Greening the operating room

Greening the operating roomA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

In an effort to recognize April as Earth Month, the American Society of Anesthesiologists (ASA) is taking action to help hospitals across the country green their operating rooms with a white paper by the ASA Task Force on Environmental Sustainability.

Physicians such as anesthesiologists are responsible for the health of the community, which is dependent on a healthy environment. Unfortunately, the health care sector is not as environmentally friendly as you may think. It accounts for 8 percent of total green house gas emissions in the U.S., according to a study from the University of Chicago. Hospitals have the greatest negative impact on the environment, emitting 39 percent of health care’s total green house gas emissions.

In particular, operating rooms are the biggest consumers of energy and generate 20-30 percent of total hospital waste. As anesthesiologists, we recognize that our role constitutes a hospital-based practice integrated into operating rooms, diagnostic and procedural areas, as well as other patient care areas. As a result, we have the insight and ability among hospital leadership to affect change and promote environmentally-positive practices.

Addressing four specific issues will help anesthesiologists mitigate the negative effects of health care on the environment:

  1. Anesthesia equipment choices
  2. Anesthetic agent choices
  3. Waste stream management and recycling opportunities
  4. Environmental sustainability in perioperative settings and operating room design

Many types of anesthesia equipment are purchased in reusable or disposable form. Reusable equipment requires additional cleaning and disinfecting solutions to prevent contamination. While on the other hand, disposable equipment contributes to the bulk waste of landfills, and may release toxins into the environment. Unfortunately, there is little scientific information to guide best practice. Life cycle analyses (calculations of environmental footprint from manufacturing through disposal) are needed to help determine whether reusable or disposable equipment choices, in particular settings, are better for the environment.

In the meantime, there are solutions to reduce operating room waste, including intraoperative recycling programs to collect plastics and papers free of infectious materials. The collection of disposable equipment for reprocessing by certified companies is another way to minimize waste, as it helps divert disposables out of the waste stream and saves health care dollars. Many organizations also accept the donation of unused clean equipment.

An easy way we can reduce the eco footprint in operating rooms is to modify anesthetic techniques. Potent inhaled anesthetics and nitrous oxide are greenhouse gases. A relatively simple way to reduce and reuse anesthetic agents is to utilize low fresh gas flows during the maintenance phase of the anesthetic. The environmental impact of inhaled agents can also be reduced by preventing the scavenged gases from being released into the atmosphere. Development of systems to collect and reuse anesthetic gases is under way. Life cycle analyses that include inhaled and intravenous agents will help us understand the relative environmental impacts of our various anesthetics.

Operating room design should strive to limit the amount of environmental impact. Organizations such as the Leadership in Energy and Environmental Design (LEED) and Green Guide for Health Care offer green design guidance for remodeling or new construction. Elements to be considered during the design phase should include water and energy conservation, low impact materials for construction and air quality.

Greening the operating room helps reduce waste, energy, cost and the amount of exposure patients and the public have to hazardous chemicals. A greener health care delivery will have a positive impact on the environment.

To access the white paper, please read Greening the Operating Room: Reduce, Reuse, Recycle and Redesign.

T. Kate Huncke and Susan M. Ryan are co-founders of the ASA Task Force on Environmental Sustainability.

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