Boston Hospital cuts carbon-intensive O.R. trash, sees significant reduction in costly disposal

BOSTON — It’s a place that demands the highest medical skills for outcomes that are sometimes seen as miraculous. But here’s the dirty little secret about hospital operating rooms: They generate trash -- and tons of it.

“We use a lot of disposables,” said Elizabeth Yates, MD, a general surgery resident at Brigham and Women’s Hospital. “We use a lot of different kinds of waste.”

The most expensive trash to dispose of is regulated medical waste -- known in the hospital as ‘Red Bag Waste’ because, as the name suggests, it is disposed of in red plastic bags. Red Bag Waste includes biologically contaminated items -- such as bloody bandages or gauze -- and it takes a circuitous and expensive process to get rid of it.

“The Red Bag Waste gets put on a truck and taken to Rhode Island, where it gets autoclaved,” said Yates.  “But Rhode Island doesn’t want our nasty trash, so it gets back on a truck for final disposal here in Massachusetts.”

The cost to dispose of Red Bag Waste is five times that of regular trash, said Lewis Nguyen, MD, MBA, MPH, a vascular surgeon at Brigham and Women’s.

“Although the use of them was very appropriate, we’re seeing a lot of times people were just dumping inappropriate things inside a Red Bag,” Nguyen said.

And the result was too many Red Bags going out for disposal from Brigham and Women’s, where more than 35,000 surgeries are performed each year.

That prompted Doctors Yates and Nguyen to collaborate on a waste reduction effort they called Watching Our Waste or WOW.

“We really care about the environmental impact of our work because we know that our patient’s health is affected by the environment in which they live,” said Yates.  “While it’s really important to deliver the highest level of care that we possibly can -- we can still do that while improving the impact on the environment that we have.”

Implementing WOW was not done via mandate or even direct persuasion.

“In economics, people follow logical things,” said Nguyen. “But people are human and they make illogical choices. The key is -- are the illogical choices predictable.”

Playing off that, Yates and Nguyen used subtle means to change behavior. Instead of placing the red bag in close proximity to the patient, they moved it further away.

“As we are finishing up the surgeries and we’re taking our gowns off and materials, instead of dumping into the first available container, we’ll use the regular container, and anything that needs to be in a Red Bag, we’ll take a few steps,” Nguyen said. “It was not something we dictated. It’s something people agreed to.”

While habits are hard to break, Yates said it seemed the staff was ready for this environmental intervention. The doctors estimate the use of Red Bags has dropped 30 percent in Brigham’s operating rooms -- and perhaps more than 75% in other patient care areas of the hospital.

By some estimates, the U.S. healthcare industry is the source of 10 percent of the nation’s greenhouse gas emissions. While the WOW initiative may seem a small step -- it seems to have yielded larger, long-term benefits.

“It’s brought people closer together in a way that it makes it okay for us to all be now, ‘tree huggers,’ Yates said.

This is a developing story. Check back for updates as more information becomes available.

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