Operating rooms are the most resource-intensive area of the hospital. They drive up to 60% of a hospital’s revenue, but consume three to six times more energy per square foot of building footprint, and produce more than 30% of the waste and two-thirds of its regulated medical waste. To mitigate these impacts, we have implemented a variety of programs with our OR staff and clinical champions.
In 2019, we began to monitor the greenhouse gas emissions from our anesthesia use. Anesthetic gases are potent greenhouse gases, and desflurane is the most carbon-intensive of the three that we use in our hospital. It’s ~50x more carbon-intense than sevoflurane, and it’s also the most expensive. The good news is that it can be used interchangeably with sevoflurane for most surgical cases. In the course of two years we were able to reduce the percentage of cases where desflurane was the primary gas chosen by anesthesiologists from an average of 13% down to an average of 1%. Due to this success, we are now planning to remove our desflurane vaporizers and make it available for use only for medical necessity or teaching purposes. This initiative saved over $190,000 since inception and removed the equivalent of 250 cars off the road.
We will continue to work in reducing harmful anesthetic gases. In FY2023, the UC Health system is focusing on reduction of nitrous oxide. 1 pound of Nitrous oxide is 300 times more potent and harmful that 1 pound of CO2. UCLA Health will be evaluating its use of nitrous oxide to identify inefficiencies and potential leaks in piped infrastructure as well as the potential to migrate from piped gas to canister, where infrastructure will allow.
Our clinical leaders and facilities teams are working to identify areas to reduce overall energy use and improve efficiency, by conducting assessments of each OR’s energy use and analyzing areas for improvement. UCLA Ronald Reagan Medical Center and Santa Monica UCLA Medical Center operate as acute care, level 1 trauma centers, meaning certain Operating Rooms must remain open 24/7. This presents unique challenges as well as opportunities for clinical and operational collaboration to reduce the ORs footprint.
Single-use Medical Device Reprocessing
Our physicians use a variety of devices during surgeries and many of these items are able to be collected and reprocessed by an outside vendor. By collecting these devices, we are able to divert them from a landfill and purchase them back after reprocessing. Reprocessed medical devices are disinfected, cleaned, sterilized, and packaged by FDA-approved reprocessing vendors, undergoing more stringent testing requirements than the original manufacturing. At UCLA Health, we track our collection rates and repurchasing rates and collaborate with our clinicians and reprocessing vendors to evaluate and optimize both collections and buyback. We’ve identified significant additional opportunities in the OR and hope to greatly expand on our collection efforts and buyback.
Operating rooms are challenging environments to collect recyclables because of the potential for contamination by biohazardous waste during a procedure. To mitigate this risk, we utilize a pre-case recycling program where our nurses open and collect all of the recyclable packaging that is expected to be used during a case. These bags are removed from the OR before the patient is brought in for surgery, minimizing the risk of contamination of the clean recyclables.
One of the bulkiest and lightest materials that we segregate out of our waste streams is blue wrap - also known as surgical or sterilization wrap - which is made out of #5 polypropylene fabric that can be recycled or repurposed into other materials. In the past, we have partnered with UC Irvine to recycle blue wrap and repurpose the material into masks for vulnerable populations in Los Angeles. We are working with vendors now who will recycle blue wrap into new materials for the hospital, such as gowns and bedpans.