Reduce—recycle—reuse: guidelines for promoting perioperative waste management

AORN Journal,  April, 2007  by Gary Laustsen

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The inclusion of the environment as an important professional nursing domain and the promotion of holistic nursing practices provide a theoretical and ethical base upon which environmentally sustainable nursing practices can prosper. The profession is recognizing the anomalies that exist in the current, parochial understanding of the concept of environment.

   Through clinical and research efforts
   on behalf of environmental health issues,
   nurses can provide current and
   future generations with the opportunity
   for a healthy home, neighborhood,
   and planet. (1(p27))

A healthy ecosystem requires a healthy environment, and anything that alters ecosystem health also may alter the health of its inhabitants.

The professional activities and behaviors of individuals, including nurses, may influence local and global ecosystems. Nursing practices cause known and sometimes unknown effects on ecosystems. The health of an ecosystem is intertwined with human activities, and the health of humans also is intertwined with the health of an ecosystem. Considering the complex interactions between organisms and the environment may lead to alternative behaviors and actions that reduce environmental degradation. Such behaviors can become a part of both the personal and professional activities of individuals.

Many people seek to act, both personally and professionally, in more ecologically appropriate ways. Promoting environmentally responsible practices in the work setting may provide congruence between a nurse's personal desire to behave ecologically and his or her ability to work ecologically. It is important, therefore, for nurses to understand and study how their personal and professional behaviors may have positive or negative interactions with the ecosystems upon which all life depends.

As proponents and caretakers of human health, nurses should seek to participate in professional activities that minimize the negative effect on the health of local and global environments. Exploring ways in which nurses can work ecologically will provide insight into these activities and encourage nurses to reflect on their own practices.

Environmental degradation is a multifaceted problem that has ecological effects on the health of all living populations, including the human population. Richardson (2) offers some advice and examples of what could be considered ecologically friendly nursing practices. He refers to these behaviors as "green nursing." Melamed (3) elaborates on ways perioperative nurses can contribute to pollution prevention in the health care setting. Green nursing practices may reduce the negative effects that nursing activities have on the environment without altering the quality of patient care.

A challenge for the nursing profession is to translate a concern for global ecosystems and general ecological beliefs into professional practice activities. Developing ecological behaviors in the nurse's professional environment can

* improve local and global environments,

* decrease the amount and cost of waste disposal, and

* reduce potential human and environmental health threats.

Ultimately, such ecological activities will help promote a more sustainable human ecosystem. Green nursing practices also can be promoted through improved management of materials in the hospital perioperative setting.

HISTORICAL AND LITERATURE REVIEW

Excessive waste in health care settings has developed into a significant problem during the past 30 years. Concern about the spread of bloodborne diseases (eg, HIV, hepatitis B) and public exposures to inappropriately disposed medical waste has led to increased regulation. (4) Concurrently, there has been an increase in the production of disposable medical supplies. (5)

Large health care facilities, such as hospitals, historically used incinerators to dispose of medical waste. Many products used in health care settings contain polyvinyl chloride, which, when incinerated, can result in the release of dioxin, a known carcinogen, into the environment. The US Environmental Protection Agency (EPA) at one time considered dioxin from incinerated medical waste to be the second largest source of this known carcinogen. (6) Medical waste incineration also is responsible for the release of mercury into the environment. Mercury, when converted to methyl mercury, can enter and ascend the food chain, becoming concentrated in fish. Ingestion of mercury-laden fish is a health concern, especially for pregnant women and young children. The problems of medical waste incineration, improper waste disposal, and general environmental degradation and the effects of these issues on human health eventually were recognized. Organizations such as the EPA, American Nurses Association, Health Care Without Harm (HCWH), and Hospitals for a Healthy Environment (H2E) have looked for ways to reduce the negative effects of health care practices on the environment.

Both HCWH and H2E are organizations that were established to promote responsible health care activities that positively affect environmental health. Health Care Without Harm seeks to