Greening ORs: A guidance document for improving the environmental sustainability of operating rooms

1. Reduce
    1. Reduce energy use in operating rooms

      1. Reduce energy use from HVAC systems by implementing a setback program, reducing air circulation when not in use and/or installing occupancy sensors.
      2. Reduce energy use from OR lights by switching to LED surgical lights, and/or implementing a lighting setback program and/or installing occupancy sensors
    2. Reduce waste in the operating rooms
      1. Reduce water waste by using alcohol hand rub in place of a traditional surgical scrub
      2. Keep opioids out of sight and reach of children and pets
      3. Reduce pharmaceutical drug waste
      4. Reduce waste from surgical trays by using specialized trays
2. Reuse
    1. Use reusable products or extend the use of disposable products wherever possible. The following are commonly used disposable products that can safely be switched to reusable:

      1. Use reusable anesthesia breathing circuits or extend the use of disposable breathing circuits
      2. Use reusable laryngeal mask airways
      3. Use reusable laryngoscopes
      4. Use reusable linens (gowns, drapes, scrub caps)
      5. Use reusable sharps containers
    2. Use remanufactured single use medical devices (SUMD) wherever possible
3. Recycle
    1. Develop and implement an effective recycling program in the OR
4. Rethink
    1. Rethink the use of anesthetic gases, carrier gases and capturing systems
      1. Use sevoflurane for surgical procedures requiring general anesthesia
      2. Use air as a carrier gas when using halogenated anesthetic gases
      3. Use low fresh gas flows wherever possible
      4. Use anesthetic techniques other than inhalational anesthesia wherever possible
    2. Rethink the management of waste and unused supplies
      1. Rethink waste management practices
      2. Rethink the management of unused supplies, older machines and devices through donation where appropriate
    3. Rethink the use of blue sterile wrap and consider the use of reusable hard cases wherever possible