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Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Vital Signs

No more singing the blues about OR waste

By Jennifer Durgin

The blue drapes and basins in the DHMC ORs are no longer universally disposable.

Most operating rooms are a sea of blue—blue gowns, blue drapes, blue wraps. But over the last five years, the DHMC ORs have become increasingly green. The effort includes recycling plastic containers, encasing sterilized equipment in reusable hard cases instead of disposable wrap, and reprocessing single-use devices.

Reuse: When people first hear that "we are reusing things that are not 'supposed' to be reused," says John Leigh, manager of waste and recycling, they "freak out." But peoples' fears subside once they learn that the devices are sterilized and prepped for reuse according to strict Food and Drug Administration guidelines. "Infection prevention and patient safety are always going to trump other considerations," says Leigh.

Operating rooms are among a hospital's most resource-intensive, waste-generating areas, typically producing 20% to 30% of total waste volume. At DHMC, operating room waste makes up a significant portion of the eight tons of waste produced each day, says Leigh. So efforts in the OR to reduce, reuse, and recycle make literally a ton of difference for the environment.

Line: The efforts even benefit the bottom line. In 2010, for example, DH saved approximately $300,000 by reprocessing some devices instead of tossing them and buying new ones.

Operating rooms typically produce 20% to 30% of a hospital's waste.

To help promote green practices in ORs across the country, and to learn and share best practices, Dartmouth-Hitchcock recently joined a national collaborative of more than 85 hospitals. The effort is led by Practice Greenhealth, a membership organization for health-care institutions that are devoted to environmentally responsible operations. DHMC was already a member of the organization's Environmental Leadership Circle. (For more on DH's efforts to reduce its environmental impact and minimize employees' and patients' exposure to toxic substances, see the article "Ever Green" in the Summer 2007 issue and watch the web-extra video "Inside Waste Management at DHMC.")

By being part of the collaborative, "we're finally getting credit for a lot of great behind-the-scenes work," says Leigh. Much of that work is done by OR nurses, he adds, who are "constantly asking good questions" about how to "be green."

For a long time, Dartmouth OR nurses have been "pushing to recycle more," says nurse Katie Steuer, a clinical educator in the OR. Now, OR staff can recycle that ubiquitous blue wrap (which is made of polypropylene), as well as unsoiled drapes and gowns; rigid, empty plastic containers; and boxboard, which is often part of equipment packaging. Any items in the surgical field—the area immediately surrounding the patient—cannot be recycled once surgery has started. However, almost 80% of packaging waste from a procedure is generated before the patient even enters the room, notes Leigh.

Can do: With support from Steuer and other OR staff, Leigh is also exploring the possibility of replacing many common disposable items, such as drapes, gowns, and basins, with reusable ones that can be sterilized. "John has been instrumental in making us aware of what we can do," says Steuer—in seeking ever more ways to bring some green to the sea of blue in the ORs.

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