This article appears in the July/August issue of  Surgical Products.

The term sustainability has outgrown its status as merely a buzzword and has become a real fixture in many organizations’ business plans for many reasons, including cost savings, competitive advantages, and a positive environmental impact. Though these benefits are realized across many industries, they can profoundly impact healthcare. Healthcare facilities have a large and costly environmental footprint, both in terms of waste production and carbon dioxide emissions. According to a study in the Journal of the American Medical Association (JAMA), the American healthcare sector is responsible for producing eight percent of the country’s total carbon dioxide emissions (1). In addition, hospitals produce nearly 7,000 tons of waste each day (2).  If not recycled or able to break down, this waste ends up in landfills for indefinite periods of time, negatively affecting communities and the environment through disease, toxic air pollutants and soil and underwater contamination.

Fortunately, having such a large environmental influence means hospitals also have the opportunity to make an impactful change through increased sustainability efforts. Research from this year’s CleanMed Conference, a leading healthcare sustainability conference, found sustainability investments in the healthcare sector dramatically increased in 2012, with a particular focus on waste reduction. Hospital operating rooms (ORs) account for a large part of a hospital’s total waste volume – between 20 and 30 percent (3).  Thus, starting sustainability efforts in the OR can not only significantly reduce the amount of waste created, but may also lower costs, create a healthier environment for patients, staff, and the community, and ultimately lessen the carbon footprint of the healthcare industry.

OR Sustainability Survey
To better understand the sustainable practices hospital ORs currently have in place and trends that may result based on their future goals, Ecolab recently conducted a blind survey of nearly 200 purchasing and materials managers, directors of surgical services, sustainability officers, operating room directors, and nurse managers. The goal of the survey was to shed light on OR sustainability processes such as recycling, waste disposal policies, and reprocessing procedures.
Ecolab found that the survey results underscore a growing trend of hospitals taking concrete steps toward sustainability. For example, 70 percent of respondents had received communication about their hospital’s sustainability initiatives and felt there was a movement toward sustainability taking place that was influencing changes in hospital policies and processes.

When asked about specific efforts, 38 percent of survey respondents were aware of policy updates around waste disposal within the past year and 61 percent said their hospital had sought out products with at least some recycled content.

Consulting The "Crystal Ball"
Looking ahead, we can’t predict the future. But looking at the research and actions of early adopters in the healthcare industry, it’s possible to forecast major trends we’re seeing emerge now and in the months and years to come, including:

• EPP Programs
One growing trend in the OR is the demand for sustainable healthcare products. Healthcare facilities are adopting Environmentally Preferred Purchasing (EPP) Programs to help guide purchasing decisions of products that have an overall reduced environmental impact because of the material used and its reusability and recyclability, the shipping distance, or other factors.

• Reduce, Reuse, Recycle
There has also been a general shift away from single-use medical devices. Purchasing reusable products and medical devices instead of single-use devices significantly cuts down on the amount of waste produced. Cleaning and sterilizing medical devices allows hospitals to safely re-use devices that otherwise would have only been used once.
When making purchasing decisions, many hospital ORs are considering the total lifecycle of a product and its impact to the environment once it has been disposed. A perfect example of this is the purchasing of products that can be recycled. Much of the waste generated in the operating room is solid waste that can be recycled, such as plastic wrap from disposable products, devices, or blue wraps. Recyclable waste in the OR can be mistaken for hazardous waste and not disposed of properly or recycled. However, according to the Centers for Disease Control and Prevention, only between two and three percent of hospital waste needs to be disposed of as hazardous waste. A key element to implementing a successful recycling program is ongoing education to help staff understand and differentiate between waste that is hazardous and waste that can be recycled.

• Technology Innovation
With a growing interest in sustainable products, the demand for new product development with sustainable features will increase. With this customer feedback and manufacturers’ inherent interest in creating more earth-friendly technology, we’ll likely see products designed with biodegradable technology to lessen the burden on healthcare workers, landfills, and future generations on the horizon.

• Energy Consumption
In addition to sustainable products and waste reduction, an increased awareness of the amount of energy the healthcare industry consumes is on the forefront of many hospital leaders’ minds. Collectively, healthcare is an extremely energy intensive industry, spending $6.5 billion a year in energy costs, which is second only to retail food establishments. (4) Surgical procedures can be a primary consumer of a hospital’s total energy consumption. 
There are many renewable energy sources emerging, such as wind and solar power, but smaller, more manageable changes are a realistic first step for many hospitals, and these changes can still produce big results. For example, installing LED lamps throughout the OR has been found to use 35 percent less energy without compromising lighting for surgeons. (5)

• Public Reporting and Transparency
Reporting the impact of sustainability efforts is now quite common among corporations and is starting to catch on in some hospitals. By developing a sustainability reporting framework, organizations have the ability to monitor and track the results of programs and initiatives and then disclose the environmental impact to their community. The tracking progress helps hospitals make informed decisions about future sustainability efforts and is also a valuable tool in fostering transparent relationships. In addition, sharing the program results is an opportunity to educate stakeholders and community members on the benefits and impact of its efforts on the community.

Getting Started
Creating a more sustainable healthcare facility reaps many benefits, including cost savings and a healthy environment for staff and patients. But when hospitals first venture into sustainable program development, it’s important to remember that patient safety is the number one priority. The Cleaning Industry Research Institute (CIRI) provides excellent guidance when making purchasing decisions related to the multitude of cleaning products available, stating that, first and foremost, products must clean for health and hygiene, then the environment. There are some things that cannot be compromised when “going green,” and patient safety is one of them.

Education is another key component to a successful sustainability program. Having internal champions across departments who can work together to make smart purchasing decisions as well as educate staff on the importance of hospital initiatives and policies can aid in program adherence and outcomes.

Having frequent conversations with your suppliers can provide insight into the types of sustainable products currently being offered. Since these products are increasing in demand, there are a number of commonly used healthcare products with environmentally preferable alternatives to help reduce waste and conserve energy. For example, a product’s packaging and dispensing features can be designed to be recycled and reduce waste, storage space, and shipping costs, or even be automated to help conserve water and energy. The Environmental Protection Agency (EPA) also suggests incorporating environmental language into requests for proposals and purchasing contracts.
Working closely with healthcare sustainability professionals can also help hospitals control the amount of waste brought into the hospital in the first place. For instance, Practice Greenhealth, a nonprofit aimed at encouraging best practices in sustainability across healthcare facilities, recommends working with suppliers to customize OR kits. If there are items in the kits not commonly used, adjusting the quantities can limit what ends up in the trash.

Being Resourceful
While trends tend to come and go, sustainability initiatives within hospitals and ORs are likely to continue to expand as technology advances and organizations strive to build a healthier environment for patients and communities.

Here are a number of programs and initiatives aimed at providing information to help hospitals implement sustainable programs:
• The Greening the Operating Room Initiative – A Practice Greenhealth program.
• Healthier Hospitals Initiative – A joint effort by leading health systems, Healthcare Without Harm, Practice Greenhealth and The Center for Health Design. 
• Healthcare Without Harm – An international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations, and religious groups.
• The Sustainability Roadmap – A joint effort of the American Society for Healthcare Engineering, the Association for the Healthcare Environment, and the Association for Healthcare Resource & Materials Management of the American Hospital Association.
Emilio Tenuta is a sustainability expert with over 30 years of experience. He currently serves as Vice President of Corporate Sustainability at Ecolab in St. Paul, Minn. For more information about Ecolab Healthcare visit:

(1) Estimate of the Carbon Footprint of the US Health Care Sector. JAMA. 2009;302(18):1970-1972. doi:10.1001/jama.2009.1610.
 (2) “Waste.” Sustainability Roadmap for Hospitals.Web. 1 May 2013.<>
(3)  "Greening the OR News." Practice Greenhealth. Web. 1 May 2013. <>.
(4)  Tonya Boone, PhD, . "Health Care Research Collaborative." Creating a Culture of Sustainability. Health Care Without Harm. Web. 1 May 2013. <>.
 (5)  Rita Tatum. "Energy Efficiency Prescriptions for Health Care Facilities." FacilitiesNet. Mar 2008: n. page. Web. 31 May. 2013. <—8384>.