Reprocess and Reuse
Create a more sustainable operating room through procurement.
Identifying areas of opportunity in the surgical suite to reduce supply chain expenses without affecting quality of care can lead to significant environmental, financial, and health benefits.
The key to any good strategy is to focus on areas where changes can elicit the largest impact. For this reason, the operating room and surgical department are key targets for concerted sustainability efforts. The OR is a major hub within a health care facility, generating as much as 40 percent of patient-related revenue, and a key driver of hospital admissions. On the flip side, the OR is also a significant cost center. It is the leader in medical supply usage for the entire hospital—estimated to account for approximately 33 percent of all hospital supply costs—has large requirements relative to energy use, and is the largest generator of regulated medical waste (RMW) in the hospital.
So where does purchasing fit in? Within the OR, supply costs can comprise more than 50 percent of the departmental budget. A study by Park and Dickerson found that "reducing supply chain costs represents one of the largest cost savings opportunities." Thus, identifying areas of opportunity in the surgical suite to reduce supply chain expenses without affecting quality of care—such as reducing supply overage by reviewing OR kits and custom packs, opting for reusable and reprocessed items wherever possible, and switching to DEHP-free products—can lead to significant environmental, financial, and health benefits.
Just about everything in the OR is a result of a purchasing decision, so it can seem overwhelming trying to identify a starting point for Environmentally Preferable Purchasing (EPP) in the operating room. However, Practice Greenhealth members have identified "low-hanging fruits" that can kickstart the smarter, sustainable purchasing mindset that results in financial savings.
Reviewing OR Kits
"More is better," "just in case"—these sneaky, often subconscious notions have found their way into well-intentioned purchasing habits, resulting in both inventory overage and the unnecessary disposal of unused, unopened, and/or expired medical devices and products. This can be avoided by reviewing OR kit contents and preference cards regularly to avoid unnecessary up-front supply costs and reduce back-end waste as well.
Making OR kit review an established, annual team activity offers an opportunity for engagement and teamwork, as well as the chance to assess current practices and determine if there are areas for improvement. Remember to start small, recruit champions, and celebrate any and all successes along the way.
The University of Minnesota Medical Center, Fairview began this process several years ago when surgeon Dr. Rafael Andrade recognized the enormous amount of unused supplies that ended up as trash. Dr. Andrade reviewed the contents of one surgical kit, gathering the weight and cost of each item. By analyzing this data, Dr. Andrade was able to give an example of how much the facility was losing on supply and waste disposal costs by including unnecessary items in their OR kits. With the rest of the surgical team and the sustainability manager on board, they reviewed 39 kits and saw opportunities where they could save.
Mayo Clinic also implemented an OR kit review process that included the surgical staff, inventory team, nurse managers, and vendors to identify clear goals and streamline the process. Since 2009, Mayo Clinic has saved nearly $125,000 in avoided supply costs and reduced waste.
OR Kit Review
The OR kit review process might seem obvious to some, but taking a methodical approach and implementing a standard review process is such a valuable opportunity for both environmental and financial sustainability that it has been identified as a "Challenge" opportunity for the Healthier Hospitals Initiative. Like Greening the OR, the Healthier Hospitals Initiative provides free tools and resources to help facilities implement these processes, reduce their environmental footprint, and increase the overall health of their communities.
Like OR kit review, reprocessing is also seen as an optimal strategy to reduce the environmental footprint of a facility while also having a positive impact on the bottom line. For this reason, reprocessing is identified as a Smarter Purchasing Challenge in the Healthier Hospitals Initiative. Facilities are encouraged to sign on—whether they already have a successful reprocessing program in place or are just getting started, the resources, tools, and data are available to all.
Reusables vs. Disposables
Reviewing the contents of OR kits isn’t the only way to make smarter purchasing choices for surgical services. Determining if the products have the potential to be reused, reprocessed, easily recycled, or made from recycled or refurbished materials can help reduce the environmental impact of the operating room.
Choosing reusable products over single-use or disposable products where possible—while still meeting or exceeding clinical standards—can drive smarter purchasing efforts. There is a growing body of evidence supporting the number of devices and products on the market that are safe for reuse. This list is continually growing and includes such items as:
- Reusable linens and basins
- Reusable laryngeal mask airways (LMAs), endotracheal tubes (ETTs), and
- anesthesia circuits
- Reusable patient warming devices
- Reusable grounding pads
- Reusable rigid sterilization containers
- Reprocessing medical devices
A recent review by Dr. Michael Overcash compared reusable vs. disposable linens and found that there are substantial benefits to using reusable linens, including energy, water, carbon footprint, waste, and instrument recovery. The study also noted that when comparing cost, comfort, and barrier protection, reusables had a comparable or superior ranking to disposables. These results highlight the growing amount of support for reusables in regard to sustainability and other benefits.
The University of Maryland Medical Center (UMMC) moved to reusable textiles in the OR more than 15 years ago, using a vendor that provides clean, sterilized surgical textiles. In 2010, UMMC avoided the creation of 138,748 pounds of waste as a result of using reusable textiles in the OR, demonstrating an estimated cost savings of $38,849 in avoided waste disposal costs and an estimated $39,000 in returned instruments.
Kaiser Permanente’s use of reusable surgical gowns and basin sets reduced the organization’s regulated medical waste by 30 tons, at a savings of 3.8 percent.
Reprocessing of medical devices is another growing movement in the health care industry. Not only does using reprocessed "single-use" devices provide a significant opportunity to reduce the volume of regulated medical waste, but it’s also a safe and effective method to reduce the operating room’s supply budget and save valuable financial resources. Reprocessing of single-use devices is now common practice in many ORs, with all of U.S. News & World Report’s "Honor Roll" hospitals choosing to reprocess single-use devices and 82 percent of Practice Greenhealth Award winners in 2011 choosing to reprocess medical devices, for a combined savings of more than $11.75 million.
Third-party reprocessors collect a set of FDA-approved devices (many labeled "single-use") and clean, test, sterilize, and package them, making them available for resale to hospitals at a significant discount. The FDA stringently regulates third-party reprocessors. Any liability for a faulty reprocessed device is transferred to the third-party reprocessor, and a reporting system captures any adverse events related to reprocessed medical devices. In 2008, the Government Accountability Office released a study demonstrating that the FDA’s analysis of reported device-related adverse events indicates that reprocessed single-use devices present no increased risk compared with originally manufactured single-use devices. The report also notes that third-party reprocessors are more stringently regulated by the FDA than the Office of Emergency Medical Services (OEMS).
Savings Through Reprocessing
Hospital Corporation of America (HCA) reduced costs by $17.6 million in 2010 and $21.7 million in 2011 through system-wide single-use device reprocessing. In 2010 and 2011, they also diverted 296 and 364 tons of waste, respectively.
Metro Health Hospital in Wyoming, Michigan, realized cost savings of $75,978 in 2008, $84,825 in 2009, and $75,000 in 2010 due to reprocessing of single-use medical devices.
The University of Washington Medical Center in Seattle, Washington, diverted 5.8 tons of waste and saved the organization $496,123 by reprocessing in 2008.
Advocate Christ Medical Center was able to save $400,000 and avoid sending almost five tons of waste to the incinerator or landfills in 2010 through reprocessing.
From an environmental perspective, most single-use devices that are not collected for reprocessing make their way into the RMW stream. Health care organizations pay a premium to dispose of RMW—6 to 10 times the amount it costs to dispose of solid waste. Reprocessing provides a way to divert these devices from the RMW or solid-waste stream and put them back into use. A single hospital can divert more than a ton of devices from the waste stream each year. Additionally, reprocessed devices typically cost between 40 and 60 percent less than the original device, which can mean huge cost savings for the organization.
Reprocessors collect devices in color-coded reusable totes designed specifically for medical instrumentation and deliver packaged sterile devices back to the hospital in reusable totes, eliminating excess packaging brought in by new devices. Most third-party reprocessors also track waste diversion and estimate device purchase savings data for their customers.
The Bottom Line
The operating room uses vast amounts of energy and resources, so taking a targeted approach to make this department more efficient and sustainable can see dramatic results for the facility. There are many opportunities to reduce OR waste; for more information and resources, or to join the community and share your own successes, please visit greeningtheor.org.
I hear over and over again that procuring sustainable products is one of the most challenging tasks for a hospital working toward a greener environment. Several departments may be involved in making even the smallest procurement decisions, a system’s facilities have different needs, existing contracts need to be honored with established vendors, and of course, there’s the proverbial bottom line to consider.
Although these are challenges, addressing potential environmental problems and costs before product and service providers even come in the door can save money (not to mention headaches) in the long run. Many health care organizations have found that working with suppliers is a crucial factor in achieving environmental goals such as eliminating mercury, introducing safer chemicals, reducing energy use, and properly segregating waste.
You don’t need an environmental purchasing program or even an environmental policy to get started with Environmentally Preferable Purchasing. Practice Greenhealth members have found these 10 steps helpful when starting a sustainable procurement journey.
Greening the OR: Innovation in an Image
What does Greening the OR mean to you? Tell your story through a photo.
Practice Greenhealth is asking for Greening the OR participants and members to submit an image that captures sustainable innovation in the operating room or surgical department. This contest is your opportunity to highlight your creativity and hard work—take a photograph that captures how you reduce costs while also reducing waste, energy, and worker and patient exposure to hazardous chemicals.
- Promote sustainable innovations and successes in health care and your surgical department through a photograph and 200-word description.
- Highlight how Practice Greenhealth and the Greening the OR program has helped you achieve your goals. Have fun, make it interesting, and capture what Greening the OR means to you and your organization. You may enter more than one image, but each will be judged independently based on content, creativity, and context. These images may be featured at CleanMed, on the Practice Greenhealth website, and in Greenhealth Magazine.
The winning image will receive two free registrations to CleanMed 2014 and one free download of all CleanMed 2013 sessions.
For more information about the contest or to enter, visit www.GreeningtheOR.org
Deadline to submit: Friday, March 20th 2013.
Photos must be high resolution – 300 dpi or greater.
*You must have the rights to the photo in order to submit. By submitting you agree that any images submitted may be used by Practice Greenhealth for future publications including but not limited to promotion of educational events, Greenhealth Magazine, Practice Greenhealth website, articles, and more.