In 2009, the Journal of the American Medical Association published a report showing that the American healthcare sector accounts for nearly one-tenth of the country’s carbon dioxide emissions, the largest contributor to global climate change of any industry sector. According to Practice Greenhealth’s Greening the Operating Room Initiative, the operating room generates approximately 42 percent of a hospital’s revenue—but it’s also responsible for between 20 and 30 percent of a facility’s total waste. Thanks to required air exchanges, detailed lighting and equipment needs, and a cool environment necessary for surgeons, the OR is a significant contributor to a facility’s environmental footprint and, consequently, is an area ripe for improvement.

At Providence St. Peter Hospital, a 340-bed facility in Olympia, Wash., Geoff Glass, director of facility and technology services, and Keith Edgerton, construction services and sustainability coordinator, work together to find new ways to improve the environmental performance of their hospital (recognized as an Energy Star Partner of the Year in both 2004 and 2007), focusing on strategies for cutting energy and water use, and reducing waste. They shared some of their tips for creating a healthier operating room.

Air systems
Providence St. Peter added two operating rooms to its existing nine in 2009, and with a utility grant’s support of $52,000, purchased a high-efficiency, direct drive HVAC unit and added a night setback sequence of operations to the two new rooms. This means that when the operating rooms aren’t in use, the air exchanges slow down from their rate of 15 exchanges per hour. Only when individuals are sensed in the room, through infrared (movement) and ultrasonic (sound) sensors, do the air exchange controls kick back in. By using this approach, the hospital could save approximately $6,000 per year, resulting in a payback of 8.6 years.

Each operating room is also monitored for airflow, temperature, and differential pressure so that critical environments can be managed continuously. The two operating rooms were designed with re-circulating air systems that minimize the use of outside air, saving additional energy. The decision to use recirculating air systems in a surgical environment was made once the hospital’s infection control committee signed off and after a search of evidence of infection control issues turned up no reasons for concern. Also, Washington state construction regulations don’t require 100 percent outside air systems and the recommendation (from a code, energy, and system-sizing perspective) was for this approach.

Finally, air diffusion systems allow for effective ventilation air mixing to prevent air stratification in the operating room and permit the discharge air temperature to be maximized for minimum reheat. For example, the hospital is able to deliver operating room temperatures of 64 degrees with a discharge air temperature from the central fan of 60 degrees. The initiative was so successful that it’s now being proposed for the remaining nine ORs.

A combination of fluorescent and LED lighting was used in the ORs at Providence St. Peter, for both flat panel and spot lighting, to improve energy performance. Each light has a 10-year lifespan and very low maintenance requirements. While hospitals cannot eliminate mercury altogether, recycling these low-mercury bulbs is the best choice available. Installation of lighting occupancy sensors was approved for more than 20 rooms in the surgery department along with the trial of occupancy sensors in two ORs. The hospital also uses natural daylighting wherever possible to help reduce the need for lighting. For example, the Providence St. Peter design team included daylighting in the corridor outside of the OR suites and used skylights in the sterile core. When a bank of large windows on a west-facing wall resulted in issues with sunlight deteriorating sterile supplies, a clear window film was added to knock down the UV light entry by 85 to 90 percent without eliminating the natural light. Also trialed was a flexible tube system with a mirrored finish on the inside that curves up onto the roof and brings daylight into interior spaces in a cost-effective manner. Today, the system is a standard used to add daylighting to new projects across the Providence St. Peter campus.

For the ORs, Glass and Edgerton have tried various flooring choices—including rubber and linoleum—but they found that neither has the cleanability or the durability required and that vinyl provides. Flooring is an area that will continue to be monitored for environmentally preferred products that can withstand the maintenance needs of the operating room.

Keys to success
Balancing a “can-do” spirit and quest for more savings at Providence St. Peter comes a responsibility to maintain a safe, high-quality environment for staff and patients. Glass and Edgerton say their most important lesson learned is to start small, gain experience, work out kinks, get comfortable, and only then go public. They firmly believe in a “crawl before a walk” approach.


Janet Brown is a contributing editor for Healthcare Design. She’s the director of facility engagement for Practice Greenhealth and the director of content and outreach for the Healthier Hospitals Initiative. She can be reached at