SUSTAINABILITY CERTIFICATION EXECUTIVE SUMMARY: 

AMBULATORY SURGICAL CENTERS

INTRODUCTION:

The healthcare sector serves as society's essential foundation for health and well-being, yet it simultaneously emerges as a major driver of environmental harm through its substantial energy demands, massive waste production, complex global supply networks, and extensive chemical usage.

Ambulatory Surgery Centers (ASC’s) have a unique opportunity to adopt environmentally responsible practices and improve operational efficiency while benefiting from significant financial savings. Accreditation organizations recognize the importance of these goals and their role in guiding ASC’s through a sustainability certification process utilizing a tiered structure to meet ASC’s where they are in their sustainability journey. A detailed introduction to the tiered structure and point system is described in this expanded Introduction to the GreenCare ASC Certification Program.

The condensed summary below lists options that ASC’s can choose from to work toward a sustainability certification. Links in title connect to more specific actions and details of financial savings, including the tiered approach toward certification.

CORE KEY PERFORMANCE AREAS

Energy Management:

  • Turning off equipment: Encouraging staff to power down lights, equipment, and other electrical/vacuum devices when not in use can reduce energy consumption.
  • Optimizing temperature and ventilation: Adjusting temperature and ventilation settings to align with occupancy and usage patterns can save energy. 
  • LED lighting: LED lighting is energy efficient.
  • Financial savings: Reduced energy usage translates to cost savings on energy bills while powering down equipment can reduce wear and tear.

Anesthesia Gas Management:

  • Switch to lower Global Warming Potential (GWP) gases: Desflurane has a much higher GWP, so choose sevoflurane; consider alternative therapeutics and techniques (i.e., Total IV Anesthesia, regional/local anesthetics).
  • Minimize use of nitrous oxide (NO2): Central piping systems of nitrous oxide are prone to leaks, so use only portable e-cylinders.
  • Minimize fresh gas flow rates
  • Financial savings: Sevoflurane is significantly less expensive than desflurane, which can add up to significant cost savings.

Waste Management:

  • Single-use item reduction: Reviewing preference cards and custom packs and remove/hold items not universally used; Transitioning from single-use to reusable alternatives for items like sterilization wrap, suction canisters, sharps containers, gowns, drapes, surgical instruments, patient monitoring equipment, and patient position and transfer devices when appropriate can significantly decrease landfill waste.
  • Reprocessing single-use devices (SUDS): Many SUD surgical instruments and endoscopes can be reprocessed by companies that specialize in reprocessing.
  • Proper waste segregation: Ensuring accurate separation of regulated medical waste and solid municipal waste, recyclable and non-recyclable materials minimizes contamination and maximizes waste reduction and recycling efforts.
  • Financial savings: Reusable and reprocessed items pay for themselves over time.

Sustainable Procurement and Supply Chain:

  • Purchase environmentally preferable products: Reduce the number of products with high environmental impact, including energy use, toxicity and recyclability.
  • Reduce the amount of expired product waste: Apply just-in-time ordering and work with vendors to return unused items. Track the volume and cost of expired or unused products written off, donated, or disposed of. Develop inventory management policies and practices to reduce excess inventory.
  • Packaging reduction: Explore bulk purchasing with vendors to reduce packaging. Choosing packaging that minimizes waste and is easily recyclable can also reduce the overall volume of waste generated.
  • Financial savings: Reduced waste, reduced write-offs, and bulk purchasing save money

Water Management:

  • Low-flow fixtures: Faucets, toilets, showers (if applicable) having low-flow fixtures can reduce water use by 20-50%.
  • Water efficiency: Reduce the amount of water consumed.
  • Financial Savings: Reduced water and steam  reduces both water and energy costs.

Office Sustainability 

  • Energy efficiency:  Reduced energy use curbs greenhouse gas emissions.
  • Waste reduction: Reduced waste reduces the amount going to landfill or incineration.
  • Financial Savings: Reduced operational expenses.

IMPLEMENTATION GUIDE:  

To ensure foundational commitment and a consistent, achievable approach to sustainability, ASCs pursuing GreenCare Certification can set goals to establish a structured pathway toward significant financial savings and environmental improvements. Review this Implementation Guide to establish core elements of a sustainability program.

SPECIALTY-SPECIFIC SUSTAINABILITY FRAMEWORKS

These sections provide tailored guidance for specific Ambulatory Surgery Center specialty areas, detailing how the general sustainability principles and benchmarks outlined can be applied within their unique operational contexts. Each specialty framework includes specific measures, rationales, and anticipated benefits to guide implementation.

Gastroenterology

Ophthalmology

Orthopedics

ADDITIONAL OPTIONS:

Chemical Management and Safety 

Preoperative Antibiotics Guide

Regulated Device Reprocessing

Sustainable Pharmaceutical & Inhaler Procurement

Sustainable Commuting and Transportation