If hospitals nationwide worked to reduce their energy use, waste and surgical supply inefficiencies, total healthcare savings would total $15 billion over the next decade, according to collaborative research supported by the Healthier Hospitals Initiative and Health Care Without Harm.

Operating rooms are large consumers of energy and waste management resources and account for 33% of all hospital supply costs, say the researchers. In their study, hospitals that sent single-use devices out for certified reprocessing and bought them back at a fraction of the price of new saved $12 per procedure, not including the resulting waste disposal savings. Extrapolated over 5 years and across all hospitals in the United States, those per-case savings would total $2.7 billion, according to the study.

The researchers also identified custom supply packs as sources of significant waste, as well as opportunities for substantial savings. Hospitals that asked suppliers to remove routinely unused supplies from packs saved $4.33 per procedure. If all hospitals reformulated their custom packs, say the researchers, savings would top $1 billion over 5 years.

In addition, the study stressed the importance of recycling, segregating non-infectious trash from medical waste and energy-reducing strategies such as lighting upgrades, installing occupancy sensors in public areas and lowering OR ambient temperatures.

"This research turns on its head the belief that introducing environmental sustainability measures increases operating costs," says Blair Sadler, JD, senior fellow at the Institute for Healthcare Improvement, one of the study's authors and the former CEO of Rady Children's Hospital in San Diego, Calif. "With little or no capital investments, significant operating savings can be realized."

Daniel Cook

An audio therapy known as binaural beats can significantly reduce patients' anxiety during cataract surgery, according to a study by Thai researchers presented at the 116th Annual Meeting of the American Academy of Ophthalmology, jointly conducted this year with the Asia-Pacific Academy of Ophthalmology.

Binaural beat audio therapy consists of 2 tones, each pitched at a specific, slightly different frequency, and delivered to a separate ear via headphones. The technique evokes alpha-frequency brainwaves, which are linked with relaxation and reduced perception of fear and pain. The study's researchers combined binaural beats with soothing music and nature "soundscapes" (such as ocean and forest sounds).

The study was conducted using 3 groups, each consisting of 47 patients, matched for age, gender, cataract type, and other health factors. The binaural-music patients had less anxiety, slower heart rates and significantly reduced systolic blood pressures. The music-only patients saw an improvement only in blood pressure. The third group of patients heard the usual sounds of the surgical suite. Researchers measured patients' heart rates and blood pressures pre- and post-op, and assessed all patients before and after surgery using the State-Trait Anxiety scale for diagnosing anxiety.

Stephanie Wasek

When it's thought about at all, ultrasound transmission gel is generally seen as a benign and harmless substance, if a bit messy (and cold on patients' skins). Under some circumstances, however, it may be an overlooked source of surgical site infections. A team of Michigan epidemiologists has drafted guidelines aiming to prevent such risks.

The researchers pursued the issue after witnessing a gel-triggered outbreak at the Beaumont Health System and discovering that little guidance had previously been published.

In December 2011, the health system's infection control surveillance efforts detected a cluster of Pseudomonas aeruginosa in the cardiovascular surgery ICU. The outbreak was linked to ultrasound gel used in intraoperative transesophageal echocardiography, which had been contaminated during its manufacture (and resulted in a national recall).

While ultrasound gel contains substances that inhibit bacterial growth, the researchers note, it is not an antimicrobial substance and could transmit bacteria to patients. They recommend taking the following precautions:

Who in your facility has final authority to approve a patient for a case or cancel that case? Is it the surgeon, anesthesia, medical director or administrator? Tell us in Outpatient Surgery Magazine's InstaPoll.

"Ambulatory surgery" best describes what you do, according to 61% of the 460 respondents to last week's poll question. Coming in second with 27% of the vote was "outpatient surgery," followed by "same-day surgery" (10%) and "day surgery" (2%).

Dan O'Connor