A new analysis suggests hospitals could save serious money and shrink their ecological footprints by adopting a "five R" approach to running operating rooms.
In addition to the old standards — "reduce, reuse, recycle" — hospitals should rethink and research, said the authors of the analysis, published in this week's issue of the Canadian Medical Association Journal.
They suggested too much material from operations is being designated as "biohazard waste" — a category of waste that requires carefully handled, packaged and incinerated. As well, many single-use items are being thrown away, without ever having been used.
"When you see some of the items that are being thrown away and are still functionally useful, I think it can be disappointing at times," said Dr. Yoan Kagoma, first author of the paper and a recent graduate from the University of Western Ontario's medical school.
Kagoma and his three co-authors started looking at hospital waste as part of a project they were required to do for an ethics course in second year of medical school. They watched knee surgeries. More to the point, they watched what was thrown away during and after knee surgeries — and were startled by the amount of waste the procedure generated.
They extrapolated their results to estimate the scope of waste generated by knee operations in Ontario, and Canada-wide. Their results are due to be published by a medical journal.
"We were just astounded. In Ontario alone, just from knee surgeries, we showed that there was over 400 garbage trucks worth of waste produced just by volume in Ontario... per year," Kagoma said.
Hospitals are energy hogs. In 2008, hospital activities were the second most energy intensive activity in the commercial and institutional sector, Kagoma and his co-authors wrote. While few institutions have published their ecological footprints — a calculation of the bioproductive land and water needed to sustain a population — those assessments that have been made public speak to the magnitude of the problem.
In 2006, for instance, London Health Sciences Centre in London, Ont., reported an ecological footprint that was 384 times larger than the plot of land on which it sits.
Operating rooms generate between a fifth and a third of total waste produced in hospitals, Kagoma and his colleagues noted.
About 85 per cent of hospital waste is non-hazardous, but a significant portion of it is inappropriately labelled as biohazard waste, the analysis said. Somewhere between 50 per cent and 85 per cent of waste that could be disposed of as solid waste is steered into the biohazard stream. That's an expensive diversion: it's estimated biohazard waste costs eight times more per tonne to dispose of than solid waste.
The analysis showed that some hospitals are trying to get a grip on the problem. For instance, Magee-Women's Hospital in Pittsburgh, Penn., set about to get hospital staff to segregate waste more accurately. They decreased the amount of biohazard waste from their operating rooms by 47 per cent, saving more than $89,000 US.
Kagoma acknowledged it is important to dispose safely of materials that truly are biohazards and to adequately wrap materials that must be kept sterile. But people seem to go overboard, he suggested, noting that prostheses arrive in an operating room encased in as many as four layers of protective wrapping.
"You were opening all these packages to get to the item you were going to use," he said in an interview.
"There are definitely concerns about sterility and making sure, obviously, that we provide the best level of care possible. But I think for us some of the big points that came from our study and even from going into the literature was just the amount of items which are sort of incorrectly categorized as let's say biohazardous wastes."
One approach that has already resulted from Kagoma's research is an effort at London Health Sciences Centre to collect unused surgical materials that are headed for the garbage and donate them instead to hospitals in the developing world.
Kagoma explains that when an operation is scheduled, a sterile tray containing all the possible instruments, tools and materials the surgical team might need is brought to the operating room. Generally there are some items left over at the end. They haven't been used because the surgeon prefers another tool or they simply weren't needed. And typically those items are discarded.
"We've seen anything and everything unused. Drapes, gloves, metal instruments," Kagoma said.
So he and some colleagues started Operation Green. Operating room staff put unused surgical items into a bin which is later sorted by medical students. A Winnipeg-based charity called International Hope has agreed to transport the material to developing countries.
Kagoma said in the first three months of collection, the hospital gathered about $16,000 worth of equipment, items that would have been thrown away otherwise.