Lessons in Excellence

The Greening the OR Circle of Excellence honorees reduced, reused and recycled their way to the top.

By Kaeleigh Sheehan on July 28, 2016

Greening the OR presentation slide

2016 Greening the OR Circle of Excellence Winners

  • Cleveland Clinic
  • Harborview Medical Center
  • Johns Hopkins Hospital
  • Marymount Hospital
  • Memorial Sloan Kettering Cancer Center
  • Regions Hospital
  • University of Maryland Medical Center
  • University of Vermont Medical Center
  • Virginia Mason Medical Center
  • Yale New Haven Hospital

In 2016, Practice Greenhealth introduced another level of its award program to recognize the varying levels of environmental stewardship and innovation in the surgical department. This year, 42 hospitals achieved the Greening the OR Recognition Award, a competitive award which celebrates facilities that make substantial progress in reducing the impact of the surgical environment. Practice Greenhealth also awarded the Greening the OR Circle of Excellence to 10 facilities for their outstanding endeavors to be environmental stewards in the surgical department. The Greening the OR Leadership Award recognized the highest overall performer. Here, we showcase how some of these award-winning facilities are making a positive impact.

Regulated Medical Waste Reduction

At Cleveland Clinic’s main campus, physician champion Matthew Davis audited and implemented a sequenced change program designed to promote sustainability and OR waste reduction. Davis identified five operating rooms used most often by general surgery, and over a period of ten weekdays, OR waste was collected, separated and weighed to quantify baseline waste production. The team then decreased the size of RMW receptacles and conducted another ten-day audit.

By simply decreasing the size of its receptacles, Cleveland Clinic saw an 11 percent decrease in RMW. Following an education seminar for OR staff after the second audit, RMW decreased an additional 21 percent for an overall decrease of 30 percent from baseline. Replicating the process systemwide stands to reduce 250 tons of RMW and save more than $150,000 annually.

Clinical Plastics Recycling

Monique Citro, OR communications specialist for University of Vermont Medical Center, started collecting blue wrap for recycling in the OR in 2010. As the program gained momentum, she expanded collection sites across the organization. Additionally, UVMC’s vendor created signage for blue wrap collection bins and developed marketing materials. By expanding blue wrap recycling to high-volume areas and educating staff, UVMC achieved high collection compliance, recycling 14.6 tons of clinical plastics from the OR, including seven tons of blue wrap.

Reusable Canister Fluid
Management Systems

Regions Hospital in St. Paul, Minnesota, traded in its previous fluid management system for 27 new Neptune 2 machines. In the first year, Regions avoided 88.2 tons of waste and saved more than $130,000. The team noted that the new machines were more energy efficient, required smaller plastic manifolds, were equipped with smoke evacuation technology and dramatically lowered the potential for blood borne pathogen exposure.

Rigid Sterilization Containers

Harborview Medical Center in Seattle uses rigid sterilization containers for 30 percent of its kits, saving nearly $73,000 in avoided blue wrap purchases and avoiding 14.6 tons of waste.

OR Kit Review

The University of Maryland Medical Center in Baltimore conducts a robust monthly OR kit review. Staff members return unused items from the kits in designated return bins, which are presented at the monthly supply chain meeting. One of the key measures UMMC uses to evaluate success is the percentage of returned items. Thresholds are set for each and are lowered as compliance improves. If items returned exceed the threshold, the team evaluates and reformulates the kit until returns fall below the threshold. When kits were initially introduced, the return rate was over 10 percent. In 2015, UMMC achieved a return rate of 0.74 percent, which helped the organization save over $40,000 on the unnecessary purchase of supplies and waste disposal.

Reusable Linens and Instruments

Virginia Mason Hospital in Seattle was a leader in utilizing reusables in the OR in 2015. The list of reusable items includes surgical gowns and linens, linen bags, bed linens and pillows, towels, patient-positioning devices, trocars, laparoscopic instrumentation, blood pressure cuffs, leads, tourniquets, stethoscopes and more for a total of 8.7 tons of reusable linens and devices and a savings of over $1.3 million.


Reprocessing Single-Use
Medical Devices

Yale New Haven Hospital in New Haven, Connecticut, surpassed its goal to collect and purchase 75 percent reprocessed compression devices, diagnostic ultrasound catheters, EP catheters and cables, external fixation devices, opened and unused or expired devices, tourniquet cuffs, endoscopic trocars and laparoscopic devices and achieved a 78 percent compliance rate in 2015. As a result, the hospital was able to save 20 tons of waste and $12,000 in avoided waste disposal costs. On the purchasing side, Yale New Haven Hospital was able to save more than $1.2 million on purchasing reprocessed single-use medical devices.

Medical Supply Donations

Where one person might just see yellow hospital socks, Virginia Mason Seattle Hospital & Medical Center saw an opportunity. Led by Ruth Murata-Hultgren, RN, and her fellow post-anesthesia care unit green team members, the hospital launched a sock-saving trial after obtaining approval from infection prevention and control and arranging for proper laundering with environmental services. The first delivery donated nine pounds of socks to Mary’s Place, a day shelter for homeless women, children and families, and another 11 pounds to the Oso Relief Center following a devastating mudslide.

Addressing HVAC Setback

HVAC setback remains an area of great opportunity for Practice Greenhealth members—only 37 percent of award winners indicated they had implemented a setback program in 2015. Memorial Sloan Kettering Cancer Center in New York implemented an HVAC setback program across all 28 of its operating rooms, setting the air exchanges per hour from 25 to 12 when the rooms were unoccupied. From this program alone, the facility saved over 652,000 kWh and 40,000 therms for a combined energy cost savings of $92,000 annually.

LED Surgical Lights

In 2015, Cleveland Clinic main campus facilities managers replaced 12,240 fluorescent tubes with LEDs for the pattern lights in 75 of its 86 ORs. These lights resulted in brighter, cooler ORs with increased light quality and an $84,342 annual electricity savings.


Anesthesia providers at Johns Hopkins Hospital in Baltimore, who received education on organization, saw a 50 percent reduction in total cost between pre- and post-intervention and a 47 percent decrease in total liters of gas used. Following education, and despite an increase in OR use, Johns Hopkins saw a decreased spend, down to $8,500 annually per OR.

Standard Setters

In the six years since becoming an organized initiative of Practice Greenhealth, the Greening the OR Initiative has engaged thousands of hospitals and health care providers around sustainability within the operating room space. What sets these 52 award-winning hospitals apart is not just that they understand the operating room is a key target for waste and energy-reduction efforts, but that they have engaged their staff and used data to manage their programs and continue to innovate and drive the message forward.