UCSF Sustainability Stories

John Eng

Greening the OR at UCSF

Healthcare centers are the second largest contributors to garbage in the United States, creating an average of 6,600 tons of waste daily and more than 4 billion tons of waste annually. Seventy percent of this waste is generated by operating rooms (ORs) and labor-delivery rooms [1].

OR waste consists mainly of recyclable materials such as paper and plastics from medical disposables including blue wrap, paper and plastic packaging, drapes, convertors, used catheters and other single-use medical equipment. It has been estimated that up to 50 percent of medical waste is paper [2]; in fact, 85 percent of this waste is similar to regular waste [3]. Today, most waste is collected perioperatively as part of the medical waste stream and steam sterilized, before joining municipal waste in landfills.

UCSF’s OR Greening Initiative started in 2006. Since then, we have identified and successfully implemented several recent programs to reduce OR waste to landfill.

A key initiative has been launching recycling in the OR. This involves harvesting as much recyclable packaging and blue wrap as possible prior to incision.  Pre-incision recyclable waste (paper, cardboard and hard plastics such as packaging and irrigation bottles) is recovered for recycling instead of being sterilized and directed to landfills. Joyce Naracio, RN and Sandy Wienholz, RD lead the way in this effort.

UCSF is also actively pursuing opportunities in the use of reprocessed single-use medical devices. Driven by the release of favorable experimental data and increasing FDA acceptance, there is growing acceptance of reprocessed single-use medical devices among clinicians to achieve waste reduction and cost benefits [4]. By working closely with a leading reprocessing service provider, UCSF currently reprocesses a variety of high margin single-use devices such as harmonic scalpels.

Part of UCSF’s waste reduction efforts include creating paperless work process solutions. Through a collaboration between a clinician and a software engineer at UCSF, CaseView was developed and implemented as an electronic operating room scheduling system at both UCSF Parnassus and Mt Zion medical centers.  Prior to CaseView, more than 40 OR roster documents 50-plus pages thick had to be printed and distributed around the hospital daily. Besides significant reduction in paper consumption, CaseView has also enabled a hassle-free, real-time platform for clinicians to access and manage facility and clinician scheduling information for each surgical case.  The team behind this effort include Joyce Narcario, RN, Dr. Kulli, and Ho Lom Lee.

UCSF also donates opened and unused medical supplies from the OR to MedShare.org, a non-profit organization that sterilizes and repackages these supplies specifically for use by third world hospitals and clinics.  In 2011, UCSF donated 6,000 pounds of medical supplies through the Remedy project with supplies collected and delivered to MedShare by medical students and lead by Sharad Jain, MD. 

These early efforts built up momentum for the work that lies ahead. UCSF, together with the other UC campuses, has committed to a goal of zero waste by 2020. To achieve this goal, UCSF will work closely with all key stakeholders, including medical device manufacturers, to develop the next-generation of green surgical solutions and practices.  UCSF’s success in environmental stewardship is a team effort that will only be realized through individual effort.

The author, John Eng, is a graduate student in the UC Berkeley/UCSF Joint Master’s Program in Translational Medicine.


[1]  Kwakye, G., Brat, G. A., Makary, M. A., (2011). Green surgical practices for health care.Archives of Surgery, 146(2), 131-136.

[2]  Profile of the Healthcare Industry, at p. 65, citing Health Care Without Harm’s “Setting Healthcare’sEnvironmental Agenda” Waste Management White Paper.

[3]  Health Care Without Harm.Global Green and Healthy Hospitals. 2011. http://www.noharm.org/lib/downloads/building/GGHHA.pdf.

[4]  Kwakye G, Pronovost PJ, Makary MA. Commentary: A call to go green in health care by reprocessing medical equipment. Acad Med. 2010;85:398–400.