Nurallah Rahim rips the plastic off a pack of sponges in a vacant operating room at the Scarborough Hospital.
Even though he’s clad in scrubs and a hair net, and despite the extra layer of paper protecting the sterilized pads, these unused sponges — just because they have been opened — are contaminated and must be destroyed. Rahim, patient care director of the hospital’s surgical services, is demonstrating how easily waste accumulates as a result of efforts to keep operating theatres safe and clean.

After years of nurses’ frustration with having to deal with the mountains of surgical waste, his hospital and others in the GTA are discovering ways to reduce their environmental footprint.
And they’re finding that being green is often less expensive.
Hospitals could save millions of taxpayer dollars — and tons of waste and emissions — by making some small changes, and some larger, more expensive changes, to “green” their operating rooms, says an analysis from the University of Western Ontario’s medical school, published Monday in The Canadian Medical Association Journal.
The report says hospitals produce a huge amount of waste, and as much as 33 per cent is generated in operating rooms. A single operation, for example, can produce as much garbage as a family of four would create in a week, some estimates suggest. (The statistics date back to 2009.)
“It was scary to us to think you could be working in a hospital and improving peoples’ health on an acute basis, but in the long term it hurts the environment,” co-author Dr. Yoan Kagoma says.
According to the analysis, the waste produced by knee replacements across Canada filled 2,000 garbage trucks in 2008/2009.
“We were astounded,” the recent medicine school graduate said. “So many things came double, triple, quadruple wrapped.”
Their research highlights a long list of OR sins, among them:
Too much waste is categorized as biohazard waste, which is more expensive to process.
The majority of hospitals use disposable gowns, table covers and drapes.
Anesthetic gases — 2,000 times more toxic for the atmosphere than carbon dioxide — escape freely.
Massive quantities of blue sterile wrap, a polypropylene plastic used to keep tools clean, is thrown out instead of recycle.
Surgical packs — containing many items needed for procedures — are sometimes overstocked and unused components thrown out after the package is opened.
This so irked retired Winnipeg nurse Phyllis Reader that she set up a charity to send the so-called garbage to hospitals overseas rather than have “perfectly good” items end up in a landfill. International HOPE has sent thousands of items, with a resale value of millions, to developing countries since 2001, she says.
“If it hasn’t even been touched except with sterile gloves and has been nowhere near the patient, it’s a no-brainer that it should be sent abroad, and sterilized for their use,” Reader says.
Closer to home, hospitals have found that some improvements aimed at saving money have had an environmentally friendly side effect.
“A lot of people are beginning to realize that greening and saving money on the bottom line can all coexist,” Dr. Kagoma says.
At the Scarborough Hospital, Rahim lays out the dozens of tools needed for a total knee replacement. Just one of these procedures fills an industrial garbage bag (see sidebar). More than 1,250 knee replacement operations are performed annually at the hospital, Rahim says, so small changes make a big difference.
After noticing extra tools were being thrown out, nurses and doctors analyzed the presurgery kits for the procedure to create a more customized pack. The eight surgeons typically used only 29 of the 50 items, and nurses had to throw away the rest. The new pack reduces waste and saves nurses the time and the strain of opening separately packed items.
The hospital is also moving from disposable gowns to textile gowns to reduce the cost of garbage pickup and gown replacement. As surgeries become less invasive, it just makes more sense, he says.
The hospital has also introduced a new anesthetic gas recovery system that collects environmentally damaging gases instead of releasing them. While this saves only a few thousand dollars, it tightens the budget in penny-pinching times, Rahim says.
Scarborough isn’t alone in its search for green initiatives that save money.
Toronto’s St. Michael’s Hospital recycles about 57 per cent of the blue sterile wrap and packaging used in its 22 operating rooms, says Eduarda Calado, head of the hospital’s greening initiative.
Recycling is much less expensive than landfill waste and the staff was happy to make the change, Calado says, adding that a green change must be cost neutral or pay for itself in savings within three years.
Staff at both hospitals agrees that reducing energy when operating rooms are not in use is the most challenging green endeavour. At Scarborough the rooms are simply too old to regulate ventilation efficiently. At St. Mike’s, a trauma centre, they don’t have the tools to do this.
The challenge with energy saving projects is that they can require significant upfront capital even though they are cheaper in the long run, said Kent Waddington, spokesman for the Canadian Coalition for Green Health Care.
That requires persuading the government to invest in something “green” when there are competing priorities for the tight budget, Waddington said.
He has noticed, however, a major shift toward “going green” in the dozen years he’s pushed for cleaner health care. About 10 per cent of health care organizations in Canada are “getting really serious” about the environment, he said, and they wouldn’t if it wasn’t good for the bottom line.
“Back in the day, people thought green was the paint colour,” he said.
Health care facilities are realizing that it’s right that they lead the environmental charge, he said.
“They have a mandate, from many thousands of years ago, to do no harm. A lot of them are starting to take that seriously.”
What gets thrown out in a typical total knee replacement?
12 gloves
5 sponges
4 operating gowns
4 face masks
4 blades
3 syringes
3 needles
2 rolls of suction tubing
2 towels
2 drapes
1 decanter bag
1 bedside bag
1 bulb syringe
1 table cover
1 stockinette
1 Mayo stand cover
1 roll of gauze
Plus plastic wrappers, paper wrapping, elastics and more…


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