H2O and the OR

By Kaeleigh Sheehan, Practice Greenhealth Project Manager on March 4, 2014

Water savings in the operating room.

While it comes as no surprise that the operating room consumes vast amounts of energy and supplies and generates a significant portion of a facility’s waste in order to carry out the lifesaving patient care procedures daily, it can be surprising to learn that the number of operating rooms (along with patient days and staffed beds) are the best predictor of a facility’s overall water use according to Practice Greenhealth’s 2013 Sustainability Benchmark Report. There might not be any large water consumers within the physical space of the operating room, but there is certainly a strong relationship between the operating room and the sterile processing department (SPD). Although not as visible as the surgeons, anesthesiologists and perioperative nurses, the sterile processing department is part of the team in delivering patient care and ensuring instrumentation is properly sterilized, organized and ready to use.

The Sterile Processing Department

Generally, once an instrument is used in a surgical case, it is transported to the sterile processing department where it quickly undergoes a series of steps to render it usable again.

Decontamination: The instrument is physically or chemically treated, removing the potentially harmful microbials and making it safe for handling by personnel.

Assembly and Packaging: Instruments are inspected and then assembled into sets or trays and then packaged.

Sterilization: Instrument sets are sterilized to remove more resistant spores and microorganisms.

Quality Assurance: To ensure that the instruments meet quality standards for patient care, mechanical and/or chemical indicators are used.

The SPD is responsible for cleaning, disinfecting, sterilizing, preparing and distributing the devices and equipment necessary for patient care, meaning the supplies required for a surgical procedure come through the SPD before the case and are then returned to the SPD after the case has completed to begin the cycle again. Most of the equipment in the SPD requires large amounts of water to function.

Lehigh Valley Hospital-Cedar Crest in Allentown, Pennsylvania, is a Level 1 Trauma Center that recently underwent a large renovation, including new installations and equipment in the SPD. The SPD at Cedar Crest has three large floor loading autoclaves, which run 24/7 in order to support efficient patient care.

For every cycle or sterile process run by one of the autoclaves, 750 gallons of water were used. Despite trying to run the autoclaves at full capacity for maximum efficiency of each cycle, 750 gallons for every cycle still results in significant water consumption. A large percentage of the water used for each cycle is for the heating of the jacket or walls of the autoclave. Like many hospitals, Lehigh Valley Hospital-Cedar Crest would then use this water safely, once it had gone through several channels to cool off, for public use.

Regardless, 750 gallons of water was used every time one of the autoclaves was turned on—so the team at Lehigh Valley Hospital-Cedar Crest decided to "think green" and investigate options for reducing their water use. They found a circulator pump that would reduce water consumption from 750 gallons of water wasted per cycle to 150 gallons of water wasted per cycle—with 600 gallons being recycled and diverted back into heating the autoclave.

Once they were given the "green light" it was approximately a $5,000 upgrade per unit or a $15,000 investment. With the circulator fully implemented, Lehigh Valley Hospital-Cedar Crest was able to save 2.9 million gallons of water in one year, a savings of $28,000 in avoided water costs, and the investment paid for itself within the first year. They also found that with the circulator in place, the sterile process cycle moves more efficiently and quickly than before.

Lehigh Valley Hospital-Cedar Crest also invested in other water-saving technology while undergoing the large renovation. One system automatically applies the correct amounts of detergent and water necessary for different instrumentation loads, which helps them save both on the overconsumption of detergent and also ensure proper cleaning of the instruments.

What’s next? There’s a chiller, which when paired with the circulator, would further improve the efficiency of the cooling/heating of the water and perhaps lead to further energy and water savings.

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Lehigh Valley conserves water in the operating room while saving money. Photo Credit: Lehigh Valley Health Network