OR Excellence Awards: Environmental Stewardship: A Rallying Point for Sustainability

UnityPoint Health – Meriter Hospital’s Green Team empowers every employee to put their ideas into action.

Sometimes it’s not just who you are but also where you are.

UnityPoint Health – Meriter Hospital is located in Madison, Wis., a city where environmental awareness has long been baked into the local culture. “It’s one of those places where this is really part of the community fabric,” says Chief Operating Officer Christina Jackson, MSN, RN, CNOR, CENP. “There was never a doubt or a question about whether we could or would spend time on this.”

“This” is Meriter’s Green Team, established in 2018 and going as strong as ever. The multidisciplinary group includes members from all corners of the hospital: supply chain, facilities, perioperative services, marketing and communications, food and nutrition, safety, and design and construction — as well as nurses and physicians. Its mission is to decrease waste and encourage environmentally friendly practices across the hospital and its outlying clinics.

It’s a comprehensive, inclusive and forever-growing collective effort that has produced real-world results on any number of fronts. And it’s the diversity, ambition and intuitiveness of both the Green Team’s programs and people that has won Meriter the 2023 OR Excellence Award for Environmental Stewardship. We’re not the only organization showering the facility in accolades. Meriter was also awarded the 2023 Partner for Change award from Practice Greenhealth.

“I describe the Green Team as really a grassroots effort,” says Ms. Jackson. “That’s how it started. It didn’t come from administration to the staff. It came from the staff. They care about this whole ‘green’ thing, and want to contribute.” The team meets every month, but consistently communicates. “I’ve seen emails from time to time where people just throw out different ideas and copy the team to look for feedback and unveil additional opportunities,” says Ms. Jackson.

“The Green Team’s success comes down to that multidisciplinary work, and having champions in all spaces — from facilities to nursing staff to anesthesia and beyond,” says Tressa Gill, BSN, RN, CNOR, director of perioperative services. “It really comes down to staff engagement and championing, ensuring that we’re engaging all members of the team and keeping up on that.”

Here are some of the Green Team’s accomplishments. Their impacts come in all sizes and types, but they add up — in 2022, Meriter recycled 225 tons of its 949 tons of total combined waste.

• Reduced use of ozone-depleting fluorocarbon anesthesia gases. Desflurane was banished due to a request Ms. Jackson received in 2019, when she was director of perioperative services. “The anesthesiology department approached me about their desire to reduce the emissions from anesthetic gases that go into the environment,” she says. “There was some capital investment required — we had to purchase and switch out the vaporizers on all of our anesthesia machines to get ones specific for the more environmentally friendly gas, sevoflurane — so we had to work it into our plans.” Those plans have now come true.

• Use and recycling of single-use devices. Meriter has long worked with a vendor to recycle or remanufacture its single-use devices, and also acquires reprocessed and remanufactured single-use devices from the vendor. Products that are typically single-use, such as compression sleeves and torniquet cuffs, are collected after use in bins that are picked up by the vendor, who disassembles, cleans, function-tests and returns items to original manufacturing specifications. They are then repackaged and sterilized so they can be used again by Meriter or any other facility. “Meriter itself is not in the business of reprocessing single-use items, because that would be against instructions for use, so we work with our vendor’s sustainability team,” says Ms. Gill.

Collecting and reusing plastic caps from medication bottles. “We collect as many of them as we can,” says Ms. Gill. “In fact, one of our nurses just sent me a picture of her dumping plastic caps into the collection area. Various units throughout the hospital are doing this.” While many caps are recycled, some are used for other purposes. “Our staff will take them home after disinfecting them and do an arts-and-crafts afternoon with their kiddos or their coworkers,” says Ms. Gill. “A few years ago, our OB department put together a really pretty piece of artwork using plastic caps that’s hanging in one of our conference rooms.”

• Adjustments to straws and utensils. In April 2023, Meriter’s cafeteria switched from single-use plastic utensils, cups and plates to reusable ware. Plastic single-use straws are no longer automatically sent to patient rooms and are available upon request. These changes alone saved 122,824 straws — a whole lot of plastic. “You go to a restaurant and they don’t give you straws anymore, or they give you a paper straw,” says Ms. Jackson, who adds that those off-the-job experiences informed this idea. “Our staff looks at what’s going on around them and thinks about how they can apply it to the hospital setting.”

• Composting. Coffee grounds from both the OR lounge and the hospital’s bistro are composted instead of thrown away. “One of our anesthesiologists has his own farm, and he takes the grounds there to use as compost,” says Ms. Jackson. “They save the grounds for him.”

All of these examples are from the bottom-up rather than the top-down. “The culture of safety is very strong here at Meriter and I think that bleeds over into topics like this where people feel empowered to speak up and throw their ideas out there,” says Ms. Jackson.

“To get something like this started may seem like a huge undertaking, but engagement of team members from many different spaces is important,” says Ms. Gill. “You need to continue to stay on it, to have small goals in mind and to accomplish those goals, and then continue to reengage and reinforce and reeducate. Anything, whether it’s big or small, makes a difference. What really matters most to the individuals who are really passionate about this is reducing what goes through our waste stream and knowing we’re not putting items into a landfill.”

Adds Ms. Jackson, “The personal satisfaction is more important than the financial savings to us.” OSM

Honorable Mention

Managing Blue-Wrap and Plastic

HAVE A SEAT Staff at Carilion Clinic Outpatient Surgery Center pose around one of the benches they have been awarded due to the volume of their participation in a plastics recycling program.

Carilion Clinic Outpatient Surgery Center in Roanoke, Va., takes pride in reducing its environmental impact, particularly in terms of plastics and blue wrap.

Since 2021, its clean soft plastics have been collected and provided to Trex, a recycling program run by a manufacturer of alternative wood decking products. “Once you get to 500 pounds of plastic, you get a bench,” says Sara Wohlford, Carilion’s director of sustainability. “This department collects a lot of plastic to recycle, so it’s only taken four or five months to get a bench.” In fact, they already have two benches and are on their way to a third. “Our benches are outside, and staff uses them during lunch breaks, as do waiting family members,” says the center’s director, Vicky Beckner, MSN, RN, CNOR, NEA-BC. Plaques on the benches are dedicated to the clinic’s surgical services vice president and a surgeon who have passed away. “We’re planning for a third bench to be placed under a tree across from our facility,” she says.

To address blue wrap, the facility, which also reprocesses instruments for more than 50 clinics in the Carilion system, began transitioning to metal sterilization containers in 2021. “A lot of the clinics were all blue wrap trays,” says Ms. Beckner. “We started thinking, ‘That’s a lot of waste. Is there a better way to do this?’” Unit director Lisa Smith and staff decided reusable containers were the way to go — not just to decrease landfill waste, but also to reduce labor costs, speed up the instrument turnover process and decrease operational costs.

“Our OR educator went to our clinics to provided education on how to open up a container versus blue wrap,” says Ms. Smith. “We converted the clinics one at a time. Once a clinic was educated, we converted them over to the containers. From October 2021 through July 2023, we’ve reprocessed 5,280 containers that would have been blue wrapped.” The move has already saved the facility tens of thousands of dollars on blue wrap costs, waste haul fees and labor costs, as well as prevented several hundreds of pounds of blue wrap from entering Virginia landfills.

“The benches made our staff excited because they saw physical, tangible items that came from their hard work collecting the soft plastics,” says Ms. Beckner. “Same with the containers — they see what’s in it for them, that it’s more efficient and less work.”

—Joe Paone