AST Guideline - Environmental Practices in the Operating Room

2 • Pharmaceutical waste: The regulatory oversight of pharmaceutical waste has increased and therefore, it is important for HDOs to manage the proper disposal methods of this waste. Additionally, some states have established strict guidelines for pharmaceutical disposal including Florida, Minnesota, Washington, and Washington, D.C. • Anesthesia waste: Anesthesia waste significantly contributes to the waste stream. A study conducted by Western Hospital in Australia discovered that the anesthesia waste stream contributed to 25% of the total OR waste and that 60% of the anesthesia waste recyclable. 14, 19 • Regulated-medical waste (RMW): Also referred to as “ other potentially infectious material (OPIM) ”, this is the biohazardous waste that must be red-bagged; it is regulated by states, but is also addressed by OSHA’s Bloodborne Pathogens Standard. • Universal waste: The Environmental Protection Agency (EPA) established the Universal Waste Rule; under this rule specific hazardous waste items, such as batteries and bulbs, are not as strictly regulated and do not have to be included in the HDOs total hazardous waste poundage to encourage recycling of these waste materials. • Recyclables: Waste that can be converted into reusable material that includes cardboard, glass, medical plastics, metal and paper. The “challenge in the health care setting is how to creatively find ways to support sustainability amidst handling large amounts of hazardous or infectious medical waste while ensuring patient safety” as well as the safety of those that handle the waste such as environmental service personnel. 16 However, many HDOs across the nation including academic medical centers (AMC), which make up approximately 22% of U.S. HDOs, are adopting green practices to stem the tide of waste. For example, approximately 23% of U.S. HDOs are reprocessing medical equipment, referred to as single-use devices (SUDs), to decrease the annual tonage of RMW that is generated. 17, 39 This also translates into important cost savings that can be quickly realized when purchasing reprocessed SUDs as compared to new devices; reprocessed devices cost between 40-60% less than the original device. 24 The Hospital Corporation of America (HCA) has 163 hospitals; in 2010, HCA saved $17.6 million by reprocessing SUDs and prevented 298 tons of waste being placed in landfills. 32 This provides HDOs the ability to reinvest the savings toward improving patient care, as well as help lower the cost of healthcare and significantly reduce the volume of RMW. 37 This should also catch the attention of AMC’s that provide over 40% of charity care in the U.S. in which the net savings can help to cover the costs associated with providing unpaid healthcare services. 17 The introductory numbers and information is provided to place an additional urgency upon the importance of the following Guidelines and their adoption by HDOs. OR personnel must continue their duty of care to the patient by providing efficient, safe services that help to lower healthcare costs as well as reaffirm their commitment to society as a whole in reducing RMW.