SAINT LOUIS UNIVERSITY

College of Nursing
Baguio city

JOURNAL

Wastage of Supplies and Drugs in the Operating Room

Roy K. Esaki, MD; Alex Macario, MD
Authors and Disclosures
Posted: 10/21/2009

Submitted By:
Naulgan, Tzietel Dee C.
SLU-BSNIV
Section N Group No. 1
 Wastage of Supplies and Drugs in the Operating Room
Roy K. Esaki, MD; Alex Macario, MD
Authors and Disclosures
Posted: 10/21/2009
Introduction

Anyone visiting an operating room would be impressed by the staggering amount of garbage produced
even after a simple 90-minute surgery. In fact, a routine operation in a hospital often produces more waste
than a family of 4 might produce in an entire week. One reason operating rooms generate so much waste
is the need for absolute sterility of surgical supplies and equipment, which creates the need for extra
packaging and creates an impetus for the use of disposable equipment. There is a large environmental and
financial cost to such waste, however, and it is especially important in these times to be mindful of such
concerns. As such, this article will review what is known about waste generation in the hospital and
operating room and will discuss various waste management strategies.

Hospital Waste

A landmark study from almost 2 decades ago (performed at a 385-bed private teaching hospital) found
that 6.6 kg of waste was generated per patient per day, and estimated that 41 tons of operating room waste
(compared with 11 tons from the wards) could be saved if reusable alternatives were available. [1] The
main components of hospital waste include plastics (46%), paper (34%), liquids (12%), glass (7.5%),
metals (0.4%), and anatomic waste (0.1%). [2] Waste management strategies should be implemented
hospital-wide, and beyond patient-care areas. For example, cafeterias may produce more than twice the
amount of plastic waste than that generated by anesthetic tubing used in the operating room. [3]

Surgical Waste in the Operating Room

Based on anecdotal reports in the United States, it has been estimated that operating rooms generate 20%-
33% of total hospital waste,[4,5] even though the surgical suite represents a proportionally smaller area of
the hospital (Figure).

Figure. Waste generated from blood and other

fluids administered to a patient undergoing a major
surgical procedure.

In addition to packaging and intentionally

disposable supplies, surgical waste can also involve
more costly medical devices. A study of joint
replacement surgery found that the knee or hip
implant, each of which may cost thousands of
dollars, was wasted in 2% of the procedures. [6] The
reasons for the implant waste included potentially
avoidable causes such as improper trialing, failure to
check implant size and model before opening the
package, and dropping of the implant.

Anesthesia-Related Waste in the Operating Room

Potential anesthesia-related waste might include items such as syringes, bottles and vials for anesthetic
drugs, and airway equipment and hoses. Historically, the waste of anesthetic gases (eg, nitrous oxide and
inhaled anesthetics) has been of concern, as less than 5% of the inhaled anesthetic is metabolized by the
patient, with the majority being eliminated by patient breathing. [7] Modern scavenging systems minimize
the exposure of operating room personnel to these waste gases, but the waste gases are ultimately emitted
into the environment. Reducing expired anesthesia gas would reduce the greenhouse gas nitrous oxide
and its potential effect on global warming. Fortunately, the two most commonly used anesthesia gases,
sevoflurane and desflurane, contain neither chloride nor bromide, and thus should not pose a threat to
stratospheric ozone and are less likely to be potential greenhouse gases. [8]

Another anesthesia-related concern is drug waste, which occurs when medications are drawn up but are
unused and discarded at the end of the day. In one study, all opened but unused or unusable intravenous
anesthesia drugs left over at the end of the day were collected for 2 weeks. [9] Thirty different drugs in 57
syringes and 139 ampules were collected from 166 cases, amounting to an average cost per case of $10.86
for discarded drugs. The medications contributing to the greatest cost of waste were phenylephrine (21%),
propofol (15%), vecuronium (12%), midazolam (11%), labetalol (9%), and ephedrine (9%).

A separate study of 25,481 surgical patients calculated the percentage of drug actually administered to
patients relative to the amount dispensed. [10] Only 33% of the succinylcholine prepared for a patient was
administered, meaning that two thirds of the prepared drug was wasted. Similarly, 51% of propofol, 47%
of midazolam, and 39% of rocuronium was prepared but not administered. The most common reason for
drug waste was need to dispose of full or partially full syringes. A separate study of pediatric anesthesia
found that 80% of epinephrine, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted, with
rocuronium and nalbuphine having the highest waste cost. [11]

Given these findings, it may be beneficial to use prepackaged anesthesia drug syringes that can be saved
for subsequent cases if unopened. This may be most useful in situations where many medications need to
be drawn up at the beginning of the day. Drug waste and cost of the syringe disposal could be reduced if
full but unused syringes could be saved and reused. [12]

In addition to medications, anesthesiologists commonly use various devices that are potential sources of
waste. Interestingly, some medical products (eg, the laryngeal mask airway) are brought to market in a
reusable form, and eventually evolve into a disposable, single-use unit. This can be attributed to the
marked reduction in the cost of the disposable airway, and elimination of the need to clean and sterilize a
multiuse device.[13] In contrast, other supplies that have traditionally been disposable may eventually
switch to a reusable form. For example, reusable warming blankets are being tested as an alternative to
disposable forced air warming blankets.[14]

Reduce, Reuse, Recycle, Restrict

An approach incorporating green practices to ongoing waste management for the operating room is to
apply the standard triad of resource conservation: reduce, reuse, recycle. To these Rs we also add
"restrict," which is the appropriate separation of regulated medical waste into the appropriate containers.

Reduce
The simplest way to reduce waste is to look for ways to reduce its production from the very outset when
the hospital contracts for and acquires materials that will later become trash. Individually packaged
components generate more packaging waste than prepackaged disposable kits. However, such grouped
packages may increase waste if not all items in the kit are routinely used, or if extra kits are regularly
opened to obtain only a single component that is not available individually. Many facilities carefully
analyze the contents of surgical and anesthesia kits to avoid the routine inclusion of disposable items that
are infrequently used.

In the United States, surgical items made ready for a particular case but not actually used during the
particular surgery are often discarded. This is because these items are deemed "unsterile" even if there has
been no contact at all with the patient. [15] Because of legal concerns and US Food and Drug
Administration regulations, prepared supplies designated for a patient are not usable on another patient.
However, such medical equipment can be collected and donated to hospitals in developing countries. [16,17]

Reuse
In a study published in 1997, the term "overage" was used to quantify surgical inventory that is readied
but not used and thereby wasted. [18] The acquisition costs of such overage ranged from $5-$13/case, with
neurosurgical cases having the highest overage dollar value. To address the overage problem,
investigators studied the effect of an intervention that consisted of several elements including: (1) an
education program, (2) reduction of surgical setups that created undue amounts of overage (while
ensuring ready availability of potentially needed supplies), (3) redesign of surgeon-specific supply pick
lists to correctly identify those items needed for a surgery, and (4) introduction of prepackaged supplies
for cardiac surgery. These interventions reduced overage costs by 45%.

If unused surgical and anesthesia items cannot be eliminated prior to unnecessary opening, then one
strategy can be to replace disposable items with reusable items as appropriate. For example, a hospital
that used reusable operating room attire saved $152,000 adjusting for inflation compared with another
hospital that used disposable scrub suits and gowns.[19]

One of the foremost concerns about reusable items is the potential infectious risks posed by inadequate
cleaning and sterilization. There can also be great associated negative public relations for the hospital if
such a thing occurs. This was recently highlighted in the national news when thousands of patients were
thought to be exposed to HIV and hepatitis because the tubing, pump, and reservoir used for colonoscopy
procedures were rinsed after use but not disinfected as required. [20]

Plastic anesthesia breathing circuits that are replaced after every surgical case also represent waste.
However, because of differences in regulatory culture and practice patterns, the reuse of breathing circuits
(with single-use filters to prevent cross-contamination) is common in many European countries but is rare
in the United States.

Recycle
When surgical or anesthesia items cannot be reused, recycling is another important mechanism to
decrease waste. Recycling bins can be placed in operating rooms and other perioperative areas where
regular trash bins are located. One barrier to this is that operating rooms are already quite full with other
equipment, and there may not be enough space for additional bins. A program at an Australian operating
room suite was able to recycle 200 kg per week of non-infectious polypropylene, polyethylene and
polyvinyl chloride.[22] Similarly, a labor and delivery suite recycled glass bottles used for local
anesthetics.[23] The actual money saved, however, was only a few dollars per week. To have a major
impact, these types of recycling programs would have to be one component of a portfolio of hospital-wide
green initiatives.
Restrict (Segregate)
When medical waste is inevitable, the appropriate restriction, or separation, of different classes of waste
can still be beneficial. Placing the waste into the correct bin can result in cost savings and environmental
benefits. A study published in 1996 described a program that disassembled and sorted breathing systems
(including circuits, masks, gas sampling lines, and breathing bags) into constituent components for
recycling instead of discarding them as regulated medical waste. [4] The authors estimated that this reduced
the regulated medical waste generated by the operating room suite by 22.5%. A more recent study from
Seattle Children's Hospital found that replacing hazardous medical waste bags with anesthesia waste bins
produced $20,000 savings over 6 months.[24]

Nonsharps waste is also commonly found in sharps containers, perhaps indicating uncertainty about what
items (such as uncontaminated needleless syringes) should be considered a sharp. Rigid sharps boxes in
the operating room may contain as little as 14% appropriate sharps by weight and less than 50%
appropriate sharps by volume. Given that disposal costs for sharps containers can be several times the
cost of other OR waste disposal, considerable cost savings may result from more stringently restricting
the usage of sharps containers to appropriate sharps waste.

Conclusion

I do agree On what this journal is trying to say, its very obvious to me that the operating room actually
produces a huge amount or number of trash/ garbage in just a single day, or even in just a short surgery
this maybe due to the hospital practice of sterile technique which says that “if in doubt, consider it
unsterile” and many more other principles of sterility. In the operating room at SLU in our first rotation I
also noticed that sponges, gloves, cottons, thread and many more are left behind after a surgery may it be
used or not, and I even noticed that supplies comes in pack containing 10 in each pack etch. It is the
responsibility of the nurse to estimate if a needed material or instrument is necessary but sometimes
nurses do over analyze and bring out supplies that are beyond the need. In this journal they are trying to
limit now the garbage and consider the principle of 3R’s which is reuse, reduce and recycle. In the reuse
aspect they say that Individually packaged components generate more packaging waste than prepackaged
disposable kits. However, such grouped packages may increase waste if not all items in the kit are
routinely used, or if extra kits are regularly opened to obtain only a single component that is not available
individually. That is Why it is better also if some supplies are not packed per surgery which is usually
done in the states all supplies in a certain surgery is already prepared but here in the Philippines they
seldom do that because of course we lack financial support. On the Reuse aspect they said that to address
the overage problem, investigators studied the effect of an intervention that consisted of several elements
including: (1) an education program, (2) reduction of surgical setups that created undue amounts of
overage (while ensuring ready availability of potentially needed supplies), (3) redesign of surgeon-
specific supply pick lists to correctly identify those items needed for a surgery, and (4) introduction of
prepackaged supplies for cardiac surgery. And finally on the recycle When surgical or anesthesia items
cannot be reused, recycling is another important mechanism to decrease waste. Recycling bins can be
placed in operating rooms and other peri operative areas where regular trash bins are located. These
interventions reduced overage costs by 45%. Many facilities carefully analyze the contents of surgical
and anesthesia kits to avoid the routine inclusion of disposable items that are infrequently used. If all of
these are practiced in the operating room then I guess they could earn some money generated from the
trash collected, they can minimize the gathered trash and they can also help the patient save in the
hospital bills because everything is charged to the patient. Medical waste is directly relevant to the
practice of medicine, as it represents a misuse of resources that could otherwise be spent on patient care.
Operating rooms produce a disproportionately large portion of total hospital waste. Much more can and
should be done to better manage supply and drug waste resulting from surgical procedures. On the related
articles it also list a no. of activities or interventions that could actually save money and supplies and even
lessen the amount of garbage being produced some of which are :

 Re-assess the need for each piece of paper that we use.

 Carefully assess the need for egg crates and elbow pads, not really necessary in every case--
especially short cases.
 Use papers wrappers as covering for the arm boards.
 Change bed linen on gurneys only if necessary. Often it is clean and has only been occupied for a
very short time.
 Check items before opening for a case to make sure that you need them.
 Separate clean trash during the case and recycle all plastic.
 Save plastic bags covering sterile supplies and use as covers for foot pedals, patient's belongings,
etc.
 Disposable styro foam and plastic trays can be used for art projects.

And some other ways are listed below on the attached article. This journal is relevant to the nursing
practice for us to be able to have a knowledge about the real set up in the operating room, it gives us an
idea on what to do not just extravagantly wasting all the supplies in the operating room, in this manner we
didn’t just help the patient but as well as the mother nature since we help to lessen now the garbage being
produced maybe our role as a student nurse is very minimal but it has a huge impact if we practice and
learn how to manage this trash, this is also relevant to the nursing education for us now to atleast have
something to share to our group mates and this added information would be applied in the area and as we
continuously move forward and end up being staff nurse in the operating room we will be able to manage
and apply what ever we learn not only just merely performing our task as a nurse but to be earth friendly
as well.

RELATED LITERATURE: (summary)

 Greening the Operating Room:

As hospitals across the country look for ways to reduce environmental impact, it makes sense to start with
the departments that have the largest environmental footprints. The operating room (OR) is one of the
most environmentally intensive departments in the hospital. Case studies have estimated that between 20-
30% of the total waste generated by the hospital comes from the OR. A number of leading healthcare
institutions have begun to tackle this problem by identifying key interventions that can reduce waste,
energy, worker exposure to hazardous chemicals and save money. This initiative is an attempt to collect
data on these interventions and share them as a means to encourage widespread adoption across the
sector.

The initiative is organized into multiple phases, beginning with the Greening the OR Symposium, which
was held in Scottsdale, AZ, on April 27, 2010. The second event in the series was a pre-conference
workshop at the CleanMed Conference in Baltimore, MD on May 11, 2010.
  Hospitals bring waste reduction to the operating room:
A perfect storm of incentives is pushing hospitals to clean up their act. It is not enough to heal individual
patients, they are discovering, without considering how their actions affect the health of their
communities.
Particularly in the operating room (OR), reducing, reusing and recycling can have a huge impact in
protecting the environment as well as reducing hospital costs. Reasons to trim waste output range from
good public relations, to regulations, to employee demand.
"Most hospitals are nonprofit, community organizations, and communities have started stepping up to the
plate," says Kai Abelkis, hospital sustainability coordinator at the two-campus Boulder (Colo.)
Community Hospital, where he oversees a program that reduced waste by 40 percent annually from its
1995 level, and saves $600,000 per year.
Abelkis has found that staff members often initiate recycling programs. "It's a new generation of
employees," he says. "Recycling is typical in their households. If they don't see recycling in the
workplace, they speak up and ask for it."
Meanwhile, nonprofit organizations such as Practice Greenhealth encourage environmental awareness.
One of Practice Greenhealth's newest members is HCA, Nashville, Tenn., which announced plans to
appoint sustainability coordinators at each of its 163 hospitals.
U.S. hospitals generate 2 million tons of waste per year, says Geraldine Falacy, R.N., CNOR, at
PeaceHealth, a seven-hospital system based in Bellevue, Wash., where recycling has been a long-standing
practice. Falacy told the 2009 meeting of the American Society for Healthcare Environmental Services
(ASHES) that reasons to minimize the amount of waste sent to landfills include cost reduction, but that it
is also a factor in Joint Commission accreditation under the Environment of Care standards.
One way to reduce waste, she told them, is to reduce the use of packaging and disposable supplies.
"Reducing what comes in the front door directly affects what leaves out the back door," she noted.
At first, there will be an investment in reusable products and collection bins for recycling. Obtain data,
she urged, on the recycling process, costs and the resources available to accept waste. Then, recruit
"champions" among physicians and OR nurses.
ASHES Executive Director Patti Costello says that communication and collaboration are critical for OR
nurse and environmental services managers seeking to recycle. "You can be environmentally sustainable
in the OR," she says. "But success is dependent on the culture and relationship with surgeons and
anesthesiologists. Understanding each other's space, concerns and goals will go a long way in affecting
sustainable outcomes."
Like Abelkis, Mark Mason found employee requests to be the driving force behind recycling. Mason is
administrative director of patient and support services at Beaumont Hospital, a Troy, Mich., facility that is
part of a three-hospital system in Michigan.
After fielding phone calls from employees and colleagues, Mason formed a "Green Team" in August
2008. Anyone who called him asking about recycling was invited to join the team and help plan a
systemwide program.
The initial effort began on the Troy, Mich., campus, where a building expansion gave Mason the
opportunity
to install a 1,500-square-foot recycling drop-off center. The hospital crushes cardboard, plastic, metal and
other materials for transport to a local recycler and a national firm.
In ORs, the focus is on waste generated before the procedure, such as blue wrap and paper. "That took
about 80 percent of the waste," Mason says. He is also re-educating staff on what items should not be
placed in medical waste containers.
This year, he says, "we're refining our processes and getting more people involved."
This article 1st appeared in the March 2010 issue of HHN Magazine.

 Save the Planet: Recycling in the OR:

by Kathy Donaldson, RN, CNOR
For most people, the term "medical waste" means infectious waste, including used needles and blood.
However, approximately 80% of a medical facility's waste can be classified as general refuse, or
municipal solid waste, and therefore is similar to the kinds of waste generated in hotels, restaurants,
shopping centers, office buildings, and private residences. 1
In the hospital, a significant portion of waste can be attributed directly to the types of products that are
brought on site for facility use. The hospital industry has shifted from a primarily reusable product supply
system to a primarily disposable product supply system. The majority of these supplies are sealed in
individually wrapped packages. This shift has dramatically increased the waste production of medical
facilities. It has been reported that the hospitalized patient generates an average of 15 pounds of hospital
waste per day.1
It is estimated that half of medical waste generated from hospitals originates in the operating room 2 and
that almost 80% of the waste from a single operation is generated before the patient enters the surgical
suite. Because everything must be sterile, almost all the supplies, instruments, drapes, and other
equipment come sealed in disposable polypropylene wraps, rigid plastic packaging trays, or other
packaging material. It is not unusual for such packaging from a single cardiac or other large case to fill
three or more large garbage bags. Much of this waste is filling landfills when it could be reused or
recycled.
In an effort to reduce the amount of waste deposited into the waste stream and raise the consciousness of
the operating room staff regarding recycling, a special project was launched in the operating room at the
University of California Davis Medical Center (Sacramento, Calif). Ideas were solicited from the OR
staff regarding recycling, reusing, and reducing waste. Staff were encouraged to put their ideas in "Save
the Planet" boxes located in the unit. The ideas and tips were collected and presented in an inservice.
Prizes were given for the 1) most ideas, 2) most ingenious idea(s), and the 3) most original idea(s). The
following are examples of some of the ideas:

 Use instrument tray wraps instead of chux.

 Save and reuse paper instrument tray liners to use to wipe spills or for household cleaning.
 Save plastic sponge containers to hold paints, desk items, or give to schools for art projects.
 Save foam from inside of donut shaped headrests for preschool painting sponge or water toy.
Saved foam can be wet with soap and water and used with a razor instead of opening a shave kit.
 Epidural/spinal trays make great toy or hobby organizers.
 Use paper drapes for sewing patterns, sample garments.
 Re-assess the need for each piece of paper that we use.
 Carefully assess the need for egg crates and elbow pads, not really necessary in every case--
especially short cases.
 Use papers wrappers as covering for the armboards.
  Change bed linen on gurneys only if necessary. Often it is clean and has only been occupied for a
very short time.
 Check items before opening for a case to make sure that you need them.
 Separate clean trash during the case and recycle all plastic.
 Save plastic bags covering sterile supplies and use as covers for foot pedals, patient's belongings,
etc.
 Disposable styrofoam and plastic trays can be used for art projects.
 Save empty irrigation bottles for water bottles for hiking, camping, etc.
 Items opened and not used for a case should be sent to the missions or other entities in need of
these supplies.
 Use reusable cloth products and basin sets.

The contest winners where announced at the recycling inservice. The winner of the most ingenious idea
made a Halloween dress out of the paper instrument tray liners and modeled it for the staff. Another staff
member made a beautiful quilt from assorted operating room paper products, winning a prize for the most
original idea.
Since this hospital is a teaching facility, supplies opened and not used for a case are used for teaching in
the operating room training program. Supplies are also given to an affiliated Veterinary Medical Teaching
Hospital. What the Vet Hospital cannot use is given to the missions.
Finding a charitable organization to donate supplies to can be difficult. One organization that facilitates
this process is REMEDY (Recovered Medical Equipment for the Developing World). REMEDY
(www.remedyinc.org) is a not-for- profit organiztion that will help hospitals and medical personnel to
identify organizations, either locally or nationally, who have experience and resources to support effective
overseas shipping and distribution. This service is provided free-of-charge.
According to the Association of Operating Room Nurses Recommended Practices for Environmental
Responsibility, "Personnel should become ecologically sensitive and advocate changes that reduce the
quality of waste generated while maintaining quality patient care and worker safety." 3 Operating room
nurses have a responsibility as healthcare providers and as inhabitants of this planet always to look for
ways to preserve the environment. It is a challenge to provide both safe care for the patient and for the
planet.
Kathy Donaldson, CNOR, RN, is a Staff Developer, Operating Room, at the University of California
Davis Medical Center (Sacramento, Calif).

July 7, 2010
 Half of Hospitals Recycling At Least Some Medical Waste:
About half of U.S. hospitals are recycling at least some of the medical supplies the would otherwise
dispose of, as the health care industry is beginning to tackle the problem of medical waste, according to a
report in the New York Times.
One hospital owner, the Hospital Corporation of America, recycled 94 tons last year. HCA owns 163
hospitals throughout the country. Reprocessing and remanufacturing programs from Ascent Healthcare
Solutions has saved its hospital partners more than $82 million in supply chain costs during the first half
of 2009.

The paper reported that the amount of medical waste produced in the U.S. is completely unknown, since
the last estimate of 2 million tons is from several decades ago. Although hospitals have traditionally been
unreceptive to calls to reduce or recycle their medical waste, the increased stress of a prolonged economic
downturn as forced health care providers to look for ways to reduce costs, including costs associated with
the use and disposal of medical waste.

The report highlighted one environmental non-profit, Practice Greenhealth, which counts 80 companies
and 1,100 hospitals among its members. The group is trying to find new ways to reduce waste in the
operating room, which according to the report generates 20 to 30 percent of hospital medical waste.

Changing the hospital culture of profligacy with its equipment and supplies can save hospitals money on
the purchasing end, while reducing the amount of waste produced can save on landfill fees, the paper
reported.

Disposable single-use medical devices, for example, can be recycled and resterilized at processing
centers, than resold to hospitals at 40 to 60 percent less than the cost of unrecycled products.

The use of disposable shot up during the 80s, when many reusable pieces of equipment were gradually
replaced with disposable plastic alternatives, often in response to concerns about exposing patients to
HIV. Safety concerns, and a protest by the medical device trade group the Advanced Medical Technology
Association, slowed the adoption of recycling schemes for medical waste. However, a 2008 study by the
Government Accountability Office found no increased risk to patient health due to the use of recycled
medical supplies.

Hospitals are also asking medical suppliers to reduce the amount of equipment they include in sterilized,
single-use packs. These single-use devices, though they may never be used in the course of a surgery, are
usually thrown out once the sterile pack is opened. By reducing the number of devices within the pack,
hospitals have reduced the overall amount of their waste production. One operating room team was able
to save their hospital $104,658 by asking suppliers to reduce their packs from 44 pieces of equipment to
27, according to the report.

Kaiser Permanente recently unveiled a Sustainability Scorecard, which requires suppliers to provide
environmental data for medical equipment and products used in its hospitals, medical offices and other
facilities. Meanwhile, GE Healthcare and ten other medical device manufacturers in the European Union
have committed to reduce the average energy consumption of new ultrasound products by 25 percent by
2012.

 Surgeons Make The Operating Room Environmentally Sensitive:

Main Category: Public Health Also Included In: Medical Devices / Diagnostics Article Date: 14 Oct 2008
- 3:00
The last thing on a surgeon's mind when he or she enters the operating room (OR) is environmental waste
or energy inefficiency. As always, the main concern is the safety and care of the patient. However,
surgeons at Oregon Health and Science University (OHSU), Portland, are finding that they can protect the
environment as well as the patient by recycling solid waste and conserving energy use in the operating
room. "The commitment that people are making in their personal lives to recycling and creating a more
sustainable environment doesn't have to end the minute they walk in the OR. Just because we are dealing
with life and death issues doesn't mean that we have to stop thinking about the environment," according to
Juliana E. Hansen, MD, FACS, chief of plastic surgery and associate professor of surgery.
Since 2004, surgeons at OHSU have been actively involved in waste conservation and energy efficiency
activities. Dr. Hansen reported on their efforts in a scientific exhibit at the 2008 Clinical Congress of the
American College of Surgeons. She and colleagues analyzed how surgeons contributed to the university's
campus-wide environmental sustainability programs, which recycled nearly 1,100 tons of solid waste in
2007 and saved more than $85,000 in waste management fees.

In the study, Dr. Hansen found that surgeons and OR nurses recycle roughly 300 lbs of uncontaminated
paper and plastic products from the university's 21 inpatient operating rooms each day. These materials
include the packaging components that surround sterilized instruments, suture material, and gauze pads.
"Those are the things we just used to throw away, but they are no-brainers for recycling because they are
never contaminated. They are never handled by the surgeons. They are opened sterilely and removed
from surgical products before being used in an operation," Dr. Hansen said.

These accomplishments are the result of ongoing education of surgeons and staff by committed OR
nurses. "I'm sure you've seen at various recycling areas that people will throw things away that aren't
supposed to go into recycling bins. That's a big problem in the OR, because if contaminated material from
an operation gets into the recycling bin, the whole bin has to be thrown out. Maintaining awareness and
educating people on a regular daily basis is key. There are nurses who are dedicated to this project and
who put a lot of time and effort into having a system in place for capturing the clean waste, storing it in a
separate place, and getting the recycled material picked up daily," Dr. Hansen explained.

In addition, the OHSU operating rooms have been refitted with light-emitting diode (LED) lights and
low-mercury lamps, which save 340,000 kWh of energy per year. At an average cost of $0.12 per kWh,
energy-efficient lighting saves approximately $40,000 a year.

By purchasing Green Tag renewable energy certificates for the operating rooms, OHSU management has
replaced 294,000 kWh of traditional polluting energy sources of electricity with clean and sustainable
sources of energy each month. As a result, the operating rooms have decreased carbon output by 265,000
lbs each month. (Green Tags are sold by nonprofit organizations that support and promote renewable
energy programs. Each purchase of a Green Tag fosters the development of renewable energy on power
grids, solar power systems for public buildings, wind power systems for communities, and watershed
restoration to improve water quality. Each Green Tag is equivalent to 1,000 kWh of renewable energy
and 1,500 miles of offsetting emissions from a standard automobile.)

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