MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- For the third year in a row Madigan proved itself a green leader by winning the Practice Greenhealth Emerald Award. Kerry Turner, environmental protection specialist with Madigan's Environmental Health Service, attended the Environmental Excellence Awards Gala at the CleanMed national conference May 9 in Nashville, Tennessee.

Practice Greenhealth is a membership organization that supports environmentally sustainable solutions in health care. It has a membership of 1,100 U.S. hospitals to include all Army military treatment facilities.

"The Greenhealth Emerald Award recognizes outstanding hospitals from around the nation. This competitive award recognizes the top 20 percent of applicants and is focused on advanced environmental sustainability programs and exemplary scores in a range of categories," said Turner.

In addition to the Emerald Award, Madigan again won the Greening the Operating Room Recognition that, according to the Practice Greenhealth website, "recognizes hospitals that have made substantial strides in improving environmental performance in the operating room." It goes on to explain that all awards, "honor hospitals and health systems that are building sustainability into their mission and their operations."

The application for the awards is substantial. All online, it includes tabs for topics covering recycling and all forms of waste; chemical use; water and energy use; food use, waste and environmental impact; and others. Each tab has pages of questions and requests for data.

A lone sampling of this information displays the number of items recycled in some fashion, whether in comingled bins or through another process, is 19. Recycling efforts alone saved 802 tons of waste from going into the landfill in 2018 and returned a rebate of $78,815.

That example reveals that implementing environmentally sustainable processes often produces more than one benefit.

The OR also offers many such examples.

The OR performs 9,338 procedures per year and produces 20 to 25 percent of all of the hospital's waste.

"Any time we can save, the OR is one of our big places that we want to turn to," Turner said.

"For us here, we go through a lot of supplies," acknowledged Maj. Kelly Shamlian, a registered nurse and clinical nurse officer-in-charge of the OR who purchases supplies. "We are using all kinds of supplies for the patients during the surgeries."

The team in the OR works constantly to find ways to reduce, reuse and recycle. Working in tandem with the Logistics Division for purchasing support and through a Department of Defense contract with an international company, they have been able to swap many of their single use items for ones that can be reprocessed.

Shamlian detailed a long list of items that have been purchased as single-use disposable items previously and are now reprocessed. Everything from leggings used for decompression to avert blood clots to instruments used in laparoscopic surgery finds a place on that list.

"We can buy them back sometimes for half the cost of what it would have been from an original and they're FDA (Federal Drug Administration) approved. They go through all their requirements, the same testing that you would for the initial first use of that single use item. It's all exactly the same, the only difference is it's been reprocessed. It comes packaged the same," said Shamlian.

"If we get the opportunity to purchase back some of those things, then we're saving in two ways. We're reducing what that waste would be but then we're also reducing the cost for the hospital to purchase new supplies," added Shamlian.

These efforts diverted 6,196 pounds of material from going into the waste stream and saved $41,684 in the process last year alone.

Many of the sustainability efforts are ongoing, but one that was an initiative this last year for the OR now has the interest of other sections around the hospital to include the Emergency Department and Laboratory.

The OR team replaced the cloth curtains that enclose beds in the pre-operative area with "clean in place" curtains.

"The big thing about it is that we can wipe them down instead of having the regular curtains where if they get dirty you have to wash them," said Maj. Sean Shamlian, also a registered nurse who is the interim officer-in-charge in the OR and has been involved in recent green initiatives.

Sometimes benefits beyond environmental and fiscal ones are realized in these efforts.

For example, in addition to resource savings, the new ones provide more comfort for the patients. "They are vinyl and thicker so they work for privacy as well. It's kind of a win-win on all counts of it," (Kelly) Shamlian said.

While the OR is an obvious area to make environmental improvements, some problems can hide in plain sight. Take phenols, for example.

Phenols, like bisphenol A (BPA), are organic compounds that are weakly acidic and both corrosive and toxic in nature. They are used in cleaners, as preservatives and in the production of plastic containers. In thermal paper, like that used for cash register receipts, they act as a photographic developer, producing an ink-free image when heated. According to the Centers for Disease Control and Prevention, some animal studies suggest phenol exposure can negatively affect hormones in the body.

While the amount of exposure a customer gets to phenols in the register receipt may be negligible, the cashiers' skin gets full time daily exposure.

This past year, the EHS worked in tandem with the Nutrition Care Division to replace the paper in the cash registers in the Madigan Grille dining facility with a phenol-free variety.

This year, Madigan came very close to receiving the Top 25 Award, which it won in 2014. Both Turner and Mike Kyser, supervisory environmental protection specialist and a Madigan's Green Team co-chair, speak of the top echelon of recognition with some reverence. Clearly, the pinnacle is the goal. With a full plate of new and ongoing initiatives for next year, to include reusable takeout containers for the dining facility and a hospital-wide replacement of fluorescent lights with LED ones, Madigan's prospects are looking good.