Replacing those plastic straws is great, Now, let’s focus on the OR.

Ternio Newsroom Staff | November 15, 2021

5.9 million tons. That’s how much garbage is produced by the nation’s 950,000+ staffed hospital beds, according to the American Hospital Association. And that’s just the tangible, physical waste produced regularly by our hospitals. At the same time, hospitals are feeling the impact of climate change. Wildfires, extreme temperatures, hurricanes, and flooding are contributing to the disruption of surgery schedules, adversely affecting patient care and community health.

More and more institutions are waking up to the fact that adopting more sustainable practices not only reduces waste and lowers costs, but also results in an improved consumer perception. A recent study by Johnson & Johnson showed that 35% of hospitals switched suppliers because of their green or sustainable product offerings and 54% said that green attributes are very important in their purchasing decisions. Additionally, 93% of global citizens said they have a more positive image of a company that supports social and environmental causes.

Eliminating single use plastic (such as straws, stirrers, bags, and utensils) is certainly an improvement, and a good place to start. While they may be essential for some disabled patients, institutions such Innova Health, Dignity Health, and Johns Hopkins have demonstrated that plastic straw use can be reduced dramatically. By switching to paper straws these 3 institutions alone have prevented over 4 million plastic straws per year from ending up in landfills or contributing to the vast Great Pacific Garbage Patch.

But focusing on plastic straws is only the first (and perhaps most obvious) steps towards greener and more sustainable healthcare.

The OR, it turns out, represents major sustainability improvement opportunities. It consumes three to six times the energy per square foot of any other part of the facility, generating 30% of the hospital’s overall waste. Perhaps unsurprisingly, the surgical supply chain represents the lion’s share (40% to 60%!) of a hospital’s total supply chain cost. And 71% to 82% of health care emissions are derived from the supply chain[i].

Here are three recommended areas of focus for improved sustainability in the OR and beyond:

Vision and Culture

“Greening” the OR will require a shared vision and leadership by example throughout the organization. Physicians, nurses, and administrators must leverage their positions of trust and respect to identify and recognize opportunities and to advance improvements in sustainable practices. These “green” practices and initiatives, supported by consistent and compelling messaging will be rewarded by improvements in loyalty and morale internally and elevated reputation in the community.


A particular focus should be placed on procurement systems and practices. Are products and materials coming into the hospital being properly evaluated for their impact on climate and waste? Are there more sustainable, safer alternatives to materials that are currently being used? Can competing products be easily shopped and compared for these features? How can centralization or streamlining of processes help to bring less toxic, less water or energy intensive materials and products entering the facility?

Surgical Resource Planning

Resource planning through the use of surgeon preference cards is a standard practice, however, suboptimized preference card systems are still in wide use throughout hospitals in the U.S.  These preference card systems regularly produce case carts with supplies and instrument that will not be used but more importantly they can be missing supplies and instruments that are required for surgery. Automation of preference cards enables data gathering and analytics to improve efficiency, reduce waste, and decrease the administrative burden on clinical staff, resulting in improved sustainability as well as better patient care and outcomes.

Ultimately, hospitals have a responsibility not only to the patient on the table, but also to the planet we live on. Though health care is the only economic sector with an expressed mission to “do no harm”, hospitals are responsible for 8.5% of all greenhouse gas emissions in the U.S., resulting in the loss of 388,000 disability-adjusted life-years in 2018[ii]. The good news is that concrete, positive steps to improve sustainability and reduce waste are available now for those institutions willing to put forth the effort.

[i] OR Management News, September 21, 2021

[ii] Eckelman M, Huang K, Lagasse R, et al. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood). 2020;39(12):2071-2079.