Your Practice - Environmental Sustainability in the OR: What Can You Do?

Review how perioperative teams and individuals can improve environmental health for all with innovative approaches. Find out what steps AORN, The Joint Commission, and individual periop nurses are taking.

Periop nurses witness the significant amount of waste generated in the OR every day, but they may not know just how significant this waste is.

Recent research is connecting healthcare waste to more wide-ranging impact, including excess CO₂ levels.

“If worldwide healthcare were a country, it would be the fifth largest polluter of CO₂ emissions, according to a 2019 Health Care Without Harm report,” said The Joint Commission President and Chief Executive Officer Jonathan B. Perlin, MD, PhD, MSHA, MACP, FACMI, during a Feb. 22 APIC webinar.

Perlin suggested OR activities that could be modified to significantly reduce CO₂ emissions. For example:

• Turning down the flow rate of fluorinated anesthetics could help reduce overall healthcare CO₂ emissions by 7%.
• Reducing the number of air changes after hours in ORs could help reduce overall healthcare CO₂ emissions by 11%.
• Purchasing surgical equipment and supplies that are labeled to emit lower CO₂ levels could help reduce overall healthcare CO₂ emissions by 82%.

Climate change can directly impact public health, such as when it contributes to extreme weather events, increases heat-related illnesses, and intensifies in vector-borne, food-borne, and noncommunicable diseases.

Perlin challenged every healthcare professional to consider ways they can take action to support environmental sustainability, which he described as a matter of health equity in the US because “people with the greatest social and medical vulnerabilities are those that are most vulnerable to the effects of climate change.”

Prioritizing Environmental Health

Recognizing the role healthcare plays in harming environmental health, The Joint Commission and AORN are taking several proactive efforts to align work toward health equity and social justice with environmental health.

As part of The Joint Commission’s support for national initiatives to decarbonize healthcare, it is reviewing existing standards to assure there is no unintended consumption. The organization is also shaping new environmental sustainability standards slated to take effect in July 2024 that will prompt CO₂ reductions, Perlin explained.

AORN agrees with The Joint Commission’s work and recommends that to reduce the environmental emissions during surgeries, health care providers adopt a combination of collaborative approaches to:

• Minimize materials
• Move away from anesthetic gases with high global warming potential
• Maximize instrument and equipment reuse
• Reduce energy use when operating rooms are unoccupied.

Work to advance environmental health is being addressed by AORN in several important ways, including through the association’s business practices. For example, AORN business leadership is exploring opportunities to advance an environmental, social, and corporate governance framework.

The environment will also be an important topic of discussion at AORN’s 70^th annual conference where several educational presentations will share innovations and interventions to advance environmental sustainability, including a session on A Sustainable Going Green OR with Bonnie Weinberg and a session on Aerobiology 101: Rethinking Air Quality Management in the OR with Kathy Warye.

Ready to explore opportunities to improve environmental sustainability in your OR? Here are a few resources to help brainstorm as a team:

• AORN Position Statement on Environmental Responsibility
• 5 Ways to Be an Environmental Steward in Your OR
• Federal Resources to Support Emissions Reduction and Climate Resilience for Healthcare Stakeholders
• Stay tuned for the updated Guideline for Design and Maintenance of the Surgical Suite that discusses considerations for a ventilation setback strategy when the OR is unoccupied.