Going green can help environment, boost your facility's bottom line

A primary focus of outpatient surgery managers used to be the bottom line. Now many are finding themselves aiming to succeed at the "triple bottom line": people, planet, and profit, says Ravindra Gupta, MD, hospitalist and co-chair of the Sustainability Committee, Inova Health System in Falls Church, VA.1

Health care facilities with environmentally friendly practices have been shown to increase financial gains, improve patient outcomes, boost staff health, reduce staff turnover, and improve their image in the community, according to Practice Green Health, an organization for health care facilities that are committed to sustainable, eco-friendly practices.

However, you shouldn't brashly jump into recycling or reprocessing, says Seema Wadhwa, LEED AP, sustainability engineer at Inova. "One of the first steps is to create an environment where people understand the impact their practices have on the environment, and correlating that to financial savings," she says. "All of these cost savings are contingent on having a green culture."

At Bronson Methodist Hospital in Kalamazoo, MI, surgery nurses have been leaders in making the hospital environmentally friendly for more than 20 years.

Surgery nurses are detail-oriented and aware of waste, says Connie A. Sargent, RN, BC, CNOR, staff nurse in outpatient surgery, who spoke at last year's meeting of the Association of periOperative Registered Nurses (AORN) about environmentally friendly practices. "They see it every day as they turn over rooms and prepare supplies, Sargent says. "They are very aware of things they generate that go into environment. It makes them want to be on board for cost savings, but also for saving the environment."

Hospital saves $410,000 annually

Reducing Bronson's regulated medical waste from 45% of the waste stream, with a significant amount coming from surgery, to about 6% of the waste stream has saved the hospital $410,000 annually, according to Lisa Hardesty, MA, CHCC, HEM, environment of care and sustainability manager. Hardesty also spoke at last year's AORN meeting on environmental issues.

The hospital placed recycling containers throughout the surgery department.

"In outpatient surgery, the key was making sure nurses understood regulated medical waste, and were adhering to our internal policies and procedures," as well as Occupational Safety and Health Administration (OSHA) requirements, Hardesty says.

Regulated medical waste costs $600 a ton for disposal, she points out. In comparison, general waste only costs $45 a ton, she reports.

"Just by properly segregating medical waste, you will pay for the entire program," she says.

Once medical waste was being properly segregated, the next focus was recycling, which costs $25 a ton. Surgery piloted the recycling program for the hospital. "They proved it could be done successfully," Hardesty says. The surgery department recycles paper, cardboard, packing materials, plastics, glass, metal, ink toner cartridges, and batteries, Sargent says.

The program was successful because the recycling bins were put in appropriate and convenient locations, Sargent says. In the surgery area, they were placed between ORs in a substerile room, in pre-op, and in recovery. Even the physicians have bought in and are aware that some products have recyclable paper, she says.

The cost for waste and recycling containers for all 19 of the operating rooms and the procedure room was $1,610, Sargent says. Hardesty says "That's a fraction of your savings."

You also save money with recycling because you pay more taxes on the general waste than you do on the recycling material, says Sonja Wilcox, RN, CNOR, ONC, lead OR nurse at Minnesota Valley Surgery Center in Burnsville. Wilcox suggests that you meet with your waste management provider before you begin recycling to ensure that they approve of your recycling clean products. "They were very on board with it all," Wilcox says.

It's critical to have support personnel who will pick up the recycling, Sargent points out.

In addition, clean, unused items from packs are sent to local schools, nonprofit organizations such as the local free clinic and the YWCA, and overseas medical missions including International Aid (www.internationalaid.org) whenever possible. One staff person who participates in annual mission trips takes many items home to store for those trips.

Saving with O2 bottles and packs

Changes were made in the recovery room, too. Bubblers were reduced from 1,000 cc to 500 cc plastic bottles, which eliminated the waste generated by use of this product by 50% and reduced costs. "Sure enough, it saved money, and also there was less plastic going into the environment," Sargent says.

A change was made from disposable to reusable component packs. Gowns were eliminated from every pack, and several disposable custom packs were replaced with reusable components. After analyzing the components of its custom packs and eliminating less frequently used items, Bronson saves about $26,000 each year. "We had a theory: If we couldn't use it 75% of time, by 75% of surgeons, we would delete certain items in the pack," Sargent says. Also, gowns were changed from disposable to reusable.

Wilcox says that once you've reduced your packs, you should periodically review them "to make sure constantly you're not wasting anything in those packs."

Orthopedics is one example, Wilcox says. "Ortho is an ever-changing beast," Wilcox says. "If the technique has changed, ask, 'Do we need this in the pack?'"

Wilcox buys packs from Presource (www.cardinal.com/us/en/brands/presource), which will periodically make online recommendations about how to save money with the packs such as changing brand names.

Cutting back on blue wrap

Bronson's surgery department also increased its use of metal instrument containers, which reduced the amount of blue wrap, Sargent says. "It's a little more expensive up front, but in the long run, I think it saved money and what goes into the trash," she says.

Preference cards also were made more generic to reduce the amount of paper needed.

If you are wondering where to start with an environmentally friendly program, consider setting up a "green team" to focus on minimizing waste. At Bronson, the outpatient surgery department had the hospital's first such subcommittee. Such teams can include reprocessing, recovery, pre-op, surgery, administration, education, and the clinical coordinator, Sargent says. Include environmental "champions" who won't be reluctant to educate and speak up when someone isn't recycling, she advises.

"The broader you can make the green team to represent the whole area, the more support you will have," she says.


  1. Gupta R. Greening the health care sector. EP Lab Dig 2009, 9. Accessed at www.eplabdigest.com/articles/Greening-Health-Care-Sector.


For more information about the sustainability program at Inova Health System in Falls Church, VA, go to www.inova.org/about-inova/sustainability/index.jsp.

Groups that have information about good environmental practices for health care organizations include:

  • The Green Guide for Health Care. Web: www.gghc.org. The Green Guide for Health Care, a project of the Center for Maximum Potential Building Systems and Health Care Without Harm, is a voluntary, best practices green building and operations toolkit. It is available as a free download from www.gghc.org.
  • Practice Greenhealth. Web: www.practicegreenhealth.org. Practice Greenhealth is a networking organization for health care that have made a commitment to sustainable, eco-friendly practices.
  • LEED (Leadership in Energy and Environmental Design) for Healthcare. Go to www.usgbc.org and select "LEED." LEED is a green building certification system developed by the U.S. Green Building Council (USGBC). It provides owners and operators a framework for green building design, construction, operations, and maintenance.