Achieving Environmentally Responsible Practices in the Operating Room

Healthcare is uniquely positioned to positively impact the health of our planet. Within an operating room (OR) space, clinicians notice the considerable amounts of waste generated each day. However, OR teams may not fully understand the true impact of such waste. Here are some actions to take for more environmentally responsible practices in your OR.

There is no question that the challenges of the COVID-19 pandemic have been vast and severe. Within healthcare systems around the world, to quickly provide protection for healthcare workers and patients, a substantial amount of disposable personal protective equipment (PPE) has been used. However, the World Health Organization (WHO) reports that across the globe, safe healthcare waste management practices are often lacking, and the COVID-19 pandemic has led to significant, troubling increases in the amount of waste on our planet.

There are also other interrelated areas of concern:

• Since the start of the COVID-19 pandemic, plastic production has more than doubled, which raises troubling questions about both the short-term impacts on fresh water, oceans, and air quality, as well as the long-term impacts of how plastic waste breaks down (or does not break down) over time (source).
• The United States’ health sector is responsible for an estimated 8.5 percent of national carbon emissions, and as a piece in The New England Journal of Medicine notes, the U.S. health care system is becoming more, not less, polluting: emissions increased 6 percent from 2010 to 2018. 

The COVID-19 pandemic presented what the WHO refers to as a “double-burden” for healthcare systems – there was a clear and urgent need to protect patients and staff while also demonstrating care for the surrounding environment. Yet, a recent article in the Frontiers in Public Health journal notes that some pandemic-driven responses have continued. Many healthcare systems have “sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste.”

While some of the healthcare waste generated is understandable, there is an opportunity now to implement lessons learned while continuing to move forward together toward more sustainable and environmentally responsible practices.

Many other healthcare associations and organizations recognize these environmental imperatives and have shared their own position statements on environmental responsibility. The Association of periOperative Registered Nurses (AORN), as one example, states: “All health care professionals have an ethical and professional responsibility to protect patients’ health through advocacy. Because human health is affected by and is dependent on the surrounding environment, health care professionals must actively work to incorporate best practices that mitigate negative environmental impact.”

Within an operating room (OR) space, clinicians notice the considerable amounts of waste generated each day. Research indicates that the average OR alone generates 30% or more of a hospital’s waste. However, OR teams may not fully understand the true implications of such waste, including the actual cost (including the acquisition of various items and their eventual disposal) or the larger environmental impact.

Here are some actions to take to begin implementing more environmentally responsible practices in your OR:

1. Purchase supplies that are designed to reduce CO₂ emissions.

Hospitals tend to have a larger environmental footprint than other types of public buildings. CO₂ emissions in healthcare are generated by factors such as higher energy use; greater associated transportation use; the need for various pharmaceuticals, plastics, equipment, and many other supplies that collectively contribute to a system’s overall carbon footprint.

In fact, more than 70% of a health system’s greenhouse gas emissions are embedded in the products and services they buy (source).

In these complex, energy-reliant facilities, one step teams can take is to buy what matters. This means purposefully evaluating and purchasing surgical equipment and supplies that are designed to emit lower CO₂ levels. Experts estimate that this action alone could help reduce overall healthcare CO₂ emissions by 82% (source).

While retrofitting existing buildings and building better, more energy-efficient new facilities are important strategic actions, healthcare teams can make an impact now by purchasing innovative, safe, and sustainable OR supplies.

2. Incorporate Life cycle Assessments (LCA) into your procurement processes.

Traditional procurement processes for surgical equipment and supplies may consider factors such as safety, efficiency, availability, price, and physician preference.

However, purchasing teams may be missing or unintentionally overlooking essential information about the full life cycle of a particular product—including the environmental impacts of its production, use, and disposal, as well as all the associated costs (source).

When evaluating a surgical gown for a facility’s OR, for example, every stage of the item’s life cycle should be considered, including:

A systemized and strategic framework, Life Cycle Assessment is an invaluable tool to help healthcare systems evaluate the environmental impacts of products and services.

Vendors should participate fully in sharing transparent, accurate LCA data with purchasing teams.

3. Adopt and support reusable PPE systems.

Reusable solutions should be carefully considered over single-use products whenever possible.

A peer-reviewed study published in 2023 by researchers from the Canadian College of Health Leaders finds that “adopting and supporting reusable PPE systems throughout the health sector can […] provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs […] and improved environmental performance such as reduced waste and greenhouse gas emissions.” The study notes that the largest contributors to OR waste quantity are gloves, followed by gowns. Disposable gowns and gloves also significantly contribute to the OR’s CO₂ emissions.

Public data cited in the study on the use of reusable surgical gowns during the first two years of the pandemic from healthcare sites across Canada revealed that reusable gowns displaced at least 83,100 metric tons of plastic disposable gown waste, while also displacing an estimated 721,300 tons of carbon emissions.

Additional evidence in support of reusable PPE solutions:

• With isolation gowns being one of the most-used pieces of PPE in healthcare settings, changing to more environmentally friendly reusable isolation gowns is another way to make a positive impact. Research shows that reusable isolation gowns offer promising reductions in energy and water use, solid waste, and carbon footprint, according to a public health article titled “COVID-19 Solutions Are Climate Solutions: Lessons From Reusable Gowns.”
• A study published in the American Journal of Infection Control found that “reusable systems outperform disposable systems in all key environmental impacts” and that “selecting reusable gowns can help healthcare facilities meet sustainability goals.” 
• In a comprehensive environmental analysis of reusable and disposable surgical gowns published in the AORN Journal, researchers examined a variety of activities, from the manufacture to the end-of-life disposal of both reusable and disposable surgical gowns. Laundry and wastewater treatment options were also considered. Results showed that the selection of reusable gowns over disposable options “reduced natural resource energy consumption (by 64%), greenhouse gas emissions (66%), blue water consumption (83%), and solid waste generation (84%).”

Moving toward a more sustainable, environmentally responsible healthcare culture, while ensuring patient and staff protection and comfort, is possible with the integration of highest-quality reusable surgical solutions.

Our team has been inspiring care, comfort, and change in our communities since 1940. We can help reduce your medical waste, strengthen your supply, and provide the protection your staff and patients need. To connect with a member of our healthcare team of experts, contact us today.