The problem of operating room trash (and a solution to it)
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- Опубліковано 7 чер 2024
- The sheer volume of disposable packaging for operating room equipment is actually a major environmental problem. In this video, I get an inside look at what Mt. Sinai Hospital does to reduce the environmental impact of its operating rooms.
Maggie Xiao et. al. "A Roadmap for Environmental Sustainability of Plastic Use in Anesthesia and the Perioperative Arena", Anesthesiology, 2021: pubs.asahq.org/anesthesiology...
0:00 Start
0:21 Operating room trash?
2:09 The problem
4:46 A solution
5:27 Following the recycling
The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.
#Anesthesiology #Residency #MedicalSchool - Наука та технологія
I worked for several medical device companies over my long career as a product design engineer. Medical devices are intentionally designed to follow the "razor / razor blade" model. The very expensive-to-manufacture "razor" part of the system is sometimes sold at a loss, or loaned to the medical facility in order to generate a steam of "razor blade" sales. The "razor blades" are single use only, sometimes because they are used up (blood glucose test strips), but many times because of sterility concerns. This results in an amazing quantity of perfectly usable equipment being sent to the landfill.
With New York’s recent flooding problem, could you make a video on how hospitals are better prepared to handle natural disasters?
For that he will need to visit Coney Island Hospital.
NYC HHC just built its first hospital in over 40 years. Because Coney island hospital was flooded during sandy, flood gates and all the utilities of the building are being raised to the 5th floor.
Water isn't the only issue with flooding. A loss of power is so much more likely, so hospitals rely on cogeneration and mini power plants to stay reliable and operational.
@@hubert187why not just put the generator on the roof like a lot of places do near me and I don’t even live in flood zone
@@berra5739because hospital generators are huge, you would need to massively over engineer the hospital to house it on the roof, whilst also having a way to pump all the diesel up there and spare parts.
I've had the privilege to be a part, as a child, the demolition of an old hospital (old Darwin Hospital in NT Australia), and also an ex mechanic that has been called to the "new hospital" for a basic service as a sub contractor. Its huge but in a location that is protected from nearly all elements except MAJOR flooding, but it's also accessible enough so that you can have access to refuel and service all systems, from memory the standard is two redundant systems, with 40,000 gallon diesel tanks that feed two banks of 2-5 generators. Alot of redundancy is required for a hospital when life or death can happen.
Also putting it on the roof will require craning, large cranes at that, cannot be changed out in high wind conditions, and can destabilise the building if it starts to pick up a a resonant frequency sway, which is worsened by the extremely heavy top weight. Air-conditioning systems and water tanks cause enough of that problem and take up more than enough space. Esp when you have minimum space requirements around them, you have incineration chimneys etc.
Not a bad thought don't get me wrong, but the cons far outweigh the one or two pros for it.
opening up a disposable sterile tool both feels so satisfying and painful to me
Even as a type 1 diabetic, the amount of plastic waste my medical devices create is absurd
I work in O.R. supply and I can safely say that between expiration waste and operating wastes, hospitals are bleeding money from a wound no one wants to address and put effort into closing.
Irony.
most of the soft plastics that were dumped on the table were not recyclable and would have contaminated the recycling stream, when a recycling load is too contaminated, which often times it is due to poor sorting or dirtiness, the materials get diverted back to landfill, if the material is thin and “stretchable” I would trash it next time than put it in the recycling bin, only hard plastics like you would find holding a tray kit are recyclable. the best plastic candidates for recycling would be found in items like a yankeur or chest tube canisters but obviously those items would be dirty and would have to be trashed.
It depends on the factory.
It isn't just the plastic waste that is generated. What about the general waste that is generated by surgery and the supplies that goes to waste if it is opened and not used. Those items can be reused as "practice " instead of students needing to buy their own things like sutures
Excellent news that you successfully finished your residency!
Thank you for making this video, Dr. Feinstein! This is SUCH an important issue to be talking about - sterile procedures produce so much single use waste, and as a Medical Assistant specializing in wound care and vascular surgery, I frequently hear from patients "I hate that you're using so many things". I always have to explain to patients and families that we are doing things like changing gloves, opening fresh packages, using new materials, etc in order to keep them safe (which cannot ever be compromised), but we of course try to balance that with not being wasteful whenever possible. There are lots of creative ways that supplies can be repurposed to minimize things being tossed in the trash.
I have a port and require home infusions frequently for my chronic diseases, and all my infusion supplies are shipped to me in tons of plastic bags. I started saving all of the bags because I hated throwing away so many ziplock bags, and now whenever I want a bag to organize something in my house, for a present for someone, or for anything that isn't a use for food where I really need a fresh ziplock bag, I reuse those bags that come from my infusion supplies. Haven't had to buy plastic bags in a long time!
Efforts like the ones highlighted in this video (and in these comments) are so important and so uplifting! Thank you for giving this issue a platform!
the plastic bag thing drives me crazy! I have a Hickman and feeding tube, when I unpack my home health supplies I always end up with a big plastic bag full of other bags. idk what to do with them, but I save them for something 😂
I hope this can extend hospital wide to other peri op areas. It can also be done in the med room for syringes and other supplies (it's also before patient contact). I'm sure if there was a place people can pick up supplies from cancelectomies they can be saved from the trash. Those blue sheets make good covers for home improvement projects, laps and towels are handy in the kitchen and bathroom. The plastic bowls good for plants/fruit/cleaning etc. Congrats on finishing residency!
is cancelectomy what i think it is? because LOL!
@@quincyboyce845 maybe! lol when the case is cancelled but alot of the the stuff we opened cannot be used because the next case is a different surgery or it was the last case of the day. In these cases those items get thrown away :(
I'm a Phlebotomist who loves your channel, and the amount of waste that's produced for a basic venipuncture procedure is insane. I can't imagine the surgical waste bin.
I'm interested in the article mentioned but I don't yet see the link. Could you add it to the video description as well?
Yes, added! Here's the link for convenience: pubs.asahq.org/anesthesiology/article/135/4/729/115935/A-Roadmap-for-Environmental-Sustainability-of
Very good video on the topic, Max! I always love to see the anesthesiologists side of surgery! Hope to see this gain traction in more hospitals around the country and world!
Notes from my life as chemical engineer. I applaud you trying to reduce and reuse because recycling is a huge myth put out by industry. Only some plastics are actually recyclable... Just because it has a number doesn't mean it can be actually recycled even if taken to a recycling facility. It is usually burned. Additionally, Plastic is only recyclable a couple times before it is broken down too much to be reused. Finally, plastic cannot really be sorted by type except by hand and it can't be recycled until sorted. Any plastic being sorted automatically is probably destined to be burned or sent to landfill.
Very interesting, I enjoyed watching that. I am amazed at all the recycled items after surgery. Love your videos, Max❤
I'm interested in the "red bag" waste but I'm going to check out that paper. Thanks as always for being the "Wizard" that lets us see behind the curtain :-)
I was wondering about exactly this just the other week! Thank you Max and Muoi for the super informative video. Also congrats on completing residency!
That was so cool and interesting! That was awesome to see! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist physician, I have to have a eye surgery in a few weeks because my right eye muscles is crossed because of my cerebral palsy! I know I’ll have a good anesthesiologist like you
I work in a CRO and hate how much waste we produce. I wish there was a way to recycle gloves. I’ve never tracked how many I use personally but I know it is a lot. Sometimes we have to double glove for certain things, and when we have to work on multiple studies a day and then change out between dose groups in a single study it can become a lot of waste.
I always learn something from your videos. Very interesting topic.
Great information. All the IVs and ports we access everyday and the waste they produce is a problem.
Dr. Feinstein, I am an avid viewer of your channel and I NEVER miss an episode. However, if I may offer a piece of constructive criticism? I wish this video would have not only been longer but also more detailed. Honestly, all I learned in this video is that anesthesiology makes a ton of waste and that it's brought to be recycled. Mind you, that was only paper and plastic waste. What about medication vials and unused medication vials. In addition, what happens to sharps? How are they recycled? I would love to know more. Other than this video I LOVE all your others. Even though I don't love this video I rate it an 8.5 for the effort and I'm smashing that like button! Keep doing what you're doing Max! We love you, man. I've been with you since you only had 1,300 subs. It's been a joy to watch your channel grow!!!!
Wow. I have never once thought about how quickly such a small decision could compound like that.
As somebody who has worked in these "recycling" facilities
The majory of your waste ends up as shredded confetti called "SRF" (solid recoverded fuels) which is then sold to manufacturering processes to be burnt as fuel
What's really amazing is finding two doctors with such great personalities 😂😂😂
Congrats on graduating!
Well done. That's a great initiative.
As an OR scrub RN and circulator I am horrified each day when opening for a case to see how much waste is generated , before the patient even enters the room. What's is also VERY concerning is that anything that is used during the surgery is not recycled as its considered "contaminated" this includes large plastic basins, jugs, dishes , blue towels and lots of plastic drapes, I trained many years ago when everything was linen and was washed and sterilized and reused. All the plastic ware was stainless steel and also reprocessed . We will have to go back to these old tried and true practices to cut down on our carbon foot print and waste.
My local hospital still uses stainless basins in the OR. We have plastic as a backup but we barely ever use them.
Love the information!
This is really awesome! How did Dr. Trinh go about making this happen? I feel like this needs to be in ORs everywhere
Congratulations on your graduation!
Hey! At 6:21, that's awesome Max. Congratulations! (Now back to the video.) (edit: apostrophe)
can you please do a video of how certain paralytics can cause your muscles to tense and contract. i just had sinus surgery. the surgery was not to bad my nose did not hurt very much. but almost immediately after waking up my groin and stomach muscles hurt so bad. like I had ran 100 100k marathons in a row. it was so bad. my doctor told me is was a reaction to one of the drugs used to paralyze me. I really thought something was wrong. i watched most of your videos before i had my surgery and they really helped to calm down and understand the process. thank you very much for making them.
But what happens to the recycling after that??
I do home dialysis for my brother. A full 1/4 of my trash goes to medical waste. I have started separating the paper out before the procedure starts, but the post procedure trash is still a lot
Hopefully this gains traction. I'm not surprised at the waste, but it is sadly a requirement for hospitals as you don't want to reuse surgical materials.
I am EMT in Colorado and Kansas, and its always astonished me just how much waste there is, and none of it can be recycled, or gets recycled. Sterilization is one thing, but when I fill up a garbage bin after an EMS call just with the stuff needed for one person you know it gets excessive.
Healthcare industry should get the least flack for amount of waste they create. Good for you guys doing something anyways.
Max are you applying to cardiac anesthesia fellowship?
im definitely not a hospital, but i was shocked at how much single use product waste i make just doing simple shots, having a feeding tube, and doing at home infusions. just a single dressing change for my hickman makes a whole small trash can full of trash
My biggest issue with recycling plastic is that only a small portion of plastic can be recycled, something like 3%. The rest of it is burned or buried.
Looks like you found yourself a future business idea. Seems like a very interesting problem to solve.
$8k worth in plastic. $5k worth of paper inside. Cost about 10$ to make. I think they will keep their individually wrapped items.
I wonder if it would make sense to have manufacturers create kits with all the needed stuff inside. This way you'd only have one outer bit of wrapping instead of wrapping for all the individual items.
They do make kits. The issue then of course, is if there's something in the kit you don't need, it's been opened and is now waste
People have actually tried to make it out of biodegradable materials but there were a few issues including the smell, shelf life, etc. Tbh you think that's a lot of plastic waste but it's probably only 1kg of plastic. You should see the waste generated by manufacturing of literally any product.
How you do intubate patient with a long lasting hickups?
I'm not at all surprised. I had to have 30 days of antibiotics through a PICC line to treat Lyme disease, and the amount of daily trash was upsetting.
Now I have 4-5 doses of injected meds each week, and they also create a ton of trash - some of which has to be separated because of sharps or blood.
Cant we just use natural rubber cases or glass cases with tree cotton as a cushion to prevent braking.
OH is that gp3 OR 22. Great place to be!
I did a face palm on how much stuff you had to open for just one guy
When I was hospitalized, I tried to figure out how many of the disposable objects were made of materials that could be repurposed. I was shocked by how much stuff got thrown in the garbage. Before leaving, they let me take all of the supplies from the room because they said they were going to throw it away anyways. New syringes, metal hemostats, tapes, etc. Even some stethoscopes! I took it all. Unfortunately many of the plastics used are thermosets, ie one and done. I wanted them to reuse the water pitchers and such, but of course that would be a contamination risk. I just ended up making a stack of them to take home and use for other things lol. If things could be made of thermoplastics it'd be so much easier. The heat during reforming would theoretically sanitize the end-product. Of course this would only be for non-sterile situations. There has to be a solution.
How is waste possibly contaminated with prions from Jakobs Cruzfeld patients? I mean like reusable metal clamps etc? Autoclaves dont protect against prions right?
Autoclaves can do that ☺️ cook them at 130 ish degrees c, at 20 psi for a hour. Trained sterile services are in change to that job, but cleanroom technicians like me copy what they do all the time. V important work, often forgotten
so is Mt Sinai putting in place any definitive plans to reduce waste?
Sinai has a more robust recycling program than the vast majority of hospitals.
Another thing is that a lot of very high quality steel gets essentially wasted because so many single-use tools are simply thrown away after use.
From that recycling facility, straight to a field in Indonesia 😭
Doing surgeries on the buses and cars that get the doctors, medical surgeons and staff to work produces a lot of plastic. Big bins every day just to make sure that you can have a safe bus to get to your hospital on time.
What about that stuff you opened to show us how much used, now you can use it and have to another one for the actual surgery.
you use canva to make thumbnails
Most recycling will end up at the landfill anyways because the cost of recycling is cost prohibitive.
Sealed metal containers that are ultrasonically welded to seal? Metal like stainless steel can be recycled.
Cool! Interestingly enough, my area experiences contamination: nuclear. I think you guys would faint if you saw how much waste is produced by one person’s PPE lol
Your waste management companies need to build an incneration system to make electric and central heating for houses in the city.
"Smells a little bit like the Bronx, and that garbage smell" Nope thats just the Bronx.
No disrespect intended. You are obviously very smart and capable. But the last thing i want any of my surgeons thinking about is "will this recycle". I want you to think, "what is best for the patient" and to some degree, I understand that has to be tempered by "what will insurance pay for". Beyond that, stop thinking. Others, who aren't smart enough to do your job will figure out if there is a better solution. But I strongly suspect that if there was a better solution, the market would have thought of it.
Also, I have a very simple rule of thumb I use to decide when to recycle: If someone will pay me for the waste, it is worth recycling. If I have to pay someone to take it away, it is trash because the economics (read, energy required to recycle) don't justify recycling.
It's still questionable whether plastic films like in your video are truly recyclable or if they get only incinerated as a fuel source.
Did you mean to post this?
I feel like this was meant to be unlisted and sent to peers for review
@@xorinzor But oh well, he did good.
@@xorinzorwhy do you say that?
Healthcare sector should be exempt from plastic rules. Don't get me wrong, recycle where you can but don't make things mandatory. We already have to do so much to save lives and keep up with the latest evidence based medicine and now we need to fight the environmental battles which other people should champion. There are a million other industries that can change their packaging habits. The same goes for Anesthetic gases and the ozone and global warming.
Healthcare is a team sport and we’ve all got to do our bit. There is a lot a staggering amount of waste in the operating theatre, that includes unnecessary wastage/accidental opening and oversized packaging for the tiniest of items
@@Upsidedown_em I agree. Where things can be done to reduce they should, but the same mentality policy makers apply to the general public shouldn't apply to the medical industry. E.g. banning plastic from certain industries or adding specific taxes to curb consumer usage
OMG...this is no joke. The amount of waste that gets pulled out of our cath lab is boggling. But it's all biowaste and has to be incinerated. Can't recycle most of that. At least not here.
Max please do not call this "Recycling" as plastic waste here in the western world is simply a process of "Down-cycling", as most plastic waste is contaminated with food or other biological waste or paper labels. In contrast aluminum is 100% recyclable as any contaminants will burn up during the remelting process as the melting point of aluminum is 1220 deg F in an open crucible. Where as the plastic is melted by extrusion at temperatures ranging from 300-550 deg F, with minimal filtering of contaminants. Case in point was a Danish company purchasing plastic utensils made from recycled plastics that ended up making the dinners sick with Heavy Metals, at which time it was discovered that the origin of the waste plastics was from Heavy Metal containers. I know their will be nay-sayers out there, but it is just not economical to clean plastic for recycling when virgin plastic is so inexpensive.
I think your efforts are valiant, but misguided and the resources are wasted effort & $'s when that could be put to better use elsewhere. I am sure New York State is giving y'all tax incentives to do this so-called recycling, but ultimately it is a waste of tax-payer dollars, and the economics aren't able to support this.
Aloha...............................
It's too bad they don't use reusable packaging.
Kinda hard to in surgery to maintain sterility
@@NickzAndMikz Not really. Just sterilize it between uses.
In Ecuador the spinal kits were hand assembled and wrapped in cloth and sterilized in the autoclave. Completely recyclable, except for the needles, gauze, gloves used, and the medication vials. Worked just fine, as long as I could decipher the drug labels in Spanish, but that’s my problem.
@@Boodieman72 How does one effectively sterilize packaging?
@@NickzAndMikz Autoclave is one option.
Recycling plastic and packaging? What a joke, waste of energy to make people feel good about all that trash. Not a solution. Divert waste? What do you think happens to all of that after sorting?
If you really want too save the planet, then we have too eliminate the hazard at the source, corporations, corporations operating under the system of capitalism are burning through our resources at an astonishing rate, far more then is necessary, and it’s starting too lead to massive issues.
We need too target corporations with our efforts, such as banning packaging that doesn’t get recycled, making producers the ones responsible for the recycling process of their products, and incentivizing lowering production amounts too more reasonable levels.
Ideally we could implement socialism which would do all of this naturally, as it values quality of life and sustainability more then profits, but that would probably take too long.
Soon joe will try to ban surgery
Oh
Trump-sempai will never notice you