Stop throwing money away! Here's how to cut back on OR waste
Stop throwing money away! Here's how to cut back on OR waste
Review red-bag procedures, collect unused supplies, experts advise
Do you want to save tens of thousands of dollars painlessly? Just stop throwing it away.
Despite the growing emphasis on cost containment, hospitals and surgery centers are still opening (and wasting) too many surgical supplies and putting too many items in the "red bag" for biomedical hazardous waste, environmental experts say.
Nationwide, as much as $200 million in medical supplies are opened but unused in ORs, says William H. Rosenblatt, MD, assistant professor of anesthesiology at the Yale University School of Medicine and the Yale-New Haven (CT) Hospital.
In 1991, Rosenblatt founded a program called REMEDY to donate opened, but unused, supplies to developing countries. Yet, by highlighting the problem of waste in the OR, REMEDY also has saved Yale-New Haven Hospital about $30,000 to $50,000 a year, says Rosenblatt, who spoke in March to the annual Congress of the Denver-based Association of Operating Room Nurses (AORN).
Other hospitals have saved a bundle by scrutinizing what gets thrown into the red bag. For example, the Fanny Allen campus of Fletcher Health Care System in Colchester, VT, a small community hospital, saved $30,000 a year by reducing red-bag waste.
Regular trash disposal typically costs 2 to 6 cents a pound, while red-bag disposal may cost 19 to 60 cents a pound because of the greater precautions required by state agencies for the handling of regulated medical waste, says Hollie Shaner, RN, MSA, president and cofounder of CGH Environmental Strategies of Burlington, VT, a consulting firm that specializes in waste minimization for health care facilities.
When Shaner audits waste disposal at hospitals and surgery centers, she often finds unnecessary red-bag trash items such as tape that touched the patient's arm, minimally stained surgical gowns, and soda cans the patient drank from.
"There's a real opportunity for savings if nurses only put what's truly contaminated in the red bag," Shaner says. According to federal standards and recommendations of leading infection-control organizations, regulated medical waste includes needles, sutures, and other sharp, disposable instruments, and items that are dripping with blood or body fluids. (For resource information on the definition of regulated medical waste, see box, p. 39.)
Start with a task force
Environmental experts offer the following advice to same-day surgery managers who want to save money by reducing their unnecessary supplies and waste disposal costs:
* Create a task force to review current policies and practices.
Everyone involved in waste disposal needs to be included in a review of your policies, Shaner says. The task force or committee may include environmental services (housekeeping) managers, OR managers, staff nurses, infection control personnel, and risk management and safety officers, she says.
A unified approach is important because waste is handled by different employees, Shaner notes. For example, nurses may assess the level of contamination and reduce the number of items that are tossed into a red-bag. But if housekeeping staff are not informed, they may mix regular trash with red bag waste and label it all biohazardous. "We've seen that in case after case," Shaner says.
Although a formal task force may not be necessary to reduce unused OR supplies, efforts to eliminate waste should include physicians, nurse managers, circulating nurses, and scheduling clerks, Rosenblatt says. For example, if a case has been canceled, that information needs to be available in a timely fashion to prevent the case from being set up unnecessarily, he says.
* Monitor actual OR practices related to the opening of supplies and disposal of waste.
In the REMEDY program, a special collection bag is placed on the case cart. At the end of the case, all excess supplies from the scrub table that are not contaminated, sharp, or damaged are placed in the bag, Rosenblatt says. For example, sutures that have been removed from the outer wrapper but still have an intact wrapper would be placed in the bag.
Monitor supplies you don't need
By sorting the bag into broad categories, such as gloves and sponges, you can get an idea of unneeded supplies. For three months of every year, Yale-New Haven collects detailed information about unused supplies for a REMEDY database. Commonly recovered supplies include sutures, staplers, urology and anesthesia equipment, drapes, and gowns.
Collection and monitoring are an impetus to changing OR habits, Rosenblatt says. From 1992 to 1994, unused supplies for laparoscopic cholecystectomies dropped from $5 per case to less than $1 per case, he says. Similarly, wasted supplies dropped from $5 per case for hernia repair to $1.30. Even with the reductions, Yale-New Haven Hospital sends $100,000 to $150,000 in unused supplies to charity each year, he says.
"Because we need to be prepared for the emergency that may happen in the OR, there's always going to be something opened and new used," Rosenblatt says.
The minimal cost of paper bags is all that is required to donate those opened but unused supplies to overseas hospitals, Rosenblatt says. Charities will pick up the materials and deliver them to hospitals in need of supplies, he says. (For more information on REMEDY, see box, p. 39.)
It's not necessary to decontaminate the items, although Yale-New Haven and other facilities put items in extra space in their sterilizers, he says.
Collecting the unused supplies and separating different types of trash requires a change in OR routine, Shaner says. In their haste to turn around rooms quickly at the end of a case, OR staff may roll up everything in the draping of the back table and toss it in the red bag, she notes.
"Every product that is used in surgery, you pay for twice," Shaner says. "You pay for it when you buy it, and you pay for it when you get rid of it."
When she helps hospitals or surgery centers revise their waste disposal systems, Shaner first conducts an audit of how the garbage is managed. She observes OR turnaround and actually follows the trash to the back door.
"If you discover your waste is not being handled the way you planned, identify the point of breakdown in the system and fix it," Shaner says. "Once you fix it, don't ever think you're done. You have to really pay attention to it and monitor it."
* Check with state environmental or health agencies and the local Occupational Safety and Health Administration office to determine waste disposal requirements.
Regulations vary widely regarding what must be considered "regulated medical waste," or red-bag material. In fact, 42 of the 50 states define red-bag waste differently, Shaner says.
In 1992, AORN convened experts from 13 organizations and created a document that defines regulated medical waste and its disposal mechanisms.1 Four categories were developed:
* sharps (used and unused);
* cultures and stocks of infectious wastes;
* animal waste of animals inoculated with infectious agents;
* selected isolation waste related to highly virulent diseases, such as Lassa Fever or Ebola.
Regulated medical waste includes "only those things that could pose an infection risk, either because of extremely high numbers of organisms or because organisms would have a way to get into another body," says Janet K. Schultz, RN, MSN, vice president of professional services of AMSCO International, a Pittsburgh-based manufacturer of OR products. Schultz was also a member of AORN's Special Committee on Environmental Issues.
* Educate your staff about proper handling of waste and supplies.
Through inservice training, same-day surgery managers should educate nurses and other OR personnel about how to cut back on OR waste, environmental experts say.
"Many nurses believe that anything that touches the patient in a surgical suite should go into a red bag," says Schultz. "Some carry that further to say once it's in the room, it should go into the red bag."
In fact, OR personnel don't even need a red bag until after the case begins. "You have just spent the last 20 minutes opening some of the cleanest packaging on our planet," Shaner says. That packaging often can be recycled -- and certainly doesn't need to go in the red bag, she says.
From 40 to 2 red bags a day
At the Fanny Allen campus of the Fletcher Allen Health Care System in Colchester, VT, nurses, techs, and aides once threw everything into the red bag. After a recycling and waste separation program began, only contaminated items were placed in the red bag, says Jeannine Gamache, RN, CNOR, staff nurse and educator at the hospital. The OR now fills only about two red bags a day compared with 40 before, which accounts for much of the hospital's savings of $30,000 a year as it reduced overall red-bag waste, Gamache says.
"We never really had any negative reaction" to the policy change, which was introduced in an inservice session, she says. "It was very well-accepted."
Good communication and education is also an important step toward cutting down on wasted supplies, says Rosenblatt. For example, preference cards should be updated at least monthly or quarterly so unnecessary items are not picked for the case, Rosenblatt says. Some commonly used supplies, such as extra gloves, also may be made readily available on shelves in the OR, so the circulating nurse can access them if necessary, he says.
While waste reduction is often a part of cost-containment efforts, donating products to charity and reducing hazardous waste are lofty goals of their own, environmental experts note. Some facilities have benefited from good community relations because of these projects. For example, the local newspaper may be interested in an article on your program to donate unused supplies overseas, says Rosenblatt.
"It's win-win," he says of the REMEDY program, which reduces waste and benefits developing countries. "The only one who might lose is the medical manufacturer who likes to see you throw away things."
Reference
1. Association of Operating Room Nurses. Regulated medical waste definition and treatment -- A collaborative document. Standards & Recommended Practices 1995:35-38. *
For more information about REMEDY or for a free REMEDY Inservice Teaching Packet, contact:
* William Rosenblatt, MD, President, REMEDY, 333 Cedar St., P.O. Box 208051, New Haven, CT 06520-8051. Telephone: (203) 785-2802. Fax: (203) 785-6664. E-mail: [email protected]. Home Page: http//:Info.med.yale.edu/REMEDY.
For more information about waste management issues, contact:
* Hollie Shaner, President, CGH Environmental Strategies, P.O. Box 1258, Burlington, VT 05402. Telephone: (802) 878-1920. Fax: (802) 878-9507. E-mail: [email protected].
For training materials or more information about waste disposal, consider these resources:
* Regulated Medical Waste: Definition and Treatment: A Collaborative Document, is available free of charge by sending a stamped, self-addressed No. 10 envelope to Diane Neumann, Association of Operating Room Nurses, 2170 S. Parker Road, Suite 300, Denver, CO 80231-5711 or from AORN's Fax On Demand (four pages at $1 per page, document no. 6511, credit card payment required): (800) 755-7980.
* An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities (Order no. 057007, $29.95 plus $6.95 shipping and handling for members, $50 plus $10.95 shipping and handling for non-members), published by the American Society for Healthcare Environmental Services of the American Hospital Association. To order, write AHA Services, P.O. Box 92683, Chicago, IL 60675-2683. Telephone: (800) AHA-2626. Fax: (312) 422-4505.
* "Regulated Medical Waste Management" is a video produced by the Denver-based Association of Operating Room Nurses ($70 members, $140 non-members, plus $6 shipping and handling). It includes a study guide and one contact hour for nurses. For more information, contact Cine-Med, 127 Main St. N., P.O. Box 745, Woodbury, CT 06798. Telephone: (800) 633-0004.
* "No Time to Waste" is a video with a study guide that provides examples of waste reduction at hospitals. ($250 to purchase, $50 a day for rental, catalog no. LL-156) Fanlight Productions, 47 Halifax St., Boston, MA 02130. Telephone: (800) 937-4113. Fax: (617) 524-8838.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.