Protect your patients and their environment

Going 'green' can save money, involves staff

Although patient care is the No. 1 priority for outpatient surgery managers and staff members, a growing number of health care employees are recognizing that their workday activities can affect more than a patient's health. They also can affect the environment.

"Many of us recycle and conserve resources in our homes because it is easy to see how to do these things in our personal life, and it is harder to see how to carry this philosophy into our professional lives," says Gary Laustsen, PhD, APRN, assistant professor of nursing at the Oregon Health and Science University in La Grande. Surgery programs provide a wide range of opportunities to decrease waste, conserve resources, and recycle, he says. "We can't solve all of the environmental problems of the world, but we can start with small things, and the effects add up to a bigger impact."

In Boulder, CO, the effort to reduce the amount of blue wrap used in the sterile processing area resulted in a 50% decrease in the amount of waste material, or approximately 11 tons annually, which translated to a yearly financial savings of $111,000, says Julie Moyle, RN, MSN, surgery manager at Boulder Community Foothills Hospital. Such efforts prove that environmentally friendly efforts can be presented to administrators as potential cost savings, Moyle says. "Reducing waste is the right thing to do for the environment, but sometimes you need to prove that a change in protocol or materials used will also be a sound business decision."

Her hospital system has an environmentally conscious, or "green," culture, which reflects the philosophy and beliefs of the surrounding community, Moyle says. Thus, it makes sense that all employees look for ways to recycle and conserve resources, she says. Her facility opened in 2003 and was constructed as a "green" facility with features that enabled her staff to easily conserve resources from the beginning, but her surgery staff are always coming up with new ways to reduce waste and recycle, she reports.

"One of my nurses set up a recycling cart at the employee entrance near the time clock," says Moyle. Surgery employees, as well as other hospital employees, are encouraged to place packaging or other items on the cart for everyone to sort through in case they need boxes, bags, or even irrigation bottles for projects at home, she explains. "One of our pharmacists is using irrigation bottles from the cart as mini-greenhouses for seedlings that will be transplanted to a garden in the spring," she says. "The key to finding environmentally friendly projects that work is to be creative."

Finding ways to recycle materials is one way to reduce the amount of waste that must be disposed of by incineration or by burial in a landfill, says Laustsen. "Saline bottles that have expired dates or 4-by-4 bandages that have been opened but unused and are clean but not sterile, can be used by local veterinarians," he suggests. Other supplies such as unopened packs, blue sheets, or gowns can be donated to international medical relief organizations, he adds.

You also can reduce waste by controlling what comes into your surgery program, says Laustsen.

"Work with vendors to minimize packaging and to customize packs to include only the most commonly used items," he says. If you notice that an item is routinely not used by most surgeons, leave it out of the procedure pack and have it available as a separate item for use by the few surgeons who may use it, Laustsen suggests.

The biggest culprit of inappropriate disposal of waste is red bag waste vs. regular trash, says Laustsen. In a study he performed at one hospital, a red bag was removed from an operating room following a procedure, and each item in the bag was removed and inventoried as legitimate red bag trash or regular trash, according to state guidelines for regulated medical waste. "I found that 97% of the trash should have been placed in the regular trash bag," Laustsen says.

Not only can red bag trash be up to 10 times more expensive to dispose of, but the incineration of items such as intravenous bags and tubing can release dioxin into the atmosphere if the incinerator's temperature is not high enough, Laustsen points out. "The less inappropriate trash that we put into the red bags, the less chance that dangerous chemicals will be released into the atmosphere," he adds.

In addition to routinely reminding staff members what items are red bag trash and what items are regular trash, Moyle suggests that trash bins for regular trash be easily accessible to staff members. "In our operating rooms, the red bag container is actually difficult to reach for most staff members, and the regular trash container is more convenient," she says. This placement reminds staff members that the majority of trash does not have to go into the red bag, Moyle adds.

While the idea of reducing waste throughout the surgery program may seem overwhelming, the first step to take is to conduct a waste assessment, suggests Laustsen. The assessment will give you a good idea of how your program is handling waste, what waste you generate, and how the waste disposal affects your program financially, he says. After the assessment, you can identify which areas you want to address first, Laustsen adds.

Don't try to make all of the changes at one time or address every area at once, warns Moyle. "Start small and choose a project that will produce results that everyone will notice," she recommends. "Report those results in clear, easy-to-understand language that lets employees know how their efforts positively affected the environment." For example, if you reduced water consumption over a period of time, don't just report the number of gallons saved; instead, tell employees how many five-minute showers that represents, she suggests.

When evaluating your waste disposal procedures, don't forget medications, says Laustsen. "If you have to waste a narcotic, don't pour it down the sink," he says. "That just puts the drug into our water system," he points out. Pour the medication into a trash bag, he suggests. "There's no danger of anyone getting that narcotic as it soaks into other trash."

Overall, health care employees are very receptive to opportunities to have a positive effect on the environment, says Laustsen. "People are usually not resistant, just ignorant of the opportunities that exist in a surgery program," he says. "The key is to explore alternative ways to approach conservation and waste reduction, and to take baby steps as people get accustomed to the new approach."