It's no secret that healthcare facilities produce huge amounts of trash, specifically 6,600 tons per day, much of which ends up in landfills or in expensive incineration or autoclaving processes. About 70% of that comes from operating rooms and obstetric procedures.
But a study in the latest issue of Archives of Surgery by researchers at the University of Maryland's Bloomberg School of Public Health says that with a little thought and planning, hospitals can realize billions in savings. Some of the waste is hazardous and must be properly and expensively disposed of, but some of it is actually harmless, they say.
The researchers, led by Martin Makary, MD, Bloomberg associate professor of surgery, itemized five categories of surgical setting waste reduction that could save energy, avoid unnecessary purchases, and better manage pharmaceutical waste.
"There are many strategies that don't add risk to patients but allow hospitals to cut waste and reduce their carbon footprints," Makary said. "If we're going to get serious as a country about being environmentally conscious, we need to look at our biggest institutions. When an individual decides to recycle or dispose of waste differently, it has an impact. When a hospital decides as an organization to go green, the impact is massive."
There are five kinds of medical room waste: infectious/pathologic such as tissue and human tissue/body fluids, sharps, pharmaceuticals, radioactive and general. Hospitals use special containers for sharps and radioactive waste, and two kinds of disposal bags, clear bags for all noninfectious waste red bags for infectious or pathologic waste, which is extremely expensive to properly dispose of. In fact, hazardous waste amounts to only 4% of the volume of hospital waste, but eats up 52% of a hospital's waste disposal budget.
Makary and colleagues write that the problem is much worse than it has to be, because what usually happens is that an awful lot of general waste is misallocated into these red bags, making the volume of more expensively discarded waste that much greater.
"In fact as much as 90% of red bag waste does not meet criteria for red-bag waste," the authors write. If not visibly soiled, dripping or caked with blood or bodily fluids, the following items commonly put in red bags can instead be easily placed in clear bags: paper towels, vent tubing, suction tubes, intravenous bags, foley bags, foley catheters, batteries, masks, gowns, drapes, linens, casts and splints, packing materials, alcohol preps and wipes, dressing sand gauze, cotton, tapes, diapers and incontinence pads, bedpans, urinals and emesis basins.
Combined, hazardous and regulated medical waste make up only 24% of medical waste, but account for 86% of the costs. Yet, "an estimated 40% of regulated medical waste form operating rooms is packing material and another 40% is suction canister waste. Therefore, if the quantities of these two items were reduced, the volume of regulated medical waste could be decreased by more than 30%," the researchers say.
One solution is for staff to make clear bags more readily available prior to the beginning of surgery, and then replacing them with red bags just before the patient is wheeled into the operating room.
One medical center that tired this also began washing and reusing all surgical scrubs and jackets, and ended up reducing waste volume by 50% over seven years. Another hospital reduced waste by 50,000 pounds and saved $60,000 a year by switching to reusable surgical gowns.
Another hospital switched from blue wrap, used to store instruments, to hard cases and saved $26,000 a year.
According to Makary, one in four U.S. hospitals and 2,700 ambulatory surgery centers use at least one type of reprocessed single-use device. For example, Ascent Healthcare Solutions in 2008 saved $138 million and avoided 1,950 tons of medical waste that otherwise would have had to be disposed of in landfills. While concerns remain over the safety of reusing reprocessed single-use devices, Makary says, to date, "the U.S. Government Accountability Office has found no evidence indicating that the use of reprocessed devices increases health risk."
By purchasing supplies from vendors who use environmentally friendly raw materials and products, hospitals can, for example, avoid products containing mercury and other substances that require specialized disposal. Other products include unbleached recycled paper instead of chlorine-bleached white paper, which releases dioxins into waterways. "By using 100% recycled paper hospitals can reduce manufacturing energy use by 44%, decrease greenhouse gas emissions by 37%, and cut solid waste emissions and water use by 50%."
Hospitals can also avoid products that contain latex, polyvinyl chloride, and diethylhexylphthalate.
"It is estimated that a 1,000-bed hospital could save, for example, $175,000 per year and reduce waste by 34,000 pounds if they used reusable sharps containers instead of disposable ones."
With better management of energy use by replacing older lighting, air-conditioning, water chilling, and pumping systems with more efficient systems, New York-Presbyterian Hospital expects to save $1.77 million a year. Makary and his co-authors say that energy-intensive medical equipment, special lighting needs, 24-hour operating cycles and other energy needs may consume 25% of a hospital's operating costs.
Surgical practices, however, "could save between 25% and 45%" of their energy costs with energy efficient programs. Solar lighting, photovoltaic systems come with potential tax advantages. Cogeneration systems and more efficient lighting systems as well as better heating, venting and air-conditioning system designs may add to savings.
With increasing evidence that pharmaceutical products such as antibiotics, corticosteroids, hormones, and other drugs are contaminating drinking water, many public health officials are concerned over the long-range impact of these compounds on human health.
Makary and co-authors aren't specific about what hospitals should do to avoid adding to the problem, but they say pharmacies and waste management services in hospitals should develop guidelines for correct disposal of pharmaceutical waste and provide education to surgical staff.
In conclusion, they wrote, "the field of surgery represents a high-yield area for which green practices can be implemented, often with associated cost savings...As physicians we share a common desire to deliver the highest possible quality care to our patients directly and indirectly. This goal should guide our efforts as we seek ways to improve public health and sustainability through green initiatives.