By Kelly M. Pyrek
The healthcare industry is rife with opportunities to reduce the environmental impact it creates, with the added benefits of institutional financial gain, improved patient outcomes, better staff health and reduced turnover, and community benefit, according to a report from Practice Greenhealth and from the Institute for Innovation in Large Organizations.(1) An increasing number of healthcare institutions are endeavoring to reuse, recycle and repurpose medical supplies and devices to promote better sustainability.
“With the healthcare sector accounting for a large part of the U.S. carbon footprint – 8 percent, according to a 2009 JAMA study(2) – industry involvement in and support of sustainability efforts is no longer a question of ‘why’ or ‘when,’ but of ‘how,’” says Lars Thording, senior director of marketing and public affairs for Ascent Healthcare Solutions. “Although a commitment to sustainability is about reducing environmental impact, it is also inexorably tied to the issues of cost and quality care. These are top issues in the burgeoning reform of healthcare. A sustainability measure is not realistic and cannot be effectively implemented if it does not take into account impacts to cost and patient care.” Thording continues, “A positive sign of progress is that hospital sustainability coordinators and green teams are on the rise. They are helping to guide purchasing decisions and are formulating policies for hospital employees. But a green team isn’t enough. Nurses on the hospital floor, surgeons in the OR, administrators and suppliers are all a part of the solution.”
Healthcare professionals should be conscious of how healthcare contributes to the waste stream. “The hospital industry generates multiple types of waste that can be categorized into 10 waste streams,” explains Debra Gillmeister, MBA, a director for Stericycle’s healthcare service division. “Eighty percent are highly regulated, such as regulated medical waste (RMW), pharmaceutical waste and hazardous waste. Each of these must be properly segregated and disposed of to insure that the environment is protected and that laws and regulations are followed. Effective segregation diminishes total waste and the facilities’ carbon footprint.” Gillmeister is a former advisory board member for the American Hospital Association’s American Society for Healthcare Environmental Services.
Gillmeister points to the aforementioned JAMA study and notes, “The healthcare industry operates 24/7 similar to the airline industry, yet unlike plane schedules that may decrease during off-peak hours, hospital emergency departments and associated trauma services are always open and often at, or over, operating capacity. This factor contributes to the significant energy utilization by hospitals. Fortunately hospital leaders are becoming increasingly aware of their impact on the environment. One example is the number of hospitals starting green teams. Data from more than 800 attendees at Stericycle’s educational seminars found that 54 percent of hospital respondents have established a green team, with many more facilities planning to establish one.”
Gillmeister says that the country’s 5,000-plus hospitals are beginning to understand that 80 percent of their waste streams are highly regulated. “While volume and disposal costs vary based on geographic location and facility size, all should focus on appropriately segregating waste streams,” she says. “Key to appropriate segregation is staying compliant and developing environmentally sustainable practices.”
Developing sustainable best practices requires modification of staff behavior, Gillmeister emphasizes, adding, “This occurs most frequently through ongoing staff education. Education and supporting processes are one of the most critical elements to effectively managing waste streams, and appropriately segregating all forms of medical waste. With an increased awareness of these waste streams, many hospitals are making strides towards a coordinated management by implementing a facility-wide green approach, including the formation of green teams. In 2009, Practice Greenhealth (PGH) surveyed 1,550 hospitals (473 were PGH members who are committed to sustainable, eco-friendly practices), 67 percent created a team or committee for environmental sustainability planning.”(3)
In general, Gillmeister says that healthcare-related green efforts could include:
-- Garnering senior management support and initiating an interdisciplinary team
-- Eliminating solid waste that can be recycled such as glass, cans, boxes, paper, etc.
-- Assuring that the hospital formulary has been characterized so that hazardous and non-hazardous pharmaceuticals can be kept out of the environment
-- Appropriately segregating and disposing of pharmaceutical waste
-- Use of reusable container systems for sharps and pharmaceutical waste, not single use disposable containers
“As greening efforts evolve, reusable containers reduce landfill waste and dramatically reduce the amount of carbon released into the environment, therefore improving air quality. For long-term water quality, a hospital’s green team could implement a comprehensive pharmaceutical waste compliance program that helps keep pharmaceuticals out of the water,” Gillmeister adds.
The Operating Room Goes “Green”
There are several areas in the healthcare institution that lend themselves particularly well to sustainability efforts. One of the most significant is the operating room. A sweeping and prescriptive path to green the nation’s operating rooms is underway by Practice Greenhealth, a membership and networking organization for institutions in healthcare that have made a commitment to sustainable, eco-friendly practices.
The "Greening the OR Initiative" is examining a range of interventions that will not only reduce the environmental impact of the OR, but also potentially reduce cost, increase quality and improve worker or patient safety. Among the areas for ”green” interventions in the operating room are single-use device (SUD) reprocessing; using reusable gowns, surgical drapes, basins and other reusable products;
fluid waste management systems; lighting and patient thermal comfort; regulated medical waste minimization; substituting reusable hard cases for sterile wrap; recycling medical plastics; “green” cleaning and disinfection in a surgical setting; and donating unused medical equipment and supplies instead discarding them.
“Ascent has been working with Practice Greenhealth and other stakeholders from major hospital systems, manufacturers, government agencies, and hospital staff to help the healthcare industry reduce the environmental footprint of our nation’s hospitals, and in particular their operating rooms,” Thording says. “The outcome will be a series of Greening the OR best practices guidance documents, including case studies and implementation recommendations. Reducing the environmental footprint of operating rooms is going to require both large and small changes. The Greening the OR best practices guidance Documents will address these 12 categories with specific recommendations for infrastructure changes, as well as more basic policy changes and educational efforts that aim to shift how OR staff think about the environmental impact of their daily actions. Reprocessing programs, for example, don’t require major infrastructure change in order to implement.
“For most hospitals, the benefits of ‘going green’ in the operating room are considerable: reductions in energy and water use, a reduction in staff exposure to toxic chemicals, increased patient and staff safety, and a much-reduced impact on the environment,” says Bob Jarboe, executive vice president of business development for Practice Greenhealth.
According to Practice Greenhealth, “Operating rooms are some of the most resource-intensive and waste generating places in a hospital, generating between 20 and 30 percent of a facility’s waste. Much of that waste is disposed of as regulated medical waste, which costs 10 to 15 times more in disposal fees than regular waste. Half of budgets for operating rooms are generally spent on supplies that are thrown out, being used once or not at all during procedures, even though re-use may be an option. Likewise, it is a significant cost-center for materials, devices and supplies.”
“The most basic ways to reduce medical waste stream are through conservation and re-use,” Thording says. “Looking at how resources in general are used responsibly is a dedication that leads directly to the selection of resource strategies that are about re-use and reduction of unnecessary costs. Reprocessing has an obvious impact in some of the most waste-intensive areas of the hospital: the OR, EP Labs, and wherever non-invasive devices are used.”
Thording says that reprocessing of medical devices has a strong sustainability component to it. “Evaluating your facility’s responsible medical device strategies is an impactful way to reduce your medical waste stream,” he says. “Purchasing reprocessed SUDs offers immediate environmental benefit and cost savings with no capital investment. Reprocessing programs are currently employed by more than 50 percent of U.S. hospitals, and more than half of the U.S. News & World Report ‘Honor Roll’ hospitals. They have become proven solutions for addressing medical, economic and environmental responsibilities without compromising safety or efficacy. A commentary from Johns Hopkins in Academic Medicine(4) recommends reprocessing as a means for curbing costs while reducing their environmental footprint.”
Thording continues, “Reprocessing allows hospitals to deploy more of their scarce resources to enhance patient care through quality initiatives. Each hospital can decide where to re-direct their cost savings based on its greatest needs, which could include hiring staff or purchasing equipment. For some hospitals, cost savings from reprocessing can make the difference between hiring and firing a nurse. In addition to direct cost-savings, some hospitals are experiencing an unexpected benefit from purchasing reprocessed devices. They are using the lower-cost devices as leverage when negotiating the price of single-use devices with original equipment manufacturers (OEMs). The environmental benefits are intuitive: by putting a reprocessing program in place, hospitals are not just recycling the materials, but also buying those devices back and re-using them, thus keeping those devices out of landfills. In addition, hospitals can expect to pay about 50 percent less for a reprocessed medical device versus what they would pay for the same device labeled as ‘single-use’. Administrators understand that they’re not only saving 50 percent of the purchase cost for each device, but they’re also saving money that would be spent on special handling and waste management of that device were it discarded into the waste stream without further re-use.”