Greening the hospital operating room – another thing best left alone

Canadian Medical Association Journal

Canadian Medical Association Journal (Photo credit: Wikipedia)

From the Canadian Medical Association Journal another one of those areas like the ridiculous attempts to green the military, where I think most people don’t give a rats patootie about whether they are getting “green care” or not. In the case of the military, we want an effective offense, one that effectively neutralizes or kills the enemy. In the case of surgical procedures, we want an effective offense, one that effectively neutralizes or kills the disease. I don’t need nor care for a twisty bulb, or green bio jet fuel, green packaging, or  whatever it might be in either situation. I want want is most effective.  They are concerned about medical waste, that’s fine, as we’ve seen with much of the green revolution, haste makes waste, so I hope hospitals don’t try to put political correctness before effectiveness.

Greening operating rooms benefit the bottom line and the environment

Efforts to “green” operating rooms can result in cost savings for hospitals and reduce the environmental impact without compromising patient care, argues an analysis published in CMAJ (Canadian Medical Association Journal).

“The operating room is a disproportionate contributor to health care waste and represents a high-yield target for change,” writes Dr. Yoan Kagoma, Schulich School of Medicine & Dentistry, Western University, London, Ontario, with coauthors.

Operating rooms produce approximately 20%-33% of all waste in hospitals, and much of this waste is subjected to specialized high-energy processing which is expensive and has negative environmental and health impacts. Figures from 2007 indicate that US health care facilities contributed 8% of total greenhouse gas emissions and disposed of more than 4 billion pounds of waste, making the sector the second-largest producer of landfill waste after the food industry. In 2008, Canadian hospital activities were the second most energy-intensive activity, consuming the energy of 440 000 homes.

“In fact, a single operation may produce more waste than a family of four produces in a week,” state the authors.

“Operating rooms pose a particular challenge to waste management because of the need for absolute sterility,” write the authors. “Fortunately, technologies and waste-reduction strategies have emerged that satisfy the ‘triple bottom line’ (people, planet and profits), by reducing health care costs and environmental effects without compromising patient care.”

Principles for greening operating rooms include:

  • Separating waste into normal waste and biohazard or medical waste streams, as the latter requires high-energy processing, and training staff to differentiate. An estimated 50%-80% of normal waste is disposed of as hazardous waste.
  • Investing in closed collection systems to discharge liquid waste into sanitary sewers, which reduces the amount of waste needing high-energy treatment.
  • Using smart monitors to reduce energy use when operating rooms are vacant.
  • Partnering with medical equipment companies to promote greener packaging; a major contributor to waste is plastic packaging.
  • Donating unused equipment to developing countries.
  • Reprocessing single-use devices to make them suitable for reuse.
  • Exploring alternative disposal methods to incineration, which is responsible for significant emissions of dioxin and furan in Canada.
  • Creating environmental stewardship staff teams to promote and coordinate greening activities.

“At a time when Canadian hospitals and health care personnel are often working above capacity, one may argue there is little room for greening efforts,” write the authors. “However, in an effort to cut costs, many health care facilities are being asked to improve efficiency. Our analysis has shown that greening initiatives in the operating room are easily implemented, require low capital investment, have a short payback period and can generate substantial cost savings.”

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48 thoughts on “Greening the hospital operating room – another thing best left alone

  1. In the good ol’ days, syringes were made of metal and glass and instruments were of fine steel. EVERYTHING was recycled through the autoclave. What’s old is new again, eh?

    In the good ol’ days, windmills dotted the landscape supplying power where needed. However, I don’t want my surgeon operating in the dark when the wind quits blowing. Sometimes, what’s old should stay old.
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    “■Creating environmental stewardship staff teams to promote and coordinate greening activities.”

    “I’m sorry. I can’t get to that heart attack patient just now. I’ve got an important Environmental Stewardship Team meeting to attend. Maybe that fellow over there could put his mop in the bucket for a few and have a look while I’m gone.”

  2. These actually seem like decent ideas, its not like they are proposing to run MRIs off of algae, scapels made out of recycled cardboard or surgical rooms lit with skylights. Other than this idea ■Creating environmental stewardship staff teams to promote and coordinate greening activities. Those committtees are magnets for busy bodies, na’er do wells and slackers.

  3. If they are truly serious about reducing waste from operating rooms my suggestion would be to cut down on unnecessary operations – i.e. putting stents in people who aren’t suffering from a heart attack, all gastric bypass surgeries, replacing hips and knees in people on their last legs (no pun intended), etc.

    Not only would this cut medical waste but since most of these procedures are done simply because the patients are on Medicare and the taxpayers are paying then we could save a bundle on health care costs as well.

  4. In “The Art of War” Sun Tzu teaches us that the objective of War is to Win, and that ANY conditions on that objective comproomise the ability to Win, and thus increase the risk of losing.
    A similar situation holds in the ‘Health Industry.” Any conditions placed upon the objective, which is to heal people, runs the risk of failing to meet that objective.
    In War, the alternative to winning is to be avoided at all costs. In Health, the alternative to healing is to be avoided at all costs.

  5. Reprocessing single-use devices to make them suitable for reuse.

    ^^^ The above should be banned, you want to reuse a medical device, buy the reuseable version. There have been too many documented cases of this practice causing issues with infections and sub-optimal outcomes to keep going back to this particular well for savings.

  6. Speaking of costs; The healthcare here in Holland has risen through the roof the past years without the greening of it. No idea what the Canadians pay these days for their healthcare, but i guess it wont get any cheaper with these measures.

  7. When I was a surgeon in practice we had glass IV bottles which could be reused, not plastic bags. We also had cloth drapes and gowns which were washed and sterilized after each use, not paper. Of course paper drapes and gowns are a better barrier than cloth but our risks of HIV and Hepatitis were much less 40 years ago. Retirement is nice.

  8. As a wastewater professional we don’t want blood or waste liquid chemicals/medicines discharged into sanitary sewers. Blood from hospitals is specifically prohibited as it increases the risk of blood born diseases for sewer maintenance personnel. Wastewater treatment plants are not designed to remove medications so these pass on to the receiving waters. Haven’t they heard that pharmaceuticals are supposedly a beg problem in the environment and drinking water supplies?

  9. Some of the initiates make sense, like separating hazardous from normal waste (I wonder how much of a problem this really is) but I got the creepy crawlies at the repurposing of disposable items. One of the major improvements in hospital contagion control was single use items like syringes. Also, reusable syringes need to be resharpened – not always done or done properly. I’m old enough to remember the old glass syringes and reuseable needles. UGH…a dull needle will ruin your day. I also don’t think that there would be much savings as the reuseable stuff had to washed to chemical cleanlyness and then autoclaved, all of which use resources and energy.

  10. Pull My Finger says:
    June 4, 2012 at 12:04 pm
    “These actually seem like decent ideas, its not like they are proposing to run MRIs off of algae, scapels made out of recycled cardboard or surgical rooms lit with skylights.”

    Just wait.

  11. I have a fictionalized account of some European nuns who were present during an early Ebola outbreak. One of the prime ways the outbreak was due to the those very same nuns’ efforts in their little health clinic. They would disinfect their big glass syringes and then use them to inject the next patient in line. The disinfectant didn’t kill the Ebola virus. Isn’t that an example of “repurposing”?

  12. I did talk a doctor into allowing reuse of an item. After he removed the stitches in my finger he was going to throw the small scissors in the trash. I took them home to use around the house.

  13. H.R. says:
    June 4, 2012 at 12:01 pm
    I’m sorry. I can’t get to that heart attack patient just now. I’ve got an important Environmental Stewardship Team meeting to attend. Maybe that fellow over there could put his mop in the bucket for a few and have a look while I’m gone.”

    Okay, I get the joke, but really, that’s not going to happen.

    The janitor has his own Environmental Stewardship Team Meeting to attend.

  14. “Figures from 2007 indicate that US health care facilities contributed 8% of total greenhouse gas emissions and disposed of more than 4 billion pounds of waste, making the sector the second-largest producer of landfill waste after the food industry. ”

    Apparently the Mafia was excluded from these figures.

  15. As long as those “greening initiatives in the operating room” remain strictly secondary to the number one priority of sterility, then, maybe. Otherwise it could be the patients who turn green.

  16. Just reinstate a profit motive and let the hospitals tend to their own needs.

  17. When you reuse a single-use medical device in the US, you become a Medical device manufacturer, which means one you assume the manufacturer’s liability and two the boat-loads of paperwork that goes along with being a Medical Device manufacturer. Having thousands of Hospitals doing this paperwork verses a couple manufactures supplying thousands of hospitals seems to me like it would be a huge negative on the greenness scale.

  18. My first thought on reading this was the not the one but TWO releases of Foot and Mouth disease from the Pirbright government lab in the UK that devastated the UK livestock industry (With lots of help from Brussels and the UN OIE) with a direct cost of around £2,100 million ~ compensation to farmers for slaughtered livestock amounting so far to £889 million (claims for each farm culled had averaged £116,000). An array of other items included £195 million spent on cleaning and disinfecting farms, £152 million for the transporting and disposal of carcasses, and £79 million to pay veterinary bills and the cost of blood testing…

    A read through the above article and What is Depopulation? on the details of “depopulation procedures” makes me wonder what the government and the United Nations have planned for human disease control.
    I really do not want to find out so “greening” hospitals is not what I would call a good idea.

  19. If I ever have the misfortune to have to have a surgical team working on me, I would like them to be concentrating on the job, not the correct receptacle for waste.

  20. Bob Johnston says:
    June 4, 2012 at 12:05 pm

    If they are truly serious about reducing waste from operating rooms my suggestion would be to cut down on unnecessary operations – i.e. putting stents in people who aren’t suffering from a heart attack, all gastric bypass surgeries, replacing hips and knees in people on their last legs (no pun intended), etc.

    Not only would this cut medical waste but since most of these procedures are done simply because the patients are on Medicare and the taxpayers are paying then we could save a bundle on health care costs as well.
    ————————————–

    In Canada elderly patients are considered a liability to the health care system, not an opportunity to make money. My mother, now deceased, had smoking-induced emphysema that was exacerbated by colds and sinus infections. She nearly died from one cold. Because she was in a state of delirium and hallucinating, we took her to the emergency department. The admitting doctor at the local Canadian hospital refused to admit her for a course of antibiotics and told my father and me to take her home and prepare for her death that night. Her blood-oxygen levels were at that point at 32. After some argument (in which “Dr. Death” – his nickname amongst local elderly patients – tried to tell us that my mother might go into anaphylactic shock if given antibiotics, and tried to scare us with other equally unlikely scenarios) my father finally convinced him to phone her family doctor, who told him that she would respond well to antibiotics. She was sitting up and eating breakfast the next morning, and lived another 7 years.

    The point is, elderly patients are undertreated in Canada to save ‘health dollars’ due to our government funded system. So your appalling ‘solution’ regarding the elderly, Mr. Johnston, is totally inapplicable to the Canadian context in which this article was produced. Perhaps one day you too may experience the same health care rationalizations that become inevitable under a government health care monopoly.

  21. I’m glad they didn’t look at the harmful effects inhalent anesthesia gases have on the atmosphere. Sevoflurane, isoflurane and desflurane all add to global warming, or so they say. If they ban those we may have to use Three Stooges, hammer on the noggin anesthesia!

  22. Me thinks, I think to much, but this appears to be another well meaning bunch of, what we in cattle country have way to much of now. Back to making interments out of obsidian. What is with this family of four comparison another meaningless statement to engender political correct agreement. I have no problem with the medical profession pronouncing on what it know about. I know they have all decided to breath CO instead of CO2.

  23. The trouble with this kind of thinking is that it imposes additional, unrelated objectives on an already complex system. The more unrelated objectives a system has to carry, the less effective it is. Whether it is the defence forces or the health system, the primary objectives are already weighed down with a whole bunch of regulatory and budgetary constraints which consume resources and detract from the purpose of the system. Adding another layer further dilutes and distorts the operational capacity, with detrimental effects.

    In the case of ‘green’ measures in hospitals, I would be a lot more comfortable if hospitals were already 100% effective at things like avoiding post-operative infections and surgical errors. But, they are not, and adding another bunch of committees and red tape to their already groaning bureaucracies is a further risk to their efficacy. And, since no-one has yet found a way to prevent human error, I would rather that they burned a bunch of non-hazardous waste with the bad stuff than wait for the inevitable day when hazardous waste accidentally goes into the wider world because it has been misclassified. This happens already, I know, but what they propose just increases that risk.

    As for re-usables, I wonder if they have computed the cost and energy use of sterilising and checking the equipment? And I must agree that any proposal to re-introduce re-usable syringes is not only dangerous, but will generate shudders in anyone who remembers what it is like to be impaled with a not-so-sharp needle.

  24. tadchem at 4 june. Tzu Sun also says ‘To win without fighting is best’. Untreated bacteria are very green, natural, and in Oz we have troubles with Golden Staph and cockroaches. At the Prince of Wales hospital my young diabetic son had an op, and I slept by his bed on a big bean bag and had to pull it away from the walls as cockroaches were crawling over me. Yes maybe they have fixed it by now as this was in the mid 1980s and cockroaches were a problem in a lot of hospitals. Bacteria love hospitals and in my doctor’s surgery, we don masks and gloves if we come in with any cold or virus so we don’t pass it on to others waiting.

  25. The only thing “green” I want about a hospital are the scrubs used by the personnel.

  26. Michael Penny says:
    June 4, 2012 at 12:48 pm
    As a wastewater professional we don’t want blood or waste liquid chemicals/medicines discharged into sanitary sewers. Blood from hospitals is specifically prohibited as it increases the risk of blood born diseases for sewer maintenance personnel. Wastewater treatment plants are not designed to remove medications so these pass on to the receiving waters. Haven’t they heard that pharmaceuticals are supposedly a beg problem in the environment and drinking water supplies?

    Thank you, Mr. Penney, you beat me to the punch on that one! Well done!

    Hospital infection control is “in my wheelhouse,” and hospital acquired infections still remain one of the leading causes of death in industrialized countries. Adherence to proper surgical suite sterile field procedures is one of the best weapons we have, and going back to the days of having nuns boiling sheets & hand-washing needles won’t do, sorry.

    Fix the incinerators, most of the waste can be pyrolyzed without difficulty. The high dioxin and furan levels indicate poor equipment selection, improper controls, lousy operation and other problems.

    I’m starting to hate these damn hippies (hilarious since I used to be one of ‘em, years & years ago!)

  27. “Law of Unintended Consequences”

    Case in point: NASA decided to change the foam formulation used on the external fuel tanks of the Saturn rocket system because the old system foam had chloro-fluoro-carbons. Save the Ozone, y’know. Susan Solomon said it was BAAAAAAD, BAD, BAD, BAD.

    Problem was, the new foam didn’t adhere to the fuel tanks, sloughed off during lift-off, and damaged the ceramic heat-shield tiles on the Space Shuttle. During re-entry, the heat shield failed and we lost the craft and crew in a blazing, stupidity-caused, environmentally correct debris shower over Texas and Oklahoma.

    As Kermit the Frog sang, “It Ain’t Easy Being Green”

    My sincere condolences to the families of the lost astronauts.

  28. Pus is green. Fungus is green. Gangrene is green.
    Greening in anything medical is not good…. Stop the anti-survival stupidity now.

  29. Make it optional. People who are more concerned with green politics than their health can have recycled sanitary equipment and less-well-packaged instruments.

    I don’t doubt there are dumb procedures in hospitals, and when they cost too much or endanger people they should be fixed. Not to satisfy a trendy agenda.

  30. I always thought that toxic medical waste was incinerated. I never thought about the water though.
    I just thought it went into the sewer like faeces? Interesting comment. Seems improvement in hygiene seems to have a backlash somewhere. What’s wrong with disinfectant? I thought that killed all germs?

  31. In the case of the military, we want an effective offense, one that effectively neutralizes or kills the enemy.

    Libs view the military solely as a large, ready-made control group for social-experimentation. Ask any Viet vet about the “MacNamara’s Hundred-thousand” debacle — SecDef *ordered* the Army to induct 100,000 young adults per year with an average IQ of 65 and below (Cat IV, in milspeak), teach them to read and write, and then turn them into thinking, rational, combat-effective soldiers.

    No way that could turn out badly, right?

  32. “johanna says:
    June 4, 2012 at 5:48 pm
    I would be a lot more comfortable if hospitals were already 100% effective at things like avoiding post-operative infections and surgical errors. But, they are not, and adding another bunch of committees and red tape to their already groaning bureaucracies is a further risk to their efficacy”

    Efficiency is not the issue.
    The issue is to find suitable employment allocations for all those otherwise unemployable greens and environmentalists.
    The so-called population problem, much commented upon by those of a green persuasion, could easily be solved by removing from the gene pool those who are mainly inclined to find employment sitting on committees.
    So not only lowering the population, but also removing unproductive labour. A policy that could be carried-forward into the political arena with great effect.
    I’ll just allocate the entire UN for extinction, as my contribution ?

  33. JohnR says:
    June 5, 2012 at 12:47 am
    I’ll just allocate the entire UN for extinction, as my contribution ?

    Start a rumor that the UN is being relocated from UN Plaza in NYC to Avenue 13 in Djibouti and then stand away from the windows.

  34. Green is a color associated with mold and inexperience, neither of which is desired in an operating room. Much of what is on the list may make sense, but don’t call it “green.”

  35. The argument against reusing surgical instruments and substituting throw away ones lies in the fact that for many operations large quantities of instruments are needed. Properly sterilised (and the protocols are very stiff!) they are safe to be used again. One source of wastefulness is the arbitrary “use-by-date” on non-reusable items, for instance, swabs, if it’s dated yesterday it can’t be used today! Chuck it out! (I know whereof I speak, having spent 20 years in operating theatres.)

    Anthea

  36. My first reaction was that it is puffed up.

    Turning lights off when not in use is common in buildings, why would a hospital not have a system in an operating room? Well, perhaps because the lights going off if people aren’t moving much as the surgeon does a very fine procedure, or the patient is recovering with a nurse sitting there, is not good. Though during the procedure intense lights should be on another power source (redundancy in operating rooms is a VGI).

    Note the “triple bottom line”, a common scam to coopt professional and business people. It is based on denial of human goodness (the tendency to do right because it is life supporting in reality), ignoring that business is people trading values (not some mystical power as Marxists believe), and ignoring that our society has a justice system to prevent initiation of force. (http://www.keithsketchley.com/monopol3.htm explains why monopolies are not possible without government force)

  37. BTW, regarding “H.R.”’s remark about windmills being common years ago, note that local storage was used.
    I lived in a house in windy country, the windmill had a bank of storage batteries. Some farms with windmills that provided power for well pumps had water storage tanks. Both were additional capital costs to accommodate variability of wind.
    The house I lived in for a few years was owned by someone who made his capital working well away from it, farming there wasn’t profitable enough to pay for the windmill system.

  38. Big General Electric gets rich in OR. They of course are into lighting, instruments and diagnostic equipment. Years ago they purchased Ohio scientific which made anesthesia machines. On a machine, there is a big grey cylinder that contains CO2. CO2 is mixed into your breathing apparatus so you will not die.
    I repeat. So you will not die. It is CO2 in the blood stream that triggers respiration.
    Yes on the disposables, there are many labor expenses using cotton vs paper disposables. Of course paper is good for the KOCH billionaires. They own huge paper mills.
    OR waste doesn’t go to the landfill. It is hazmat and must be sterilized preferably by incineration. Sharps are also hazmatt. Needles and disposible scalpel blades.

  39. So re-use needles & other things…

    Regarding separating the waste, that makes sense, but in practice it doesn’t always work so well.

    I can give examples from my years in a research lab.

    If I take a new, sterile, plastic pipette and use it to measure out some sterile, ultrapure water, where do I dispose of that plastic pipette? If you guessed it goes in the Biohazard Waste, you’re correct. On the other hand if I have a nasty cold and blow my nose in a Kleenex, that can go in the regular trash. As can a bloody bandage if I cut myself. But the plastic bottle the sterile water was in -Biohazard (although until a couple years ago, they could go in the regular trash).

    And that’s the simple stuff. In too many cases what makes logical sense and what the rules say don’t always mesh, so people end up tossing everything in the biohazard waste just to be sure.

  40. And where does the bio-hazard go. I thought it was incinerated, including foetus’ and body parts.
    I range the local hospital and they didn’t incinerate anything there, but they didn’t know where their biohazard was sent too?

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