In Toulouse, operating theaters are going green
Waste management, water consumption, electricity … Toulouse CHU caregivers have implemented actions to reduce the environmental impact in operating theaters. Encounter with Doctor Charlotte Martin, an anesthetist in neurosurgery and intensive care, at the origin of this initiative.
How did this idea of waste treatment in operating theaters come about?
Quite simply. One day, while I was in the operating room, I was watching the orderlies remove the garbage from the operating rooms. I realized that we did not sort the waste in the blocks: no upgrading of the plastic, of the paper industry. The cardboard was also thrown into the existing trash cans.
To give a vivid image, a surgical intervention will produce the waste of a family of 4 in one week! “
I noticed that we had two trash systems: black and yellow bags. But I couldn’t see the difference between the two. We discussed with colleagues and then we started to think about new ways to manage our waste.
How much waste do you produce per year?
Healthcare establishments produce 700,000 tonnes of waste in France, and operating theaters release 20 to 30%. To give a meaningful image, a surgical intervention will produce the waste of a family of 4 in one week!
Several companies are on this subject, in particular the French society of anesthesia-resuscitation. At our level, we have created a “green team” within the operating theater in Purpan. She then made “little sisters” in all the blocks of the Toulouse University Hospital, bringing together all the field workers: nursing assistants, nurses, health executives, doctors …
The aim of this approach was both to launch a reflection, and also to propose solutions to be put in place. We were supported by the management of the CHU, before being quickly joined by the cell sustainable development and that of waste management at the hospital.
What type of waste can be found in operating theaters?
There are two categories of waste in a hospital. The first concerned the DAOM (Waste Assimilated to Household Waste) that we find in our trash at home. This waste is in black bins and compacted before being put in waste to the inciner. the compaction is an important step because it reduces the volume of waste and therefore its transport to the incinerator.
When we started to think about the subject in 2019, the recommendations for the Toulouse University Hospital dated back over 15 years! “
The second category concerns DASRI (Waste from Healthcare Activities with Infectious Risks). These are the famous yellow bins. The waste distribution is governed by the Public Health Code. This indicates that it is up to the local authority to decide what should be put in a particular bin. In the hospital, it is the CLIN, the Committee for the Fight against Nosocomial Infections which decides which waste goes into which container.
When we started to think about this subject in 2019, the recommendations for the Toulouse University Hospital dated back over fifteen years! And they no longer corresponded to our practice at all, in particular because they recommended throwing certain waste into the IHCW while national regulations had evolved.
Why such a delay in these recommendations?
The last recommendations dated back to the AIDS era, so they were probably too cautious. We threw a lot in the IHCW while most of the waste was what we found at home. When you cut your finger at home, you use a paper towel that you then throw in the trash. At the hospital, it left in the infectious risks while not all of the patients were infected.
One tonne of DASRI produces the equivalent of one tonne of CO2 while one tonne of DAOM produces only 300 kilos, which makes a major difference between these two types of waste. “
DASRI waste is transported to the incinerator under seal, without being compacted. Transport will therefore be much more expensive, both financially and also in terms of CO2. A ton of DASRI produces the equivalent of a ton of CO2 while a ton of DAOM produces only 300 kilos, which makes a major difference between these two types of waste.
What solutions have you proposed to improve sorting and recovery?
The first step was to reflect with the CLIN teams on the relevance of the recommendations. This required a lot of work, because changing the recommendations in an institution as important as the Toulouse University Hospital does not happen overnight. However, we have succeeded in exchanging in good understanding between the people who work in the field and who have to deal with this daily waste, and those who edit these recommendations. These were changed in June 2020, after almost a thought. In the meantime, we had the COVID which made it difficult to move forward on other topics, which also explains the delay.
In the end, with the old recommendation formula, we treat almost 60% of our waste in DAOM and 40% in DASRI. Since the change, we have gone to 80% in DAOM and barely 20% in DASRI.
Is the issue of waste really necessary in the hospital sector?
I think that our action reflects the reality of waste management: it is not by only sorting that we will solve the problem. However, that does not mean that it should not be done. The quantities of waste in health facilities are extremely large. We must think about commenting on classifying them.
When you are in an operating room, you tend to over-prepare, in case you have a problem. At the CHU’s Purpan site, we saw that these devices, which we do not use, more than 50 kilograms of waste in a week. It is both costly in terms of public funding and it generates waste that we do not need. All this led to reflections on other themes and on a more global reduction, beyond just making sorting in operating theaters.
Has Toulouse University Hospital become a national example in this area?
Indeed, but we are not the only ones to subscribe to this approach. There are in particular the CHUs of Grenoble and Nantes which have set up systems in their operating theaters.
Our model is innovative in the sense that we have done everything at the same time: a new distribution of waste, a revaluation as well as work on energy performance, water and gas management. We are leading all these projects simultaneously, which is why we are at the forefront on these themes. Our specificity is also that our approach started from the ground and that it is supported by the management, which means that the measures could be put in place in less than a year, despite the health crisis.
Can this process be easily duplicated?
We started on the Purpan site, and now this project exists in all the operating theaters of the CHU. We also plan to implement it in the services of intensive care, which are also major generators of waste, but with specific constraints.
We are in the process of creating other “green teams” in these services and we hope to be able to set this up in the first quarter of 2022. It would be a national first because there is currently no such process. in intensive care units in France.
Did this project promote “team building” within the CHU?
Absolutely. This approach has done us good, especially in the midst of health crisis. On the one hand, this allows us to be able to talk about other things with colleagues, and to be able to come together around a subject that concerns everyone. Whether you are a caregiver or a doctor, the problem is the same, as is our involvement. This made it possible to put everyone on the same level, to “break” social barriers and for some to have contact with the management of the hospital when they had never had before.
By starting in the center of Purpan, the other sites saw that there were great results and also wanted to get started. There was real momentum around this project which was good for everyone.
Currently, we are also working on volatile agents. Anesthesia is a polluting activity in which we use greenhouse gas importantly in the blocks. We are also working on a project to change lights to put LEDs in operating theaters. All these avenues are discussed with all of the hospital’s departments.
An interview conducted in partnership with France Inter. Listen to the column Social laboratory here.