Collaborating for Sustainability: Strategies for Reducing, Reusing, Recycling, and Discarding Waste in Perioperative Settings SPEAKER NAME:

Transcription

1 SESSION TITLE: Collaborating for Sustainability: Strategies for Reducing, Reusing, Recycling, and Discarding Waste in Perioperative Settings SPEAKER NAME: Debra J. Savage, MSN, RN, CNOR Liisa J. Nenonen, BSN, RN, CNOR Julie K. Moyle, MSN, RN SESSION NUMBER: 9013 DATE/TIME: CONTACT HOURS: Monday, March 4, 2013, 8-9am 1.0 CH OVERVIEW: ORs are the largest contributors to the waste problem. This session will guide perioperative nurses and health care workers to establish effective practices to reduce waste in their environment and connect them to resources to support their efforts. OBJECTIVES 1. Define types of waste found in perioperative settings. 2. Identify the categories of recyclable waste generated in perioperative settings. 3. Describe the hierarchy of environmental actions in perioperative settings. 4. Discuss examples of success stories for waste reduction in perioperative settings. BIOGRAPHIES: Debra J. Savage, MSN, RN, CNOR, was president of Mass Chapter I She worked closely with their continuing education committee for the past two years to plan monthly educational meetings, as well as fall and spring workshops. Debbie has worked with the Combined Task Force to develop two workshops with Mass Council for AST and MCCSP for our combined workshops with vendors and over 400 attendees. She also planned the 60th anniversary celebration and the last two installation banquets for our chapter. Liisa J. Nenonen, BSN, RN, CNOR, developed a program and presented, "The Greening of the OR: Growing Environmental Awareness," for AORN Congress 1992 and a Pre-Congress Workshop on Environmental Impact in the OR in Liisa submitted poster displays on "Reduce, Reuse, and Recycle Options for an OR" and held several after-hours meetings for the RACORSE Network (non-profit she founded in 1990) during AORN Congress weeks in the early 1990s. Julie K. Moyle, MSN, RN, received her BSN from Vanderbilt and master's degree in nursing administration from Duke University. She has worked in the ORs of Shands Teaching Hospital at the University of Florida and Duke University Medical Center. Julie was drawn to Boulder, Colorado, where she currently lives, and the opportunity to oversee the opening and management of the surgery department of the first LEED certified hospital in the US. She has spoken at AORN, OR Business Manager, webinars, and other forums on implementing environmentally sustainable initiatives in clinical settings. A current member of AORN, Julie serves on the Green Initiative Task Force and News Advisory Group as an environmental expert.

2 CONTACT INFORMATION: Debra J. Savage, MSN, RN, CNOR Staff Nurse Beth Israel Deaconess Medical Center East Boston, Massachusetts Liisa J. Nenonen, BSN, RN, CNOR Staff Nurse Alta Bates Summit Medical Center Oakland, California Julie K. Moyle, MSN, RN 1 X 1 Consulting Boulder Colorado julie@1x1consulting.org FACULTY DISCLOSURE: Debra Savage Liisa Nenonen Julie Moyle COMMERCIAL SUPPORT: Liisa Nenonen 7. No conflict. 7. No conflict. 1. Pfiedler Enterprises Alta Bates Summit Medical Center (paid time) Corporate support for this session provided by a grant from Stryker Sustainability Solutions through the AORN Foundation.

3 Collaborating for Sustainability: Strategies for Reducing, Reusing, Recycling, and Discarding Waste in Perioperative Settings Connect our actions as perioperative nurses to our environmental impact Share Environmental Success Stories Reduce, Reuse Recycle Discarding Waste Discuss AORN Position Statement on Environmental Responsibility Climate Change: Causes and Effects Climate Change: Effects Human-Driven Environmental Exposure Food (pesticides, hormones, antibiotics, GMO) Water (pharmaceuticals, heavy metals) Air (pollution particulate, dioxins, flourans) Products (chemicals in food packaging, furniture, supplies) Environmental Hazards in Health Care Some Environmental Factors Known to Affect Human Health: o DEHP (Di(2-ethylhexyl) phthalate) o BPA o PVC o Asbestos o Lead and Cadmium o Mercury o EtO o Gluteraldehyde o Formaldehyde o WAGs Health Care Industry o Mission: Restore and Safeguard Health o Creed: To help, or at least to do no harm. (Hippocrates Epidemics, Bk. I, Sect. XI.) 22 Costs Health Care expenditures: 17.6% of GDP, projected to be 19.3% of GDP by 2020 (CMS, 2009) Health Care s Environmental Impact o Generates 8% of all US greenhouse gas emissions (Chung, JAMA 2010) o Creates 26lb/waste per occupied bed per day (PGH, 2010) o 20-33% of overall hospital wastes comes from the Operating Rooms (PGH, 2012)

4 Perioperative Sustainability Program o Waste Reduction Waste Segregation Fluid management Recycling Donation Blue Wrap reduction Reprocessing Reusable materials, supplies Procedure Pack Review o Energy/Water Conservation o Hazardous Material Reduction o Environmental Preferable Purchasing o Innovation Reduce Activities o Turn off lights and other electrical equipment after hours, but especially on weekends o Leave OR doors closed to minimize energy used to maintain room conditions/ temp, humidity, pressure o Don t let the water run unnecessarily Adjust stocking levels in your ORs and Supply Room o Easier to find what you need, reduces dust o Easier to rotate stock and avoid outdated supplies o Less money tied up in inventory Reuse activities Find Reprocessing company to handle selected items for your department: o Basins o Gowns, drapes, towels o Instrumentation o Saw blades o Tourniquets o SCD Sleeves o Reuse activities Gather unused supplies for donation to Developing World hospitals/charity groups/medical trips/veterinarians o American teams volunteering o Overseas hospitals receiving donations of supplies from our ORs o Nurses and surgeons traveling overseas o Non-profits running warehouses to gather donations Reuse activities o Gather supplies you cannot reuse within your own department o Collect clean supplies only- no patient/body fluid contact o Ask what they need o May be willing to take select expired supplies because they will be reprocessing many times anyway Even if your group wraps and sterilizes everything you take over for your surgeries, many times those items are salvaged from the trash and reprocessed by their departments for reuse multiple times.

5 Reuse activities Examples of useful supplies: o Lap sponges o Cautery pencils o Raytec sponges o Suction tubing o Plain gauze o Bulb syringes o Surgical gloves o Syringes o Exam gloves o Hypo needles o Sutures o Drapes o Opened sutures o Gowns o Catheters o Drains/reservoirs Overseas Medical Reuse Expiration Dates: o Refer to sterilization date or actual degradation of product? o May cause shipment to be confiscated at some borders because of misunderstanding o Items could be opened and shipped clean +/or reprocessed without expiration date o May also be usable by veterinarians Non-profits gathering supply donations: o Project Cure, multiple locations o Matthew 25 Ministries, Cincinnati, OH o Mission Outreach, Springfield, IL o Doc To Dock, Brooklyn, NY o VIDA, Emeryville, CA o MedShare, multiple locations Educational Reuse in local schools Creative Reuse in Various Settings Creative Reuse- walker hooks Basic Guidelines for gathering supplies Understanding and permission from Department supervisor Collect clean supplies only, or thoroughly decontaminate anything that has had any patient contact If item is reusable within your department, that is the best option Ask co-workers to help you collect and find people who want to use your surplus- creativity!

6 My thanks to nurse responders to online survey: o Shirley Henderson o Marie Johnson o Gertrude Dittiger o Julie Moyle o Joyce Mechaber o Anne Bonner o Carol Toney o Kai Abelkis o Sherry Hughes o Jodelle Myhre And to the countless other health care professionals who care about the Earth and her people Overview Committee History Goals Goals Achieved Typical OR Waste streams Municipal Solid Waste (Landfill) Recycling Regulated Medical Waste Fluid Waste Hazardous Waste (chemicals, pharmaceutical agents) Pharmaceutical Waste Donation Regulated Medical (Red Bag) Waste OR generates majority of hospital RMW RMW waste consumes 20% EVS budget (AORN, 2007) Cost / lb. of RM Waste: $.31 - $.57 Cost / lb. of General Waste: $.02 - $.14 Est % of RMW is general waste (Env. Research Associates, 2007) RMW Reduction Strategies Source reduction Proper segregation State, AORN Standards Annual Education Reusable Sharps Containers Municipal Solid (Clean) Waste AORN Green Initiative Task Force Update Position Statement Review draft, comment period for Position Statement Populate OR Nurse Link with discussion / resources Connect with sector partners Nurses Work Group Alliances of Nurses for a Healthy Environment

7 Health Care Without Harm / Practice Greenhealth Others AORN Position on Environmental Responsibility Priorities Preserve Natural Resources Reduce Waste Reduce, Reuse Recycle Discarding Waste Reduce Exposure to Hazardous Materials Resources: AORN Position Statement, OR Nurse Link (on-line Discussion and links to resources) Practice Greenhealth ( Care Without Harm ( Nurses Work Group (mail to: hcwh-nurses-workgroup@hcwh.org) Healthier Hospital Initiative 6 Challenges ( 10-Step RMW Reduction Best Environmental Practices American Nurses Association ( Alliance of Nurses for Healthy Environments ( Practically Green