A Multipronged Strategy

By Kaeleigh Sheehan, Practice Greenhealth Project Manager on October 21, 2014

NorthShore University HealthSystem’s green team updates key processes to tackle waste

FAL14.PGH.GreeningtheOR2The operating room is an area of significant opportunity in waste reduction. Across its four hospitals, NorthShore University HealthSystem in Illinois has implemented multiple strategies in the surgical department to minimize waste, increase cost savings and reduce its environmental footprint.

According to the health system, the first step in updating a waste program is to assess current practice to identify areas of opportunity, then develop a team, create a strategy, set goals and implement the program. Maintaining these programs requires reassessing, tracking, continued education and enthusiasm.

During assessment of its OR, NorthShore University HealthSystem saw that one prime area for change is separating precase waste—that is, waste from setting up the operating room before the patient even enters the room. This waste typically consists of clean plastic packaging, overwraps and other sterile materials. Because this material has not come into contact with the patient, blood or body fluids, there is no reason for it to be disposed of as regulated medical waste (RMW), which can cost up to six to eight times more than recycling or solid waste disposal.

The health system implemented a process to segregate this precase waste across its surgical departments, then took it a step further, maximizing waste reduction efforts by segregating waste during and after the case. The system also launched a commingled recycling program that accepted mixed medical plastics, product boxes and packaging, and blue wrap. These small changes helped to significantly decrease the waste coming out of the ORs and incur savings.

Education, communica­tion and teamwork played critical roles in the success of these programs. Clear signage, presentations, training sessions and examples of which materials belonged in each waste stream helped staff know and feel confident that they were making the right decisions. Good communication also encouraged staff to err on the side of caution when they were unsure, helping to ensure that contaminated materials were not entering the solid waste or recycling streams, which could pose a risk to the health and safety of environmental services or vendor staff.

Sharing its skills

The green team at NorthShore University HealthSystem is committed to Greening the OR work and has continued to educate, motivate and identify new areas to implement and innovate.

As part of this commitment, NorthShore sponsored the Greening the OR Symposium in September at the Chicago Botanic Garden. This one-day event hosted attendees from across the country who were interested in discussing and learning more about sustainable opportunities in the operating room.

NorthShore shared its waste reduction successes and strategies from its team’s perspective.

Avoiding Unnecessary Costs

The green team at NorthShore University HealthSystem also examined other strategies to reduce its environmental footprint.

Purchasing rigid sterilization containers for surgical kits helped NorthShore reduce the impact of blue wrap across its surgical departments. While these containers require a capital investment, hospitals can see a quick payback: Rigid sterilization containers help eliminate the upfront purchase of blue wrap; help ensure devices are properly returned to the container; and eliminate the occurrence of torn corners on sterilized surgical kits, which then require flash sterilization. All told, implementing rigid sterilization containers for about 50 percent of the kits across the health system helped save over $336,000 in the combined avoided purchase and disposal of blue wrap and helped divert 10.5 tons of plastic from the landfill. Use of these containers also avoids the downtime related to torn kits, an added benefit that has associated cost savings.

Many facilities have found that reviewing OR kits for unnecessary supplies is another great way to have an impact on purchasing and waste disposal costs. Often, items are included in kits “just in case,” but are routinely thrown out unopened and unused. These small items—a gauze pad here, a suture there—can add up quickly, impacting a facility’s environmental footprint and bottom line.

While donating these unused goods to pro­grams in developing countries can be a great and viable option that has wonderful benefits, it is also worthwhile for the organization to review current practice to reduce these unused and unnecessary supplies in the first place.

NorthShore began a process to systematically review OR kits to remove items that were routinely thrown out or not needed. This helped ensure that OR kits were up-to-date while also eliminating the up-front purchase and back-end disposal fees of these supplies. The supply savings alone totaled $104,000.

Another area of opportunity explored by NorthShore was single-use device reprocessing. A program such as this can help organizations save significant financial resources by purchasing reprocessed devices at almost 50 percent of the original price while also removing these devices from the regulated medical waste stream. However, reprocessing single-use medical devices is a program that requires time, education, re-education and considerable work with the vendors, clinicians and support services to make sure it is implemented successfully.

Understanding that starting small and building the program can lead to long-term and sustainable success, the team at NorthShore University HealthSystem began its reprocessing journey by collecting and reprocessing non­invasive devices such as compression sleeves, pulse oximeter probes and tourniquets. Invasive single-use devices were collected to be recycled or reprocessed outside the health system, which has helped divert almost five tons from the RMW stream and saved $2,811 in avoided disposal costs. The green team plans to expand the program by purchasing reprocessed noninvasive and invasive devices, but notes that for successful program implementation, health systems should take the time to ensure clinicians and staff are onboard, education has been provided and concerns have been addressed.

In other words, small steps build to bigger successes!