-use products, which account for approximately one-fifth of total hospital waste,” she says. “And the OR is three to six times more energy-intensive than other hospital areas.”
“By implementing sustainable practices in the OR, we can significantly reduce waste, energy consumption and the environmental impact of health care, contributing to global efforts to mitigate climate change,” adds Ripley.
In her role as environmental sustainability project officer, Ripley spearheaded a “green team” that was devoted to decarbonizing the OR. “We optimized PVC recycling, alternate fuel waste stream and replaced single-use PPE and anesthetic trays with reusable alternatives,” she says.
“I also initiated conversations around reducing the use of Desflurane and developed a phased approach to eliminate it entirely from the OR department,” Ripley adds. “While some staff were initially resistant, they gradually embraced these changes as we made the processes simple, provided education sessions and ensured a robust presence of green champions to offer support.”
Achieving Sustainability in the OR
Sustainability in the OR can be achieved in several different ways, such as by reducing waste, improving efficiency and promoting environmentally friendly practices. One of the most wasteful OR practices is the prevalence of single-use devices, says Ruth Plotkin Shumaker, MS, BSN, RN, CNOR, executive consultant with Perioperative Consulting LLC.
“Single-use devices, particularly disposable laryngoscopes, contaminate the environment and are a source of considerable cost,” says Shumaker. “With the switch to single-use laryngoscopes, only a handful of reusable devices are now used in many facilities. While this trend resulted from a preference for convenience and concern for cross-contamination, the environmental impacts have been monumental.”
Ripley also stresses the importance of repurposing single-use devices.
“We’ve been able to reprocess single-use items like tourniquets and blood pressure cuffs by sending them to be reprocessed and resold for reuse,” she says. “We also introduced reusable PPE in the perioperative department and replaced single-use anesthetic trays with reusable alternatives.”
According to the Association of Medical Device Reprocessors (AMDR), nearly 12,000 hospitals and ASCs saved more than $465 million and eliminated 98 million pounds of greenhouse gas emissions in 2023 by using regulated, reprocessed single-use medical devices. AMDR believes this represents a small fraction of the full amount that could be saved if hospitals and ASCs maximized their reprocessing programs.
Another source of waste in the OR are “just in case” practices, such as opening or preparing supplies and medications that often go unused.
“This leads to significant waste,” says Ripley. “Up to 20 percent of surgical items listed on preference cards are discarded or reprocessed unnecessarily.”
To mitigate this waste, Ripley suggests regularly updating surgical preference cards and ensuring that only necessary items are opened at the start of a procedure, rather than preparing extras “just in case.”
“To prevent these items from ending up in landfill, we donate them to local veterinary clinics, giving them a second life while reducing waste,” says Ripley.
Jennifer Kim Field, vice president and chief sustainability officer at Henry Schein, offers several suggestions for reducing waste in the OR.
“For starters, replace single-use plastics with reusable or recyclable alternatives whenever possible,” says Field. “Continually evaluate and enhance custom procedural packs to help eliminate excessive, unused products. And train your staff on proper waste segregation and disposal techniques to minimize hazardous waste.”
Improving OR Efficiency
To improve efficiency, Field recommends exploring renewable energy sources, such as solar power or energy-efficient equipment, and working toward implementation.
“You can also mitigate environmental impacts by assessing order patterns and rush shipping requests against planned clinical needs,” she says. “Consolidating orders will help reduce the number of deliveries and resulting emissions.”
Ripley says that smart procurement practices, such as selecting products with minimal environmental impact, play a critical role in improving OR efficiency. “Embedding sustainable practices into the operating room enables organizations to achieve both environmental and economic benefits while maintaining high standards of patient care,” she says.
According to Shumaker, medical waste is usually incinerated.
“While incineration is effective, there are environmental concerns,” she says. “Incinerators emit dioxin, mercury and metals into the air, which damage air quality and can negatively impact human health. Incinerators also use a significant amount of fuel and generate excessive greenhouse gases.”
Eliminating unnecessary single-use supplies can help solve this problem. This includes plastic gloves, which can often be replaced with simple handwashing. All clean plastics, paper, cardboard, glass and metals should be segregated and recycled instead of incinerated.
Shumaker points to a health system in New Jersey that reduced its use of surgical blue wrap by one million pounds annually.
“Overlook Medical Center estimates their recycled blue wrap tote bags prevented the use of 100,000 plastic bags and saved the hospital $30,000 in waste handling costs,” she says. “In addition to making tote bags, they recycled blue wrap into sleeping bags for people experiencing homelessness. This puts the ‘purpose’ in ‘repurpose’ in the best kind of way.”
OR Sustainability Obstacles
Despite a sound business case for sustainable OR practices, convincing surgical teams to consider changes is one of the most significant challenges to improving sustainability in the OR.
“Given the overwhelming benefits of sustainability, hospitals and ASCs should be seeking ways to improve OR sustainability and efficiency, reduce overall costs and improve the patient experience,” says Shumaker.
Many large U.S. health systems today understand the importance of sustainability from a corporate citizenship and financial perspective.
“However, most ASCs continue to struggle with translating sustainability strategies into implementable processes and workflow improvements,” says Kremer. “Meanwhile, our European market partners are among the leaders driving action within health care systems to reduce carbon emissions.”
Kremer points to several challenges and obstacles to improving sustainability in ORs and ASCs, including:
- Limited awareness and resistance to change. “Stakeholders may lack awareness of sustainability’s importance,” says Kremer, “and some are reluctant to adopt new practices.”
- Misconceptions about reprocessed devices. Kremer says that despite stringent quality assurance standards, some surgeons have a perception that single-use devices perform better than reprocessed devices.
- Cost considerations. Hospitals and ASCs must balance the supply and demand of sustainable solutions with potential long-term cost savings.
- Scarcity of green products. “The absence of standardized sustainability criteria for medical devices and products can hinder the availability of environmentally friendly options while maintaining rigorous infection control standards,” says Kremer.
Ripley points to a lack of leadership as one of the main barriers to improving OR sustainability.
“Visionary and responsive leadership is crucial for driving the necessary changes to boost OR sustainability,” she says. “For us, a few doctors educated the team on the ‘why’ behind the need to decarbonize, emphasizing its importance for both people and the planet.”
“We also adopted the Kotter model for leading innovation and change, which recognizes that people often resist change,” Ripley adds. “By involving staff in the journey and highlighting that sustainability wasn’t about adding extra work, but rather integrating sustainable practices into their existing work, we made the transition smoother.”
Embed Sustainability in Everyday Practice
Meaningful sustainability progress will require a more integrated approach “where sustainability is not only a corporate priority, but it is embedded in everyday clinical practice,” says Ripley. “This will ensure that healthcare professionals are supported and equipped to make sustainable decisions in patient care. The passion and dedication of these professionals is key to shaping the future of sustainable healthcare.”
Ripley believes her efforts to boost sustainability in the OR underscore the power of passion and persistence.
“It started with a small ripple that is now expanding,” she says. “These efforts exemplify how meaningful change is achievable when individuals believe in their capacity to make a difference.”
Field stresses that it’s never too late to take action to improve sustainability in the OR.
“Becoming more sustainable is a journey and the key is taking the first step,” she says. “Collectively, we can make a difference and promote a healthier planet for healthier people.”
