HOW SURGEONS CAN FACILITATE CHANGE

BY MICHAEL GREENWOOD, MD

Mirroring the developments in every industry, sustainability and waste reduction have emerged as critical considerations in ophthalmology. These issues have risen to the forefront not just for environmental consciousness but also for cost-effectiveness and ethical responsibility.

Among the various areas of care delivery, the operating room (OR) stands out as one of the most resource-intensive and wasteful spaces. The sheer volume of single-use items, energy consumption and improper disposal practices have raised concerns about the environmental impact and long-term sustainability of OR operations.

This challenge, however, also presents an opportunity for innovation and positive change. By addressing waste and promoting sustainability in the OR, surgeons can contribute to a healthier planet while simultaneously enhancing patient care and financial efficiency.

WHY REDUCE WASTE IN THE OR?

The OR is the epicenter of ophthalmic procedures, playing a pivotal role in patient care. However, it is also a hotspot for generating significant amounts of waste. From disposable surgical tools and linens to packaging materials and medications, the OR generates an enormous ecological footprint. This waste not only contributes to landfills and incineration, releasing harmful emissions into the atmosphere, but it also places undue strain on ASC and hospital budgets.

Furthermore, health-care institutions hold a responsibility to uphold ethical values and promote environmental stewardship. By adopting sustainable practices in the OR, ASCs and hospitals can set an example for their communities and demonstrate a commitment to the well-being of both patients and the planet.

HOW TO REDUCE WASTE

Reusable instruments

One of the primary contributors to OR waste is single-use instruments. By transitioning to high-quality, sterilizable tools, centers can significantly cut down on waste generation and costs over time. While the initial investment may be higher, the long-term savings and reduced environmental impact make this shift worthwhile.

Surgical drapes

Many centers believe in full body drapes for ophthalmic surgery, but half-body drapes are equally as effective, use less fabric and therefore result in less waste.

Linens

Patients are often required to change into supplied lines each time they have surgery. If bilateral same-day cataract surgery was more widely available, that could greatly reduce the amount of washing and drying of linens. By performing bilateral same-day cataract surgery, the amount of linens washed would be about half.

Waste segregation and recycling

Implementing effective waste segregation practices in the OR can help divert recyclable materials from the waste stream. Properly separating plastics, metals and other recyclables can significantly reduce the environmental impact of OR operations.

Energy-efficient equipment

ORs rely heavily on energy-intensive equipment. By investing in energy-efficient technologies, centers can reduce their carbon footprint and lower operational costs. LED lighting, efficient HVAC systems and properly calibrated equipment contribute to both sustainability and cost savings.

Collaborative efforts

OR waste reduction and sustainability efforts can be enhanced through collaboration between health-care professionals, suppliers and waste management companies. Engaging in partnerships that prioritize environmentally-friendly practices can lead to innovative solutions and better waste management strategies. For example, working with your local waste management group to make things as simple as possible, such as having the recycle bin as easy to use as the trash bin for ORs, is simple to set up and can have a major impact.

Education and training

Properly educating OR staff about waste reduction and sustainability practices is crucial. Training sessions can raise awareness about the environmental impact of certain practices and inspire and empower health-care professionals to adopt more eco-friendly habits.

Sterilization optimization

Optimizing sterilization processes (running cycles only when the sterilizer is full, etc.) can lead to fewer sterilization cycles and, subsequently, reduced consumption of water, energy and sterilization agents. Finding the balance between patient safety and resource efficiency is key.

SUMMARY

Waste reduction and sustainability in the OR are paramount for addressing the environmental, economic and ethical challenges that health-care institutions face. By embracing innovative practices such as using reusable instruments and linens, minimizing packaging, implementing waste segregation and recycling programs and investing in energy-efficient equipment, centers can reduce their ecological footprint while enhancing patient care. Collaborative efforts between health-care professionals, suppliers and waste management companies can drive positive change and promote a culture of sustainability within health-care facilities as well.

As surgeons and industry recognize their role in promoting environmental stewardship, the OR can become a model of waste reduction, sustainability and responsible resource management for the broader health-care industry and society as a whole.

Michael Greenwood, MD, is a board-certified ophthalmologist specializing in cataract, glaucoma, cornea and refractive surgery at Vance Thompson Vision in Fargo, N.D. He reports no relevant disclosures.

HOW INDUSTRY CAN HELP – AND PATHWAYS FOR PARTNERSHIP

BY ERIN POWERS

No matter where you look, waste in the OR is a hot topic. This year’s European Society of Cataract & Refractive Surgery (ESCRS) meeting had a general session dedicated to this. The ASCRS and ESCRS, along with many other societies, have teamed up to create EyeSustain, a collaborative industry-surgeon coalition to make health-care delivery and services more sustainable. Publications are focused on impact and pathways for reduction. Industry has started providing information on its environmental impact in annual reports and on websites.

And this is only in eye care. The World Health Organization developed a comprehensive guidance document providing an overview of the complexities and recommendations for how to begin to tackle this worldwide conundrum. Also, we are increasingly seeing a request for sustainability plans in tenders, where industry bids to have access to their technologies in government funded health-care systems. No sustainability focus = no business prospect.

So, where does ophthalmology fit into this equation? How can industry help? Who are the key players in making an impact?

With a problem this large, the solution is far from simple. Looking at cataract surgery alone, let’s break it down into a few categories:

REGULATORS

As with many industries, health care is tied to regulatory guidelines. Industry is, quite literally, handicapped to what is legally mandated to provide our products. In most cases, there is little to no “wiggle room,” even if a recommendation seems obvious to many parties.

A real-world example of this is in paper instructions for use (IFUs) for IOLs. Until very recently, regulators dictated that all IFUs needed to be printed and inserted in every IOL box. Think about your routine surgical day; now think about your practice’s routine OR day. Now extrapolate that. In the United States alone, we see around 4 million cataract cases per year. In speaking with several surgeons, we are willing to wager that maybe one of these IFUs is ever opened. That’s 3,999,999 paper packets tossed into the trash without use every year.

A simple solution would be to have a QR code that any staff member could scan and link to the IFU. Not only does this save paper, ink (yes, chemicals in ink), shipping cost and ultimately waste from procedures, it also ensures that the surgeon and staff are receiving the most updated information in their language of choice. This seems like a win-win, but it’s not so simple.

Coalitions like EyeSustain have come together to author collaborative papers addressing this issue, targeting those regulatory bodies that have not adapted to modern practices. It is time that we work with our regulators to help make systemic, impactful changes that can reduce waste and improve care delivery.

SURGEONS & INDUSTRY RELATIONSHIP

From an industry perspective, our customers, as a majority, are surgeons. Industry provides surgeons with the best products to provide the best outcomes for your customers: patients.

This seems simple, yet it is not. There is a complex global financial pressure that affects many aspects of surgery and technology utilization along with a need to maximize reimbursement and profit to ensure that the procedure is both effective and efficient.

So where does OR waste play a role in this?

Let’s take a simple example: surgical trays. Made of plastic, a new one is opened, used and disposed of after one case. Using only US numbers, that is roughly 4 million plastic trays of waste on an annual basis. Solving this is not as simple as the solution above for IFUs.

But this is 2023; we must have something better than a standard plastic tray, right? Again, this is a complex answer that involves many considerations. A reusable tray has sterilization and durability requirements. A biodegradable tray has to maintain its integrity during the packing and storage process and must be biocompatible with the instruments.

Then there is the question of cost. In speaking with Daniel Collins, the head of sourcing for BVI Medical, using a biodegradable material for surgical trays (think bamboo-like) would increase the cost at least three times. “In addition, we’ve found challenges where suppliers are unable to provide consistent data on whether the fiber trays can fully withstand the rigors of sterilization, which isn’t an area of concern when using plastic trays,” he says.

Extrapolate that for other potentially biodegradable items in your surgical pack, and you can see the problem.

Where does the relationship between surgeons and industry need to evolve? In three areas:

• Shared ideation. Sometimes seemingly smaller projects can have shockingly high results. A surgical tray is one of the larger items — but are there smaller, potentially easier items to focus on in the short term? Only collaborative, open-minded conversations can help discover even minor gains that have major impact when looking at volumes worldwide.
• Shared advocation. As with any evolutionary or revolutionary technology, there is shared cost at the inception. Economies of scale cannot be expected in the early days, and industry and surgeons need to partner. Cost considerations for sustainability need to be taken into account at the reimbursement level, and shared advocation for this between surgeons and industry can help move the dial.
• Shared voice. Any change in materials will require a conversation with regulatory bodies; in the case of biodegradable materials and sterilization, this has potentially large impact on actualization of environmental gains. Industry and surgeons advocating together share a much more powerful voice.

INDUSTRY ALONE

The question of OR waste has been on the minds of industry professionals for years — much has been done, and much still needs to be done. Large companies such as Alcon, Zeiss and Johnson & Johnson have taken enormous leaps to partner with organizations that focus on helping internal efficiencies as well as offsetting carbon footprints. But every company, regardless of size, has the opportunity and onus to review their current practices and assess how they can be better sustainable partners.

For example, when it comes to manufacturing process improvements, much of what has been done is invisible to surgeons, and for good reason. Industry is trying to reduce the amount of waste in ORs before it even arrives. You may have noticed some of this (digital IFUs), but other advancements are so small that they seem invisible — until you look at scale. For example, minimizing the seal on a plastic package seems small until you multiply it by millions (Figure 1). Additionally, industry is looking at toxic chemicals; changing from pad printing to laser marking, for example, eliminates toxic waste with zero impact on product quality (Figure 2).

Another change that could occur with IOLs is the package itself, which could easily be reduced by half to cut down on waste and storage space needed for larger consignments.

Every organization should focus on ensuring that manufacturing processes are relevant or exceed today’s environmental standards and are delivering more sustainable products for customers worldwide.

SURGEON-DRIVEN

Surgeons should increase their awareness of how their choices impact sustainability. Something as simple as using an upper body drape rather than a full drape for cataract surgery automatically reduces waste of the drape by around 50% and reduces cost for practices. Ask your industry representatives for information on how to be efficient and sustainable — the information is there, and it is a win-win within the current regulatory and financial environment.

CONCLUSION

Waste in the OR is a hot topic — and it should be. This multifactorial problem includes numerous considerations, many of which have not been discussed here.

However, we can all agree on three facts:

1. OR waste is a problem.
2. This problem can be better solved TOGETHER, inclusive of all parties, rather than independently.
3. We can never compromise patient safety.

Regulators, surgeons and industry have come a long way in a short time — but we have a long way to go. Cataract surgery will look very different in 10 years — better technologies, better outcomes and, hopefully, better for our planet! OM

Erin Powers is vice president of Sales & Marketing for the US Surgical business at Johnson & Johnson Vision. She has almost 20 years of experience in the ophthalmic industry, holding positions at BVI, Zeiss, Alcon, and AMO/VISX. Her expertise includes establishing strategic business functions, developing ophthalmic and optometric marketing segments, and medical affairs and professional education management. She is the standing president of Ophthalmic World Leaders, co-chair of the Women of Dartmouth Leadership Committee, a member of the Chief network, and holds an MBA from the Tuck School of Business at Dartmouth and the London Business School.