Wednesday, June 11, 2008

Reducing and Reusing, if not Recycling in the OR

Over at The Differential, I recently wrote about waste in medicine; lots of stuff gets thrown away, especially in hospitals. One of medicine's most egregious offenders is the OR. Items ranging from blue towels to cautery equipment to paper drapes to laparoscopic instruments to suture to bowel staplers all are pitched at the end of each case. In the past few weeks I've enlisted the help of scrub techs and circulating nurses to cut down on the footprint of the cases I'm involved with. Here's what we came up with in the reusing category:
  1. Suction irrigators run on 8 AA batteries and are designed to run for two hours. After the case, the irrigator is pitched - including the pump. If you salvage the batteries from each suction irrigator used for ectopic pregnancy or cholecystectomy cases you assist with, you'll amass 10 hours of digital camera usage per irrigator, or put another way, a lifetime powering of remote controls per surgery clerkship.
  2. Blue towels are the sterile, lint free linens that surgeons dry their hands and arms on after scrubbing but before donning gown and gloves. For folks like me, who 'scrub' using the germicidal alcohol-based Avagard chlorhexidine cleanser and come into the room 'dry,' there's a good chance that towel will go unused in the case. This makes a perfect car-drying towel. (For after you go through the automatic car washes, of course - they save water and reduce toxic runoff.)
  3. Specimen containers are especially useful for my natural history collections. (See my entries on Wunderkammern for clarification.) The sterile cylindrical canister that comes with Foley catheter kits is good for spices when you go camping. Unused but opened pathology specimen containers work well for storing small parts. Any clean container works well for storing captured insects or categorizing bark samples or some other random hobby.
  4. Sutures are thrown away all the time. Many ORs save the packets for student use and practice. Before grabbing extras off of the scrub tech's Mayo tray, be sure to ask. Not only because there's a chance open suture is contaminated with patient parts, but NEVER TAKE ANYTHING FROM THE SCRUB TECH'S MAYO TRAY!
It's hard to reduce consumption when you are a student. Since embarking on this mission, I have noticed that some providers are careful about ordering disposable items into the sterile field, asking for tools to be ready but not opened until it is absolutely necessary. This saves the patient money and reduces consumption. I'd say that counts as killing two birds with one (unopened) stone. Not that I'm advocating avicide.

Recycling will be a tough thing to implement in the OR. Most paper gets contaminated with blood, poop or iodine. I don't think we want that stuff getting into the recycling waste-stream. In the end though, shouldn't reducing and reusing decrease carbon footprint even more than recycling? Anyone have other ideas about reducing waste in the OR? Or in the hospital?

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