This article is the second in a mini-series about Yale faculty and staff who work at the forefront of healthcare and sustainability. Read the first article in the series.
At Yale New Haven Hospital, the Perioperative Sustainability Team (PST) addresses the daily challenges of sustainable practices in the healthcare setting. The team is well poised to make a positive impact, responding to the fact that nearly one-third of a hospital’s waste comes from the operating room (OR).
Dr. Jodi Sherman, Associate Professor of Anesthesiology at the Yale School of Medicine (YSM) and Associate Professor of Epidemiology in Environmental Sciences at the Yale School of Public Health, is the Anesthesiology Director of Sustainability. She launched the OR green team initiative at Yale New Haven Hospital (YNHH) in 2010. Although nearly a decade old, the team’s efforts were reinvigorated last year, when the Department of Surgery at YSM established its own green team. The perioperative team focuses primarily on challenges in the clinical spaces, while the surgery team focuses on issues in administrative and office spaces. Collectively, the two groups have created more visibility for sustainability issues in healthcare at YSM and YNHH.
Innovation in clinical spaces
One of the initial and most robust projects of the Perioperative Sustainability Team is the clinical recycling program. The program began in the operating room since more than one third of hospital waste is generated there. The clinical recycling program has now spread throughout the hospital spaces and recovers 3-4 tons of materials per month–testament to the power of one small group of people.
Unique to the healthcare setting, clinical recycling is complicated by real or perceived concerns about infectious cross-contamination. Sharps (needles and syringes) and biohazardous materials (“red bag” waste) must be kept out of the recycling bin. These “higher” waste streams require stricter regulations and a complex disposal process. Most medical waste, however, does not fall into these categories; in the operating room, a large percentage of waste consists of sterile plastic packaging from tools and supplies. Most of the recyclable matter is collected as supplies are unwrapped and prepared before a patient even arrives in the operating room.
Paired with the clinical recycling program, staff education is an ongoing initiative. Due to the complexity of the operating room setting, there may be more than 10 different waste streams. Thus, a common problem is an “over-defining” of trash. That is, sometimes materials that could be placed in the regular trash or in recycling are instead placed in a “higher” waste stream as a means of reducing risk. However, when materials are unnecessarily placed in higher waste streams, there is an increase in cost and energy required to treat that waste.
The Perioperative Sustainability Team is working to create a regular training on waste stream segregation for staff. The goal is for it to be required on an annual basis, like the regularly required trainings for bloodborne pathogens or biohazard materials management.
On the horizon is a new initiative to reduce wasted cotton blankets in perioperative settings. Based on a nurse’s observational study, and corroborated by vendor laundering data, approximately 15 cotton blankets are used per patient surgery at Yale-New Haven.
“The intention is to keep patients warm and prevent infections. Often, the reason for wasting blankets is the false belief that blankets fresh from a warming cabinet are better at retaining heat. However, there is no evidence to support that it is better for patient care, yet it is worse for public health and the hospital bottom line to waste,” said Dr. Sherman.
Although these blankets are made from reusable cotton, the cleaning process is very water and energy intensive, and happens off-site. YNHH ORs use an estimated 450,000 blankets annually, costing the hospital nearly a quarter of a million dollars. Dr. Sherman’s environmental engineering students from Northeastern University conducted a life cycle assessment to estimate the total environmental footprint from cradle to grave, including manufacturing, transportation, laundering, and eventual repurposing or disposal. The most resource intensive process is the laundering, which uses approximately 2.34 million liters of water annually. In total, the life cycle of these blankets emits 2.7 million kg of carbon dioxide equivalent annually, which is akin to driving a car 256 times around the Earth each year. This is from just one hospital.
A successful reduction initiative will be a combination of systems improvement and education regarding the effective and conscientious utilization of blankets. Supporting the PST efforts are Max Laurans, MD, Neurosurgeon and Clinical Chief and Executive Director of Perioperative Services, and Jane Wagner, RN, Nursing Director of Perioperative Services. Although this initiative is still in its early days, Dr. Sherman is hopeful that it will engage staff around improving community health impacts.
Looking to the future
Dr. Sherman and the Perioperative Sustainability Team are part of a rising group of sustainably-minded healthcare practitioners who share ideas and collaborate to find innovative solutions to common problems. Yale New Haven Hospital actively participates in Practice Green Health, a leading organization and source for environmental solutions for the health care sector. In creating innovative and cross-cutting solutions, Dr. Sherman hopes that her team can inspire others at Yale and beyond, and be a leader in a field that seeks to provide excellent care while minimizing community and ecological harm.
Yale is committed to building a more sustainable world. By doing what we do best—integrating science, the humanities, and our community—Yale creates, tests and adopts innovative solutions to the environmental and social challenges we all face.