NEWS & OPINION EWAP SEPTEMBER 2023 53 reducing cost, reducing waste, and decreasing the impact of interruptions in supply chain for disposable items. Surgeons, administrators, nurses, and staff responsible for ordering supplies and for managing waste disposal may have individual appreciation of the impact of a coordinated effort to improve sustainability and reduce waste. One example of this effect was seen when Kaiser Permanente changed from single-use to reusable sharps containers, avoiding 300 tons of plastic waste and saving more than $2.3 million annually. 4 A simple place to start is to evaluate surgical packs by monitoring what is not used and subsequently thrown out over a 2-week timeframe. Rarely used items such as extra syringes, marking pens, or gauze pads can then be removed from the pack and made available as single-use peel packs for times they are needed. A study of surgical pack supplies was conducted over a 3-week period in a children’s hospital. Items used less than 85% of the time were excluded from custom packs, eliminating 2 tons of plastic waste and saving more than $27,000 in pack costs annually. These efforts along with supply chain streamlining were projected to eliminate more than 6,000 tons of waste in the U.S. annually. 5 Similarly, a survey of 58 neurosurgical cases at the University of California San Francisco showed an average of $968 per case or $2.9 million per year in surgical waste in the neurosurgery department. 6 A task force made up of surgeons, nurses, scrub techs, and key staff that manage ordering of supplies can survey use and waste of items and make recommendations for change. Other ideas for waste reduction include eliminating full body drapes in favor of smaller drapes, eliminating gowns for patients, proper use of multidose perioperative drops until the expiration date, and recycling plastic and paper when possible. Guidelines for use of multidose drops on multiple patients can be found in the recently published multisociety position paper on reducing unnecessary topical drug waste in ASCs. 7 One simple step is to replace individual plastic bottles of water with a water cooler and paper cups in the postoperative setting. For more ideas and tools to calculate the impact of small changes on the waste produced and carbon footprint of your own OR, go to EyeSustain.org. You will find tools for making changes that can have a lasting impact on the environment, sustainability, and the financial health of your practice and the larger community as well. EWAP References 1. Eckelman MJ, et al. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood). 2020;39:2071–2079. 2. Chang DF, et al. Survey of cataract surgeons’ and nurses’ attitudes toward operating room waste. J Cataract Refract Surg. 2020;46:933 – 940. 3. Chang DF, et al. Survey of ESCRS members’ attitudes toward operating room waste. J Cataract Refract Surg. 2023;49:341– 347. 4. practicegreenhealth.org/ sites/default/ files/upload-files/reusable_sharps_ containers_ success_story_3.10.pdf 5. Cunningham AJ, et al. Reducing disposable surgical items: decreasing environmental impact and costs at a children’s hospital, a pilot study. J Surg Res. 2023;288:309 – 314. 6. Zygourakis CC, et al. Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg. 2017;126:620 – 625. 7. Palmer DJ, et al. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg. 2022;48:1073–1077. Editors’ note: Dr. McCabe is Medical Director, The Eye Associates, Bradenton, Florida. ADVERTISER LISTING Feather Page 27 www.feather.co.jp Oculus Page 14 www.cornealbiomechanics.com ZEISS Page 28-31, 39 www.zeiss.com APACRS Page 2, 4, 6, 7, 34, 54, 59, 60 www.apacrs.org
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