Like other areas of health care, there is no denying that the operating room is in need of some greening. Health care facilities produce more than 6,600 tons of waste per day and nearly 5 billion pounds annually. The operating room and labor-and-delivery suites make up 70 percent of that waste.

Over the past decade, more hospitals have been making conscious efforts to go green, with many hospitals spearheading their own initiatives to drive down medical waste and operating costs. In 2010, a nonprofit organization called Practice Greenhealth started the Greening the OR Initiative specifically to address these green issues in the operating room.

Getting on board
Yale-New Haven Hospital is one of the hospitals that believes in the importance of sustainability. The president pioneered the WorkSMART initiative, which is a committee that focuses on increasing cost savings, efficiency and sustainability initiatives.

"The hospital firmly believes that sustainability is a responsibility of its entire community, including clinical and nonclinical employees," says Cristina DeVito, sustainability coordinator at the hospital.

They began their sustainability journey by reprocessing reusable medical devices, installing LED lights and increasing their waste reduction efforts.

Most hospitals throw a lot of waste in the regulated waste stream — even waste that isn't considered a biohazard risk — but doing so is much more costly for the hospital and it has a negative impact on human health and the environment.

According to Practice Greenhealth's Sustainability Benchmark Report, hospitals generate over 30 pounds of waste per bed per day. Once the material is removed for donation or recycling, thousands of trucks transport it for "burn or bury".

Half of landfill material is made up of food, paper and other compostable material. This material produces a greenhouse gas called Methane, which is 72 times more potent than carbon dioxide over a 20 year period. The U.S. Environmental Protection Agency identifies landfills as contributing nine percent of the U.S. carbon emissions though the development of methane.

Yale-New Haven started putting more emphasis on making sure its waste was segregated properly, and as a result it delivered huge benefits.

"Not only was money being saved due to proper waste segregation, but the staff was creating a healthier environment and community for our staff, patients and their families," says DeVito.

The Johns Hopkins Hospital in Maryland is another facility that takes proper waste segregation seriously. In February 2012, they started a campaign to reduce trash and medical waste and reported a 200,000 pound decrease in the amount of waste produced each month, which was a 17 percent drop in the five months since it began.

They are continuing to educate their staff and make sure the operating rooms are equipped with the right waste receptacles. There are clear waste bags for general trash, red bags for biohazardous waste and recyclable bags for paper, cardboard, food containers, metals and glass.

Yale-New Haven and Johns Hopkins both also put a big emphasis on reprocessing their medical devices. For instance, Johns Hopkins sends products such as laparoscopic instruments to Stryker Sustainability Solutions and the company reprocesses them and sells them back to the hospital for about half the price.

"They're the ones that are taking these items into a container in every OR, specifically those laparoscopic trocars, tourniquets, and harmonic scalpels, they're the ones who are reprocessing it and then selling it back to us and we support that as an institution," says Erin Pilson, perioperative nurse educator at Johns Hopkins.

Yale-New Haven has a similar program, but it wasn't an immediate hit. "Initially, there was significant push-back because many physician leaders did not trust used products," says Yale-New Haven's DeVito.

But some physician leaders at Yale-New Haven are passionate about the initiative and they vouched for the integrity of it, which helped the program grow.

"Establishing physician leaders and showcasing their use of reprocessed products was essential to further the reprocessing program," says DeVito.

Let's talk about savings
Implementing sustainable initiatives in an operating room improves the environment as a whole, but it also saves hospitals a large chunk of money.

In Practice Greenhealth's fifth annual Sustainability Benchmark Report, data collected in 2012 showed member hospitals had annual savings of over 30 million dollars from about 500 energy projects that were implemented over the course of five years.

The hospitals also saved 25.5 million dollars by recycling and 3.1 million dollars by reprocessing. More specifically, Yale-New Haven saved over a million dollars from reprocessing medical devices in 2013, making it their most profitable initiative.

For Johns Hopkins, one of the biggest cost savings came through medical waste management. According to Practice Greenhealth, disposal costs for red bag waste costs 20 to 50 cents per pound, but clear bags cost three to eight cents per pound and recyclables bags cost one cent per pound. Most of the materials the hospital uses are paper products, so by putting them in the right bags they were able to save a significant amount, says Judith Haynos, assistant administrator of operations in the anesthesiology and critical care medicine department at Johns Hopkins.

Stanford University Medical Center is another facility that saves a significant amount by recycling their medical waste instead of sending it to landfills, in part due to a move by the surrounding community.

The city of Palo Alto in California signed a zero waste ordinance in 2005, which helped set the vision for adopting a fee structure that encouraged residents and businesses to recycle. In 2009, they signed a 10-year franchise agreement with GreenWaste, Inc. to implement this new waste program. Stanford Hospital & Clinics, as a commercial customer, saves 75 to 80 percent per compactor pull for recyclable materials versus municipal waste, says Krisanne Hanson, director of sustainability at the hospital.

Going forward
For many years, it was not a common practice in hospitals to reprocess devices and segregate medical waste so it's a constant challenge to change, to go against what was the norm. It requires the conscious effort of the whole OR team to put waste in the correct trash can, says Johns Hopkins' Pilson.

"Now we're two years into it and we're still educating, reeducating over and over again, because we do have some mistakes that are made in the loading dock and we have to go back and reeducate again. It's an ongoing effort and a complete change of culture in the operating room," she says.