GOOD TO BE GREEN If you don't have an intraoperative recycling program to collect plastics, papers and other supplies free of infectious materials, you'll pay more to pollute more.

You have the power to create an environmentally responsible surgical facility, and you won't have to install rooftop gardens, solar panels or water-free urinals to do so. Your greening efforts can start and stop in your operating rooms, home of the energy-sucking overhead lights and land of the clean waste that somehow ends up in red bags. Here are some simple ideas you can implement today that will instantly make your facility a little more environmentally responsible.

Segregating waste
ORs generate an enormous amount of waste, most of which is generated before the patient enters the room, which means it's considered clean waste and recyclable. This includes plastic packaging and disposable instruments, drapes and gowns, and maybe even a pack of opened but unused sponges from a canceled case that took a wrong turn to the landfill. If you don't have an intraoperative recycling program to collect plastics, papers and other supplies free of infectious materials, you're paying more to pollute more.

Experts say the No. 1 thing you can do today to significantly decrease your volume of medical waste is to properly segregate waste. Simply train your staff to be mindful of the 2 kinds of disposal bags used to separate waste — red bags for infectious and pathologic waste, and clear bags for non-infectious waste. As much as 90% of what ends up in red bags does not meet the criteria for red-bag waste, which of course costs far more to process, says Martin A. Makary, MD, MPA, an associate professor of surgery at the Johns Hopkins University School of Medicine in Baltimore, Md. Items that don't belong in red trash (unless soiled with blood or body fluid, including fecal material) include food wrappers, beverage containers, patient gowns or drapes, gloves, and empty IV bags and used tubing.

Dr. Makary and his team of researchers studied how surgical teams disposed of waste and found that even though hazardous and infectious waste makes up only 24% of medical waste, it accounts for 86% of disposal costs. He suggests you make clear plastic bags more readily available during surgical preparation and then replace them with red bags just before the patient is wheeled into the OR, when most red-bag waste is generated. And don't be afraid to do a little trash-picking. A great way to educate your staff is to remove items from the red bag that don't belong there ("Is this soda can infectious waste?") and to remove discarded items that can be recycled.

When Tyler Bemont, RN, BSN, worked at Community Memorial Hospital in Hamilton, N.Y., a 40-bed hospital with a busy orthopedic surgery service, he estimated that each of the 8 or so total joint replacement surgeries they performed each day generated about 35 pounds of garbage. "For years," he says, "this material wasn't recycled and ended up in the landfill."

Mr. Bemont found that the hospital had a single recycling receptacle that collected mostly aluminum cans and plastic bottles from the kitchen. This one bin cost the hospital $100 a month to have on site and another $600 to empty once every 6 months. Meanwhile, the hospital was paying $2.50 per pound to dispose of red bag waste that contained infectious material, glass vials and sharps. Mr. Bemont helped launch a program that recycled 45 pounds of glass each month.

SODA CAN? You're throwing money away when you fill red bags that are labeled as medical waste with harmless trash that could be more cheaply disposed.

From blue to green
A good way to kickstart your recycling program is to designate a recycling bin in each OR for the blue wrap from procedure packs and trays. "This is an easy first step because the wrap is removed when the room is being set up, before the patient and physician arrive and things get busy," says Juliana E. Hansen, MD, FACS, the division chief of plastic and reconstructive surgery at Oregon Health and Science University (OHSU).

Once staff gets accustomed to recycling the wrap, add another bin for mixed items — clean paper and clean plastic. Make sure that the recycling bins are well marked and a different color from regular waste bins, notes Dr. Hansen. In areas where a lot of contaminated waste is generated, recycling bins should have a lid in order to discourage nurses from throwing random contaminants in them. "The lids may discourage recycling when first introduced, but as buy-in increases, so too will recycling," says Dr. Hansen. "Eventually, recycling will be part of everyday business in your ORs." It is in hers. Each day OHSU's 21 operating rooms recycle about 300 pounds of uncontaminated paper and plastic.

Another way to reduce the use of blue wrap is to eliminate it altogether and replace it with reusable, rigid sterilization containers. These reusable containers, which don't generate any waste except for when the filter needs to be changed, can be expensive, a factor you'll need to consider, especially if you'll need to buy and store lots of containers. But keep in mind that it's time consuming to wrap instruments and costly to dispose of the wrap.

Wait, there's more
Here are 7 other small steps you can take on the road to environmental stewardship:

• Let's start with the opened-but-unused dilemma. It's not just what you throw out. It's also what you unwrap and don't use and then throw out. ORs are notorious for opening sterilized equipment that is never used, and then disposing of it like yesterday's newspaper. The Gainesville (Ga.) Eye Center donates clean but not sterile supplies to humane societies or animal shelters. "We get it out of our trash and they get clean supplies," says Clinical Manager Becky Burnett, RN, BSN.
• Use paper medication cups instead of plastic ones and non-PVC patient ID bands, says Sandra Armington, RN, of Maine General Medical Center in Augusta, Maine.
• Place a reusable ground pad with gel padding on the OR table. "We no longer have to use expensive disposable pads, and we limit all the copper wire and padding from the landfill," says Charlene Goff, RN, director of nursing at the Pasadena (Calif.) Plastic Surgery Center.
• Switch to disposable biopsy forceps. "Not only are they cost-effective and safe for the patients, but you don't have to autoclave them," says Lori Garrison of the Endoscopy Center of South Jersey in Vineland, N.J.
• To save on your energy costs, program your HVAC control system so that it sets the building into an unoccupied mode after hours. "Our energy bill last month was $1,500 less than the same month the prior year," says Scott Bergman, MBA, administrator of the Millennium Surgical Center in Cherry Hill, N.J.
• Switch to gel armboard padding instead of single-use disposable foam pads. The Florida Hospital Surgery Center in Orlando, Fla., is saving about $7,000 per year from the switch. "The gel pads are easy to use and clean, and with proper care will last you at least 3 years," says Materials Manager Ulises Ruz. The Virtua Joint Replacement Institute in Vorhees, N.J., switched from disposable foam headrests and heel protectors to reusable gel products. "We also eliminated most disposable foam positioning products and replaced them with reusables," says OR Nurse Manager Carol Childress, RN, BSN, CNOR.
• The Overland Park (Kan.) Surgery Center worked with its local trash company to have 2 dumpsters at the facility: one for trash and one for commingled recycling. "It saves us money on our trash service and we feel great knowing that the blue wraps and all the cardboard and plastic that go through our facility are being recycled and not sitting in a landfill," says OR Manager Donna Jacobson, RN.