Does your heart hurt when you see the countless bags of waste after a case?

You aren’t alone. And, you have the power to change it.

Just ask Noe Woods, MD, an OB/Gyn at Magee Women’s Hospital at the University of Pittsburgh Medical Center (UPMC). She’s also a professor, assistant dean for sustainability and a passionate advocate for climate-friendly healthcare. 

In 2021, she connected with a group of like-minded physicians, nurses, and other clinicians at UPMC to start Clinicians for Climate Action, which she chairs. In just a few years more than 500 clinicians have joined the group. Together they successfully advocated for UPMC’s Office of Sustainability. They’ve also led major projects in the OR to successfully reduce their system’s carbon footprint, such as stopping the use of desflurane anesthetic gas and trading out single-use items like pressure cuffs and oxygen sensors for reusable ones.

Why Now is the Right Time for Environmental Change in Healthcare

Minds are more open to champion environmental sustainability in healthcare today for several reasons, according to Dr. Woods.

First, shortages during COVID raised major concerns about how much hospitals rely on their supply chain. “After the pandemic, teams were inspired to be more self-reliant with practices such as processing supplies in-house, which offers serious advantages we had forgotten about.”

Second, cutting costly waste is a major focus in every healthcare organization. “No matter what sustainably intervention you do, it’s going to save costs, and that is something healthcare intuitions are keen to do now.”

Third, making changes for climate-friendly care feels right. “When we implement sustainability measures, we see higher job satisfaction, higher job retention rates and a reduced sense of moral injury.”

Last, and maybe most impactful, clinicians are seeing the effects of climate change in their communities and across the globe. “Mother Nature can be the best educator to open our eyes to climate change, especially as we see heat records and extreme weather events that are affecting humans directly.”

All of these factors are coming together to create the perfect nexus for action, the kind of action she believes nurses, surgeons and other members of the surgical team are well positioned to lead.

Good Projects to Secure Champions and Change

Any perioperative team can affect positive changes for the environment, and save time and money in the process, Dr. Woods encourages. To get this work moving, she suggests launching a green team and inviting anyone interested in sustainability to have fun, have food and start thinking about projects.

Here are seven OR sustainability projects that she’s seen work…

1. Optimize Custom Cards to Reduce Overage—An average 20% of surgical items listed on a surgeon’s preference card end up as overage—never used but opened and then discarded or sent back for reprocessing. Surgeons, nurses, and administrators can collaborate to weed out this waste.

2. Re-Evaluate Custom Packs—The only changes typically made to custom packs are add-ons. Yet, many instruments in a custom pack are never used. Even a biannual evaluation of custom-packs can prove useful to keep packs streamlined and free of non-used items.

3. Start a Linens Project—Cotton has a high environmental impact, yet linens often get thrown out with the trash and add even more to a facility’s carbon footprint. A linen education project can help teams plan smarter workflows to ensure used linens are placed in laundry receptacles.

4. Target Harmful Anesthetic Gases—Education can be powerful for a change like this. “Too often we just don’t know how harmful a product is that we are using until we learn about it and learn it can be replaced without impacting patient care.”

5. Rethink RMW Workflow—Reducing regulated medical waste is huge for the environment and costs, but it requires significant time retraining staff so it isn’t always a go-to for a sustainability project. However, small workflow changes can make a big difference, such as changing your container placement, so the waste receptacle is in closer reach than the RMW receptacle. This can help busy people make a better choice for the environment without even thinking about it.

6. Explore HVAC Set-Backs—Certain HVAC systems can lend themselves to reduced air exchanges when the OR isn’t occupied. This can significantly reduce a facility’s carbon footprint if it’s right for the hospital after consideration with engineering experts.

7. Reduce Waste in the Break Room—Nurses can also look beyond the OR for simple changes that make a difference. One easy change in the break room is to switch to reusable plates, cups, and silverware, which can significantly reduce waste.

Tips to Sell Your Project

Having been there herself, Dr. Woods knows what works to get administrator approval and front-line buy-in for a sustainability project. Try these tips to gain traction:

Tip #1: Look at What Your Competitors are Doing.

When you look at what can change people’s impressions about climate behavior, the biggest driver for change is social comparison, she explains. “Demonstrating what your competitors are doing turns out to be really effective and shows people there’s a better way that works.”

Tip#2: Build Momentum in Writing

To gain administrative buy-in on a project, try starting a petition or write a letter staff can sign. These can be useful to show people care about a change you are trying to make.

Tip #3: Avoid Impacting Workload

Don’t start with projects that require re-training such as changing draping, because this can lower your chances for securing buy-in. “People do still need to do their jobs. Threatening this can be a fast-track to project failure.”

Tip #4: Leverage Local Experts

If you start to hit a wall with project approval or implementation, look within your organization or community to find colleagues with expertise in what you are trying to achieve. Maybe they can offer a pre-recorded talk or visit an in-service to share their insights.

Tip# 5: Take Time to Rekindle Your Motivation

“When you are trying to reduce climate change, the scope of the problem can be quite deactivating psychologically so it’s important to feed the source that sparked your passion in the first place.” For her this means reconnecting with nature and her friends who are also passionate about taking action to protect the environment.

Find more ways to advance environmentally sustainable perioperative care:

• AORN Position Statement on Environmental Responsibility
• Sustainability in the Perioperative Practice Setting in AORN Journal
• Environmental Sustainability in the OR: What Can You Do? in Periop Today