Tuesday, December 27, 2011

Naval Hospital Operating Room "Goes Green"

Last month, the Operating Room (OR) at Robert E. Bush Naval Hospital in Twentynine Palms, Calif., began a new environmentally friendly program in their quest for efficiency.

Typically a single surgical case generates a considerable amount of waste because most of the items used for a procedure are disposable. All items needed for a particular case are put together by a Custom Pack manufacturer such as Cardinal Health in what are referred as Custom Surgical Packs.

In order to reduce the waste from these disposable pack contents, reusable surgical items are being used to replace many of the items found in these packs. In view of this, a coordinated effort to substitute as many disposable products as possible for reusable items was initiated by Lt. Cmdr. Brian Parton in March of 2010, and finally implemented in last month.

With the help of the Materials Management Department staff, the OR implemented the use of reusable surgical gowns, towels, basins, and various drapes from SRI Surgical in combination with smaller, more efficient surgical packs from Cardinal Health. The new items that were substituted will help the command reduce surgical waste generation by approximately 13,000 pounds per year at no additional cost.

The process was not as easy as first envisioned. Since Naval Hospital Twentynine Palms is the first Department of Defense (DoD) facility in the country to fully implement the use of hybrid packs, there were several hurdles to overcome. SRI did not have a Distribution and Pricing Agreement (DAPA) in place, so they utilized their partnership with Cardinal Health to add reusable items to Cardinal's DAPA. In addition, the typical three year contract obligation that SRI utilizes was modified in order to satisfy the requirements of the DoD.

After finalizing the custom pack modifications, determining the delivery and pickup schedule, updating the Defense Medical Logistics Standard Support (DMLSS) supply ordering system, and training staff on proper care and use, the new "Green" items were finally used in surgery. The Army and Air Force are also looking into implementing this program at some of their facilities. Their conversions should be smoother thanks to lessons learned between Twentynine Palms, SRI, and Cardinal Health.

Ensign Jenna Dimaggio of the Maternal Infant Nursing Department is currently exploring the potential use of SRI's reusable items in for their patients as well. Single pull items are also being implemented to minimize the use of disposable gowns and accessories when items that exceed the pack contents are required.

Other initiatives that have been implemented in the Operating Room over the past year include the installation of LED surgical lights in all OR Rooms that reduce energy demand by 40 percent, a new instrument washer that is expected to reduce water consumption by 100,000 gallons per year, the utilization of reprocessed devices from Stryker (Ascent) expected to generate savings in excess of $30,000 dollars, and filterless instrument sterilization containers that reduce waste generation and provide increased infection control measures.

By embracing ideas new ideas, researching innovations, and implementing various process improvement initiatives, the Operating Room staff has exemplified environmental awareness and best business practices within the workplace. They have found ways to reuse surgical items, reduce unnecessary waste, and upgrade equipment, all with the purpose to be more environmentally conscious and to contain costs within Navy Medicine, while still providing the best possible care for patients.


  1. Thanks for the post! I also agree that waste has to be reduced in order to save our environment and in the process save money. Right now Hospital Linens has been a great aid in our efforts to reuse our surgical materials.

  2. All items needed for a particular case are put Autoclave together by a Custom Pack manufacturer such as Cardinal Health in what are referred as Custom Surgical Packs.