Striving for Sustainability in Ob-Gyn Care

If the health sector were a country, it would be the fifth largest emitter of greenhouse gases on the planet, according to the international nongovernmental organization Health Care Without Harm. Alexandra Melnyk, MD, MEd, a physician at Cleveland Clinic’s Ob/Gyn Institute, is on a mission to decrease the carbon footprint of patient care, beginning in the operating room, where she specializes in pelvic reconstructive surgery.

“The production of all of the equipment we use in the OR contributes to greenhouse gases that are detrimental to our environment, and the downstream effects are real,” says Dr. Melnyk, co-founder of OBGYNs for a Sustainable Future. “We are trying to minimize our impact because it has real physiologic and pathologic impacts on our patients.”

Dr. Melnyk and her colleague Elliot Richards, MD, director of reproductive endocrinology and infertility at Cleveland Clinic, are participating in a panel discussion on sustainability in surgical care at the American Association of Gynecologic Laparoscopist’s 2023 annual global conference.

In addition to presenting at conferences, Dr. Melnyk shares her message about sustainability to the OB-GYN community through journal articles. She published results of a study on disposable supplies in the journal Urogynecology in July 2023 and a commentary in the September 2023 issue of the American Journal of Obstetrics & Gynecology.

Study shows surgical waste is costly

Dr. Melnyk conducted the study measuring suburethral sling surgical waste by cost and weight during her fellowship in Female Pelvic Medicine and Reconstructive Surgery at the University of Pittsburgh Medical Center’s Magee-Womens Hospital.

“Anytime you look at sustainability efforts, it’s always about the triple bottom line – people, planet and profits. You have to consider cost,” she says. “We observed and quantified items that were wasted, defined as opened but not used in the surgical field, so ultimately trashed.”

Dr. Melnyk and her peers observed 20 suburethral sling plus cystoscopy procedures. The most frequently wasted items included an emesis basin, large ring basin and rectangle plastic tray. Redundant supplies included a one-liter sterile water bottle and an average of 2.73 blue towels. The total weight of wasted items per case was 1.33 pounds and associated costs were $9.50. Removing items that are commonly wasted would achieve a 9.4% reduction in solid waste produced per procedure.

“We have a culture of single-use items,” she says. This stems from a commitment to infection control and efficiency in the OR. A sterile supply pack of items is opened ahead of time to streamline procedures whether all the items are required or not.

“I think the pendulum has swung so far in the direction of disposable supplies, and we need to find a middle ground,” says Dr. Melnyk. Following the initial study, she completed a non-inferiority trial related to urinary tract infections after cystoscopy procedures in the operating room using a green draping protocol, which consisted of minimal to no drapes and gowns, versus standard full sterile drapes. The results, which have yet to be published, indicate that a green draping protocol is not inferior to standard full surgical drapes.

Simple steps focused on sustainability

The journal commentary tackles the culture in surgery, as well as addressing overconsumption of energy, water and single-use supplies in healthcare and its impact on the climate. Dr. Melnyk urges clinical staff and hospital administrators to take action to reduce greenhouse gas emissions.

While creating a sustainable hospital environment can seem daunting, she offers four simple steps that her peers in ob/gyn and surgical care can take today to make a difference.

• Switch from plastic to stainless steel specula. “You can use steel specula hundreds of times, and they are safe,” she says. “If you are in a community clinic or other facility that doesn’t have access to sterilization, then of course plastic, disposable specula make sense. Providing safe care for our patients is paramount. But if we have a choice, stainless steel specula are preferable.”
• Update surgical preference cards with the necessary supplies and tools to perform a procedure. “Too often the cards are outdated, and items are pulled, opened, then thrown away unused,” says Dr. Melnyk. “Maybe there’s a change in a procedure and you don’t need an item. Or you could ask surgical techs and nurses to pull an item but leave it unopened until you ask for it.”
• Be mindful of red bag waste. Only biohazardous waste should be disposed of in red bags. “So much of the time, non-soiled items go into the bags and get incinerated before it goes to a landfill,” she says. “That is very taxing on the environment, so we need to be mindful on what we throw in there.”
• Turn off computer workstations. “If all the doctors in the hospital turned off their computers in clinic spaces and administrative offices, we could save a lot of energy,” says Dr. Melnyk.

These steps may seem minor, but combined with larger sustainability efforts they can have a collective impact, says Dr. Melnyk.

“All of the greenhouse gases emitted by hospitals are worsening our environment, which could lead to more asthma cases, pulmonary issues and other health problems,” she says. “We are not just making changes to benefit the patient in front of is, but potentially a whole population of patients.”