Newswise — The last thing on a surgeon's mind when he or she enters the operating room (OR) is environmental waste or energy inefficiency. As always, the main concern is the safety and care of the patient. However, surgeons at Oregon Health and Science University (OHSU), Portland, are finding that they can protect the environment as well as the patient by recycling solid waste and conserving energy use in the operating room. "The commitment that people are making in their personal lives to recycling and creating a more sustainable environment doesn't have to end the minute they walk in the OR. Just because we are dealing with life and death issues doesn't mean that we have to stop thinking about the environment," according to Juliana E. Hansen, MD, FACS, chief of plastic surgery and associate professor of surgery.

Since 2004, surgeons at OHSU have been actively involved in waste conservation and energy efficiency activities. Dr. Hansen reported on their efforts in a scientific exhibit at the 2008 Clinical Congress of the American College of Surgeons. She and colleagues analyzed how surgeons contributed to the university's campus-wide environmental sustainability programs, which recycled nearly 1,100 tons of solid waste in 2007 and saved more than $85,000 in waste management fees.

In the study, Dr. Hansen found that surgeons and OR nurses recycle roughly 300 lbs of uncontaminated paper and plastic products from the university's 21 inpatient operating rooms each day. These materials include the packaging components that surround sterilized instruments, suture material, and gauze pads. "Those are the things we just used to throw away, but they are no-brainers for recycling because they are never contaminated. They are never handled by the surgeons. They are opened sterilely and removed from surgical products before being used in an operation," Dr. Hansen said.

These accomplishments are the result of ongoing education of surgeons and staff by committed OR nurses. "I'm sure you've seen at various recycling areas that people will throw things away that aren't supposed to go into recycling bins. That's a big problem in the OR, because if contaminated material from an operation gets into the recycling bin, the whole bin has to be thrown out. Maintaining awareness and educating people on a regular daily basis is key. There are nurses who are dedicated to this project and who put a lot of time and effort into having a system in place for capturing the clean waste, storing it in a separate place, and getting the recycled material picked up daily," Dr. Hansen explained.

In addition, the OHSU operating rooms have been refitted with light-emitting diode (LED) lights and low-mercury lamps, which save 340,000 kWh of energy per year. At an average cost of $0.12 per kWh, energy-efficient lighting saves approximately $40,000 a year.

By purchasing Green Tag renewable energy certificates for the operating rooms, OHSU management has replaced 294,000 kWh of traditional polluting energy sources of electricity with clean and sustainable sources of energy each month. As a result, the operating rooms have decreased carbon output by 265,000 lbs each month. (Green Tags are sold by nonprofit organizations that support and promote renewable energy programs. Each purchase of a Green Tag fosters the development of renewable energy on power grids, solar power systems for public buildings, wind power systems for communities, and watershed restoration to improve water quality. Each Green Tag is equivalent to 1,000 kWh of renewable energy and 1,500 miles of offsetting emissions from a standard automobile.)

Furthermore, cleaning supplies used in the OHSU operating rooms meet or exceed Green Seal standards, which reduce the number and quantity of chemicals that may be harmful to the environment and that pollute runoff water in sewer systems and watershed areas. (Green Seal is a nonprofit organization that identifies and promotes the use of environmentally responsible products to reduce the environmental impact associated with the manufacture, use, and disposal of products.)

Dr. Hansen first became interested in environmental sustainability in the OR in 2000 when she saw the amount of waste generated during simple operative procedures. "You would do a little case in the OR, such as abscess drainage, and see that there were trash cans overflowing with waste. The waste that we produced in the OR stimulated me to propose a committee to start addressing environmental issues," she said.

In 2004, a separate entity, the Green Team, was formed by the campus director of operations and maintenance. This organization, made up of interested volunteers from all areas of the university, plans, and oversees sustainability programs throughout the institution. This group has been thriving, in part, because of a like-minded attitude among the leadership of the university that understands how sustainability balances social and environmental concerns with corporate realities, thus enhancing both the environment and the financial bottom line.

Recent campus additions include a new medical building that has achieved the highest certification standards from the Leadership in Energy and Environmental Design (LEED) program of the US Green Building Council. LEED is a voluntary rating system that ranks building projects and awards certification in four levels: certified, silver, gold, and platinum. LEED projects must meet green building criteria in five areas: the sustainability of the building site, efficiency of water usage, management of energy and atmosphere, choice of building materials, and quality of the indoor environment. To receive the highest award, building projects must meet 52 out of a total 69 points. OHSU's Center for Health and Healing was the first complex medical building of its kind to receive platinum certification in 2007.

Another new campus fixture is the Portland Aerial Tram. This tram connects the upper campus with the newer river campus, converting a 15-minute drive into a three minute, 1-km ride. It saves faculty and employees more than 2 million vehicle miles per year, the equivalent of 93,000 gallon of gasoline.

Sustainability efforts are being carried out all over campus, from the grand scale of the energy efficiency of the tram to the paper and plastic recycling bins in the operating rooms. "It's fantastic what can be done when you have a [socially conscious] mindset. You realize there are ways we can do our part in the OR without creating an environment of wastefulness," Dr. Hansen concluded.

Naiem Nassiri, BS, MD, and Dana Peterson, RN, participated in the study of the role of the operating room in hospital sustainability efforts.

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2008 American College of Surgeons Clinical Congress