How to Reduce Operating Room WasteErika Barredo
While operating rooms generate the highest revenue, these are also where most waste and supply costs come from. About 20 to 30 percent of hospital waste comes directly from the OR. Waste materials vary and are comparable to what’s disposed by different industries. Apart from surgical waste, disposal is needed for facility operations-related waste, office disposables and food or drink items; but these are not easily thrown away, like waste products found in dumpsters or landfills. There are laws in place, at the state and federal levels, when it comes to medical waste disposal. These cost 10 or 15 times more than the usual waste disposal processes.
About 20 to 30 percent of hospital waste comes directly from the operating room.
Why Operating Room Waste Needs to be Disposed
Apart from the financial aspect, medical and environmental concerns needs to be addressed. There is risk for infection and contamination when blood, fluids, clothing (surgical gowns, drapes) and materials used in operating rooms are not properly disposed.
While there are instruments which must be immediately discarded, some can be recycled and there are organizations which may help. One of these is Stryker, a recycling company for the medical industry. Some materials they accept include laparoscopic devices, blood pressure cuffs, surgical product wrapping and more. For supplies or equipment which are no longer useful but are not expired and still functional, there are organizations like MedShare which help distribute these to medical facilities that cannot afford to purchase such items.
Wrappers for various materials also commonly contribute to operating room waste. Medical products are often wrapped in plastic, cardboard boxes, or blue wrap. The latter is a form of fabric made of polypropylene plastic. Since these are discarded outside the OR to avoid risk of contamination, they can be recycled by NGOs into aprons, tote bags, or other byproducts.
Disposing of bio-hazardous hospital waste costs about 0.62 cents per kilogram. Recycling them can certainly reduce the overall cost of waste disposal. At Johns Hopkins Health System, Baltimore, the neuroanesthesia division was able to save $5 million in 2010 and 2013 for its reprocessing program.
But recycling is not always applicable for all OR items; specially, if there is risk of infection. Patient safety is of higher importance compared with sustainability.
Benefits of Reducing Waste in the Operating Room
Sustainability is not limited to waste reduction, recycling materials, and eliminating infection for patient safety. Everyone who works in the OR including physicians, anesthesiologists, nurses, medical technicians and even maintenance staff should be informed of the financial and environmental aspects of sustainability.
In a nutshell, these are the benefits of imposing sustainability efforts in the OR, or the hospital as a whole:
- Saves money
- Reduces patient risk due to infection; thereby, increasing patient safety and improving hospital quality
- Helps the hospital to comply with federal, state and other medical organizations’ regulations
- Improves organizational structure for operations
- Increases employees’ engagement with patients, fellow staff and the hospital; leading to overall satisfaction and increasing retention rates
- Signifies corporate social responsibility, creating a good public image for the hospital, improving its brand, and building for present and future patients
Everyone who works in the OR should be informed of the financial and environmental aspects of sustainability.
Guidelines Before Implementing a Program for OR Waste Reduction
Before you get started with implementing a program to reduce OR waste, here are some guidelines:
- Start with a commitment. Make it everyone’s responsibility to support waste reduction efforts.
- Let that commitment become a work culture. Create a structure which encompasses the development of programs related to sustainability.
- Support the commitment through leadership or by following the program. This may also entail a form of financial support, needing approval from the hospital board.
- There should be a continuous effort to assess the program for further rooms of improvement or at least maintain any success accomplished.
Practical Waste and Cost Control in the OR
Key points when it comes to executing sustainability efforts include creating a new structure for purchasing, storing, and disposing of operating room devices and supplies. It also involves implementing a more effective OR waste disposal system by reducing and recycling.
Here are more pointers to consider:
- Assign team members who will be responsible for the entire program or for various elements of it including planning, implementing, and assessment. Planning involves auditing the OR for areas of improvement. There should also be a group designated for educating everyone about sustainability.
- Assessment should include removing or replacing OR materials which are not often utilized and end up in the waste bin. These contribute to OR cost and waste disposal problems.
- Fluid management systems should be in effect. This makes it easier to secure and dispose fluid waste.
- Prevent greenhouse gas emissions due to inhaled anesthetics by exploring possible alternatives. Examine other medical products contributing to the greenhouse effect as well.
- Consider purchasing reprocessed or recycled medical equipment and supplies, so long as it will not put patients and OR staff at risk. The same applies to surgical gowns, sharps containers, blue wraps, and more. The latter can be replaced with reusable containers instead. Adding recycle bins to the OR will also help achieve this purpose.
- Energy consumption reduction is also part of sustainability. Conserve water and electricity usage, if applicable through usual energy conservation avenues.
Factors to Consider when Choosing OR Products
In relation to controlling OR waste, here are factors to consider when choosing which products to use:
- Performance (Standards)
- Cost (per use)
- Environmental Effect
These factors should also coincide with certain requirements such as regulatory boards in the federal and state level as well as accrediting bodies of which the hospital or it’s staff are members. Other requirements include patient requests, user (medical staff) preferences, and what the procedure itself calls for.
For decision-makers who need to make a choice when it comes to operating room materials, the options can be further narrowed down between reusable and single use items, regardless of the brand.
Controlling OR waste should consider protection, performance, safety, comfort, cost, and environmental effect.
The operating room is a big spender in any hospital. Based on a study in 2009, the OR spends about $29 per minute for simple procedures, but the cost may shoot up to $80 per minute for complex operations. The estimate does not include anesthesia expenses yet. This is why cost-cutting options are considered, particularly, for the OR.
Safety and Protection
Reducing costs should not compromise staff and patient safety because about 15% of hospital waste is infectious. This is why there are regulatory bodies such as the FDA and OSHA to ensure that all medical products pass safety and protection standards.
Critical, Semicritical or Noncritical
How each OR material is accredited depends on whether they are critical, semicritical or noncritical. Critical refers to everything which directly comes in contact with tissues or the blood stream, such as surgical equipment. Semi-critical ones are those which may become contaminated due to mucous membranes or nonintact skin, such as devices used for respiratory or anesthetic procedures. Non-critical items may contact intact skin, but not mucous membranes. Clothing materials like mattresses fall under the non-critical category.
Performance and Comfort
Hospital materials must also be comfortable and long-lasting. Although this is not applicable to medical products which should only be utilized once to avoid contamination, there are OR items which are either for single-use only or can be reusable. Some of these include surgical clothes, towels, and linens.
There are conflicting studies which support both types of products when it comes to safety, protection, and performance. The AORN’s Standards and Recommended Practices encourages the focus on reusable items while the McIlvaine Company in 2009, through a White Paper they published, endorses single use materials instead.
The utilization of reusable and single-use products both pose environmental concerns. The latter becomes a burden for waste disposal – particularly for infectious materials. While the former allows for multiple uses; thereby, minimizing waste, it may cause contamination when not properly cleansed and disinfected.
In conclusion, hospital ORs needs to consider various factors, including protection, performance, safety, comfort, cost, and environmental effect before deciding on implementing a waste reduction program.
Tine Health helps improve your patient’s care experience in operating rooms and the hospital as a whole by making sure that care providers offer exceptional care. We offer effective as well as cost and time efficient nurse training through just-in-time-training that are accessible from smartphones and tables, just in time when they’re needed; prior to a operating or administering critical devices and processes.
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