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Diversion rate measures the percentage of total waste diverted from landfill or incineration through recycling, composting, or other recovery methods.
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Recycling rate measures the percentage of waste specifically sent for recycling, excluding other diversion methods like composting or energy recovery.
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Main Operating Room (MOR)
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Ambulatory Surgery Center (ASC)
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Cath-Angio Lab (Cath-Angio)
| Department | MOR | ASC | Cath-Angio |
|---|---|---|---|
| Clinical Work Overview | MOR specializes in adult surgical procedures including Cardiac, Thoracic, Vascular, Neurosurgery, Orthopedics, Otolaryngology, Head and Neck, Plastics, General, Gynecology, Urology, Transplants, and Robotics. |
Ambulatory Surgery Center (ASC) performs adult and pediatric outpatient and inpatient procedures, including General, Head and Neck, Orthopedics, Gynecology, Plastics, Otolaryngology, Urology, Neurology, Ophthalmic Plastic Surgeries and Pain Clinic procedures. ASC also assists patients with Electroconvulsive Therapy |
The Cath-‐Angio Lab specializes in adult and pediatric Interventional Cardiology, Electrophysiology, Neuroradiology, and Interventional Radiology procedures. |
| Number of Suites | 21 | 12 | 14 |
| Total Cases / Year | 12,980 | 9,140 | 11,140 |
| Total Projected Waste Diversion Rate (%) |
23% | 11% | 15% |
| Projected Plastics Diversion Rate (%) |
18% | 9% | 12% |
| Most Commonly Recycled Item |
Blue Wrap | Blue Wrap | Film Plastic and Tyvek® |
Recyclable Material Generation in Procedural
Areas
As noted in the following chart, plastics accounts
for almost 80% of the recyclable materials
generated in procedural areas, with Blue Wrap
accounting for the greatest volume by weight.
Film and rigid plastics account for 20% of plastics
each, attributed to rigid trays and film plastic
sterile pouches. The small representation of Tyvek®
in the recyclables profile reflects the material’s
light weight, and underrepresents the prevalence
of Tyvek® in procedural supply film and rigid
plastic peel packs. Recyclable paper generated
in procedural areas includes paper backing,
supply boxes, and booklets. Below, we expand on
procedural area recyclables by material type, listed
by weight.
Blue Wrap: 36% of total recyclables. Projected annual diversion: 34 tons.
Blue Wrap, the dense, polypropylene, sterile wrap generated primarily in surgical suites, is easily captured
as sterile kits are opened during case setup. At an average of three pounds per procedure, Stanford
Hospital & Clinics’ Main Operating Room generates nearly 30 tons of Blue Wrap annually. The ubiquity of
this large volume, single material plastic in hospital waste streams
nationwide presents a steady source of valuable recyclables.
Opportunities for Blue Wrap recycling, however, have historically
been limited. Stanford Hospital & Clinics’ contracted recycler,
Greenwaste, collects Blue Wrap as part of the service provided to
the hospital, but passes the material along to a specialty film plastics
recycler. Blue Wrap is collected at point of generation in a separate
bag for easy retrieval by Greenwaste. While Stanford Hospital
& Clinics works to effectively collect and recycle Blue Wrap, the
institution has also minimized Blue Wrap use through a source waste
reduction initiative.
The Stanford Hospital & Clinics’ Blue Wrap management strategy follows the progression of sustainable
waste management protocol: reduce, reuse, and then recycle. This strategy includes use of durable
stainless steel hard cases to house sterile surgical kits whenever possible. 60% of all surgical kits use hard
cases, reserving Blue Wrap for kits containing delicate tools that require delicate encasement, and in
heavy kits that would pose a lifting hazard for sterile processing and procedural area staff when housed
in a heavy stainless steel case.
Paper: 22% of total recyclables. Projected annual diversion: 18 tons.
Recyclable paper in procedural areas includes surgical grade paper backing from peel packs,
supply insert instruction manuals, and supply boxes. These materials are easily collected and processed.
Film Plastics: 21% of total recyclables. Projected annual diversion: 17 tons.
The large volume of individually wrapped, sterile
supplies used during procedures drive the film
plastic clinical recycling profile. Film plastics were
categorized in the study as vent or header bags,
chevron or 3D formed cavity peel packs, linear tear
bags, and other film plastics. Procedural area film
plastics by category follow.
Vent Bags and Header Bags
Vent bags are large, dense film plastic tear bags with a
Tyvek® breather patch, commonly used as outer packaging of sterile
surgical packs. While only two to three of these bags are generated
during each case setup, vent bags represent 35% of procedural area
film plastics by weight. These bags are easily collected during sterile
field setup for recycling. Similar to vent bags, header bags feature a film plastic body, sealed with a Tyvek®header strip. A relatively small number
of header bags were assessed in the procedural area setting, as packaging
for sterile supplies.
Chevron and 3D-Formed Cavity Peel Packs
Film plastic peel packs are sterile supply pouches with film plastic, surgical
grade paper or Tyvek® backing. Individually packaged sterile supplies are
largely contained in film plastic peel packs. During analysis of film plastics,
these sterile packaging materials were further categorized as ‘chevron
peel pack’ and ‘3D-‐formed cavity’ packaging. While chevron peel packs
comprise 25% of film plastic
packaging by weight, it should be noted that film plastic
peel packs were separated into their disparate parts during
analysis (i.e.: film plastic was separated from the Tyvek® or
paper backing, and weighed by individual material type).
While there were a limited selection of film/film plastic peel
packs, most peel packs are one half Tyvek® or paper.
3D-formed cavity peel packs are denser by design, as
film plastic is molded in the shape of the sterile supply it
encases. The Stanford Hospital & Clinics waste analysis found a variety of flexible plastic formed cavity
material, Tyvek® and paper peel packs. While 3D-formed cavity packaging represents a relatively smaller
number of film plastic peel packs, Stanford Hospital & Clinics’ three
procedural areas will divert approximately three tons of these
items in the next year
This brings up a decision point in waste management protocol. We
know that a large number of film plastics generated in the clinical
setting are peel packs being opened during the rapid and efficient
process of sterile field setup in procedural areas. Separation of
peel packs into disparate parts (i.e.: Tyvek®, film plastic, paper)
may produce a higher value material on the recyclables market.
However, peel pack separation adds unwelcome complexity to
the clinical waste management process at point of generation.
Stanford Hospital & Clinics worked extensively with Greenwaste
to establish a film plastic peel pack collection program that was feasible for both parties. This work
is highlighted under ‘process recommendations’ in this
document.
Linear Tear Bags
Linear tear bags are film plastic bags with a notched opening
along the side. This packaging type varies in size and density
in procedural areas, from the thin film plastic sleeves covering
non-sterile products to the dense HDPE packaging of IV
solution bags, to large tear bag over-wrap on sterile kits.
These items are easily collected, easily processed, and free of
contamination.
Other Film Plastics
The remainder of film plastics includes ‘zip‐lock’ bags that carry medication deliveries from pharmacy,
film over-wrap, unused sterile equipment covers, and film backing from adhesive pads. Again, these
plastics are easily sorted into commingled recycling. This collection of various film plastics does comprise
8% of the film plastic recyclables by weight in procedural areas.
Rigid Plastics: 19% of total recyclables.
Projected annual diversion: 16 tons.
Rigid plastics in procedural areas make up the
inner trays of sterile packs, rigid peel packs
and sterile water bottles. While this category
represents one-fifth the weight of procedural
area recyclables, these dense materials represent
a smaller number of packaging materials than
film plastics. For our analysis, we categorized
rigid plastics as follows: opaque (including white
and dye-colored plastics), blue tint (PET), bottles,
corrugated and other.
Opaque Rigid Plastics
This broad category of plastics includes opaque, or dye-‐colored,
caps, lids and trays, accounting for almost one half of rigid plastics by
weight. The high diversion rate, however, is attributed to one particular
recyclable product in procedural areas. Weighing 0.4 lbs. each, light
blue rigid plastic (polypropylene, #5) trays form the base of sterile
packs commonly used in Cath-Angio, as well as other procedural areas.
Cath-Angio alone will divert more than 3 tons of opaque rigid plastics
over the next year, primarily due to recycled sterile blue trays.
Opaque Rigid Plastics
This broad category of plastics includes opaque, or dye-‐colored,
caps, lids and trays, accounting for almost one half of rigid plastics by
weight. The high diversion rate, however, is attributed to one particular
recyclable product in procedural areas. Weighing 0.4 lbs. each, light
blue rigid plastic (polypropylene, #5) trays form the base of sterile
packs commonly used in Cath-Angio, as well as other procedural areas.
Cath-Angio alone will divert more than 3 tons of opaque rigid plastics
over the next year, primarily due to recycled sterile blue trays.
Blue Tint
Rigid PET packaging was identified by label (#1, PET), or by visual
identification as a clear rigid material with characteristic blue tint.
These materials were present throughout all three procedural areas
as protective rigid product trays. PET trays are found in rigid peel
packs (these are a common packaging item for sterile orthopedic
surgical supplies), requiring processing at point of generation, as
clinicians must separate Tyvek® or paper backing from packaging.
The relatively small number of Blue Tint (PET) Rigid Plastic these
peel packs as well as the sturdy frame of rigid packaging makes this
process much easier compared with separation of film plastic peel
packs.
Bottles
An average of one to two, one-liter bottles of sterile water are used per surgical procedure.
Bottles are easily sorted into the recycling bag at case end. Stanford Hospital & Clinics keeps other
recyclables clean and dry by emptying bottles of fluid or replacing the bottle cap before recycling.
Corrugated and Other Rigid Plastics
Few packaging materials in the study feature corrugated plastics. The material registered at 1% of total
rigid plastics due to density versus prevalence. ‘Other Plastics’ largely represents clear or translucent rigid
plastic trays, holding single use disposable supplies in surgical areas, including rigid inner trays and peel
packs.
Tyvek®: 2% of total recyclables. Projected annual diversion: 2 tons.
Tyvek® is a lightweight plastic barrier made from high-density
polyethylene fibers, commonly used in medical packaging. Its
durability, light weight, and moisture barrier properties make it an
important part of the medical supply packaging profile. The Stanford
Hospital & Clinics’ Cath-Angio department primarily uses supplies
packaged in Tyvek®/film plastic peel packs. While the material is an
ever-present part of the clinical recycling stream, it represents just 2%
of procedural area recyclables by weight.
Foil: 2% of total recyclables. Projected annual diversion: 2 tons.
Foil is featured primarily as suture packaging in procedural areas. The small
volume of foil packaging generated is easily sorted and processed.
