From Blue to Green

By Nancy E. Berry on April 23, 2012

This year’s Environmental Excellence Awards winners look at ways to rethink the use of blue sterile wrap—here’s a sampling of solutions.

One of the greatest culprits of waste generated in the operating room (OR) is blue wrap. Used to cloak medical devices, instruments, and surgery kits for sterilization, the wrap makes up approximately 20 percent of the waste stream generated by surgical services in the health care industry. Many surgical units are working to recycle blue wrap waste and are seeking alternatives to reduce its use.

As part of the Greening the OR Initiative, Practice Greenhealth members have found a variety of innovative ways to recycle the woven material made of polypropylene (# 5 plastic). Jon Newkirk, sustainability director of Scott & White Hospital-Temple, explains as a part of a multi-departmental initiative, the hospital’s Surgical Services department began recycling sterilization wrap, plastic bottles, packaging material, and plastic patient care items. “Collected in the surgical suites, the materials are transported via the linen distribution system where the plastics are placed onto a collection trailer with plastic linen bags,” Newkirk says. “As part of this initiative, we saw a 20,000 pound increase in the amount of plastic recycled during the 2011 fiscal year.”

Metro Health Hospital has also worked with a local single-stream recycling hauler to accept blue sterile wrap from the OR, in addition to other medical plastics. While finding a hauler to accept these plastics can sometimes involve multiple conversations, there are a growing number of haulers willing to accept these materials.

Beyond recycling, Gundersen Health System partnered with volunteers to create patterns to transform discarded blue wrap into crafts bags to carry art supplies for pediatric cancer patients. Inova Health System went so far as to sponsor a blue wrap fashion design contest during Washington, D.C.’s, fashion week last year, asking participants to get creative with blue wrap and design everything from ready-to-wear to haute couture. Providence Centralia Hospital donates its used blue wrap to animal shelters to use as bedding.

The Case for Cases

One way to reduce the use of blue wrap is to replace it with reusable, rigid sterilization containers. The cases don’t generate any waste except for when the filter needs to be changed. This idea sounds like a practical solution, but the cases can be expensive. When analyzing the cost benefits of purchasing the cases, sustainability managers need to look at the long-term savings.

“Our biggest success in greening the OR was our conversion to reusable rigid surgical containers from blue wrap,” says Dr. Amy Collins of MetroWest Medical Center. “In 2010, we saved an estimated $29,800 and reduced our waste stream by 5,606 pounds of blue wrap as a result of transitioning 66 percent of our surgical instruments to reusable containers.”

At Providence St. Peter’s Hospital Sustainability Coordinator Keith Edgerton explains hard case sterilization containers make up 80 percent of the packaging for surgery today. He continues, “Hospitals need to look at the employee costs and environmental services when it comes to blue sterile wrap procedures. It’s time consuming to wrap instruments and then dispose of the wrap—you have to factor in these costs as well.” One of the biggest challenges of transitioning to hard cases is simply storing the cases—at St. Peter’s cases number in the hundreds. Edgerton says even though the hospital has reduced its blue wrap purchasing, it still buys one million square feet of the material a year. “We are looking at ways to partner with our other hospitals to come up with a solid recycling strategy.” Philip Kercher of Providence Sacred Heart Medical Center and Children’s Hospital has also made the switch. “We have made substantial gains in the use of rigid sterile cases for surgical items to replace blue wrap, with approximately a 70 percent conversion rate.”

The list does not end there. Magee-Womens Hospital is in the process of replacing blue wrap for sterilization with rigid cases. The main challenge for the hospital has been finding space for the containers while its central sterile supply area is being upgraded.

Although not a winner this year, Kai Abelkis, the sustainability coordinator at Boulder Community Hospital, was asked to attain zero waste in the facility and saved the hospital over $150,000 in less then one year by switching to reusable hard sterilization cases. Across the spectrum, Practice Greenhealth member hospitals are finding new and innovative ways to minimize, repurpose, and recycle a significant waste stream in the operating room.

Reuse Vs. Recycle

Even though University of Maryland Medical Center (UMMC) was recycling its blue wrap and purchased over $250,000 worth of reusable sterilization trays in 2011, the hospital was looking for an option to eliminate blue wrap altogether. In 2011, UMMC partnered with its reusable textile vendor to pilot a reusable sterilization wrap for OR trays. The pilot was successful and “the hospital will begin implementing the new reusable green sterile wrap as its standard in 2012, with a goal of decreasing its disposable blue wrap purchasing by 80 percent,” says Denise Choiniere, RN, MS, UMMC’s Sustainability Manager. “We also expect to achieve additional cost-savings, as the reusable wrap has less tears (if any), decreasing the amount of double sterilization and flashing required.”