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E. Blair Holladay, PhD, MASCP, SCT(ASCP)CM
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As initiatives to reduce carbon footprints gain momentum, the laboratory can play a key role in reducing waste and seeking sustainability. But the process can feel daunting if you’re new to green initiatives. So how do you even get started? The key is starting small, demonstrating proof of concept and financial savings, and then moving forward by adding more green initiatives once you’ve shown viability.
Critical Values spoke with Ilyssa O. Gordon, MD, PhD, Medical Director of Sustainability at the Cleveland Clinic and Associate Professor of Pathology at Cleveland Clinic’s Robert J. Tomsich Pathology & Laboratory Medicine Institute; Cary Chisholm, MD, Dermatopathologist, Laboratory Director, and Market Medical Director at Epiphany Dermatology; and Raeshun Glover, MD (PGY-3), at Vanderbilt University Medical Center’s Department of Pathology, Microbiology & Immunology, about how laboratories can be emergent leaders in green initiatives.
Because laboratories consume a great deal of energy and disposable consumables, they can play an integral role in leading a green initiative, Dr. Gordon says. To figure out where to start, begin simply by reviewing your laboratory’s unique situation.
“Start with what interests you,” Dr. Gordon suggests. “You know your workplace best and what changes are feasible. Then show the financial savings. There may be an up-front investment, but typically implementing green laboratory strategies will save money.”
Often, recycling is the easiest place to start.
In fact, Dr. Glover and his colleagues created a system for determining which of a laboratory’s assays or processes have the best recycling potential, and they tested it on comprehensive metabolic panels (CMPs).1 He suggests the following steps:
First, look at all the disposables involved in the process you’re investigating, such as reagent wedge kits, shipping packaging, and blood specimen tubes.
Look up each item’s universal recycling code (the triangular-shaped arrows with a number in the center). “These are government-mandated identifiers that let you know how a product can be recycled, if you look up the reference number,” Dr. Glover says.
If the product is contaminated with biohazardous waste, consider it non-recyclable.
From there, you can determine how much of a laboratory process can be recycled. With these steps, Dr. Glover’s laboratory found that 21.4 percent of the CMP waste he studied is recyclable.
Still not sure where to begin? Below are six concrete methods that laboratory professionals can choose from for starting their own green initiatives.
1. Formalin recycling
A good place to start is with something easy to implement with a low-cost proof of concept, suggests Dr. Chisholm, who co-authored a paper about his laboratory’s methods.2
“Take stock of what reagents you use that can be recycled,” he says. “In the anatomic laboratory setting, that’s predominantly going to be formalin, 100 percent alcohol, and xylene.”
His independent dermatology pathology laboratory was getting hundreds of formalin bottles every morning, so it was the logical start. As an added bonus, recycling 10 percent formalin didn’t require any mechanical parts that were expensive or could break.
“It’s essentially just a giant column of powdered carbon with some filters to collect any debris,” Dr. Chisholm says. “[Professionals] come in and build the column of carbon for you and get everything set up. We went from buying formalin to never buying formalin.”
Creative Waste Solutions manufactured his laboratory’s recycler. In the end, they were able to eliminate the need to buy 10 percent formalin.
2. Plastic bottle recycling
Another easy starting point is plastic recycling. After recycling formalin, Dr. Chisholm realized they had numerous empty specimen bottles that were being treated as biohazardous waste.
“I looked into state law in Texas about what qualifies as biohazard waste,” Dr. Chisholm explains. “For Texas, it’s 100 mL of gross blood in a container. For a derm path lab, it’s very rare that we’re going to have that much blood or tissue. So that really opened the door for us.”
They shred the plastic bottles so there are no barcodes or identifiable names (to comply with HIPAA) using an inexpensive plastic shredder.
“We don’t pay for biohazard trash except for a few things,” he says. “And we shred our biohazard bags as well.”
3. Xylene and alcohol recycling
Another low-hanging fruit for recycling is xylene and alcohol recycling, Dr. Chisholm says. The recycling platform is more expensive than formalin, so a laboratory might start with formalin first as proof of concept. Over time, their xylene and alcohol recycling has paid off too.
“When you recycle xylene, you don’t get 100 percent of your volume back,” he explains. “You do have to still buy a very small amount. But the majority we don’t have to buy. And in the last year or two, there have been big shortages on xylene, and we haven’t even noticed it.”
They also recycle their 100 percent alcohol into 97 percent alcohol, which has wholly replaced all the 95 percent alcohol they used to buy.
4. Solar panels
Dr. Chisholm’s laboratory is in the final stages of getting solar panels installed. While this is a more expensive investment than recycling, it can also pay off.
“We should essentially be off the grid as far as electricity goes,” Dr. Chisholm says. “That’s really good because here in Texas, I think the state’s inability to be prepared for winter is pretty well documented. We have a backup generator, which is great. But if it’s broken, you’re getting no benefit from having it. This is one extra level of protection from power outages.”
While this might not be vital for hospital laboratories who have power redundancies, it can be huge for independent laboratories.
5. Switch to new lights and motion-detector sensors
If you have a smaller budget for green changes, try something simpler, like transitioning to motion-detecting light switches.
“Change your light switches to motion detecting so they automatically turn off if there’s no one there,” Dr. Chisholm suggests. “You’re talking maybe $20 per plug or switch, and you know your lights are never going to be on unnecessarily.”
Switching out fluorescent lights for LED lights can also help.
“Your electricity usage will go way down,” Dr. Chisholm advises.
6. Recycle cardboard
Recycling cardboard can also be an easy way to get started.
“There’s a lot of cardboard that’s generated as part of a laboratory,” Dr. Chisholm says. “Don’t take it to a regular dumpster. Recycle the cardboard.”
Sometimes a simple change like that can be the fastest and surest way to start down a green initiative path, Dr. Glover adds.
“Just offering a recycling receptacle and changing the way you dispose of things can be simple,” Dr. Glover says.
To get approval, start with a low-cost initiative and then prove it will save money
Sometimes a laboratory has to get approval before starting a green initiative, whether from executives or board members. New initiatives often encounter pushback, but showing how much money you’ll save can go a long way toward getting buy-in.
In Dr. Chisholm’s laboratory, they initially expected to see $43,000 in savings in 2022 from their efforts, and it ended up being a little more. And even with inflation and the current economy, they still expect to see about $50,000 in savings in 2023.
“For some labs, that frees you up to hire another full-time employee,” Dr. Chisholm explains. “If you’re cash-strapped, you can get a piece of equipment you wouldn’t have otherwise been able to get.”
And getting started can be a low-cost endeavor.
“Some of these things are pretty cheap to start up compared to most laboratory equipment,” Dr. Chisholm says. “Our formalin recycling was less than $10,000 and it allowed us to never buy formalin again.”
With a little creativity, many laboratories should be able to find a way to get the initial $10,000 they would need to start their first green initiative, Dr. Chisholm says.
Dr. Glover notes that hospitals can also get rebates for energy purchases, such as Astera Health in Minnesota receiving a $51,551 rebate for energy-saving equipment3 and Windham Hospital in Connecticut getting a $324,277 incentive check for energy upgrades.4
Once you’ve started, keep good records on the cost, including space and staff requirements. Record how much you’re saving from products you don’t need to buy anymore, and how long it will take to become budget neutral. Once you’ve proven how well this works with something small, like formalin, you might get an OK for costlier projects.
Just don’t let fear of risk stop you.
“These recyclers are good enough now that the reagents that come back out are every bit as good as the reagents you put in,” Dr. Chisholm says. “We’ve gone through CLIA inspections with this.”
And you can verify the quality yourself.
“If you recycle a batch of formalin, there are formalin kits you can use to test it,” Dr. Chisholm says. “You can also take some leftover tissue and run it with the different formalin.”
In the end, all the effort is worthwhile, since climate change is such a dire situation right now.
“A lot of industries, such as manufacturing and food service, have implemented sustainability efforts,” Dr. Glover shares. “And now the hospital is becoming an increasing contributor to the global waste burden. While some of the clinical-facing areas have implemented sustainability efforts, the laboratory is a behind-the-scenes part where sustainability efforts are just now taking off. It’s good to start decreasing our increasing waste burden.”
Dr. Gordon agrees that laboratories share a unique burden in contributing to environmental waste.
“Laboratories with all their equipment consume a lot of energy and use a lot of disposable consumables,” she says. “It’s important for all areas of healthcare facilities to take steps to contribute to greenhouse gas emission reduction and laboratories are no exception.”
European Federation of Laboratory Medicine’s Publication, Green Labs
National Academy of Medicine’s Action Collaborative on Decarbonizing the Health Sector
Glover, Raeshun T., Booth, Garrett S., and Wiencek, Joseph R. “Opportunities for Recycling in an Automated Clinical Chemistry Laboratory Produced by the Comprehensive Metabolic Panel,” American Journal of Clinical Pathology. Published April 8, 2023. Retrieved from: https://academic.oup.com/ajcp/advance-article-abstract/doi/10.1093/ajcp/aqad031/7111063?
Chisholm, Cary and Hayford, Kelvin. “Dermatopathology Laboratory Green Initiatives: Illuminating Environmental Stewardship Opportunities in an Era of Climate Change,” American Journal of Clinical Pathology. Published November 2022. Retrieved from: https://academic.oup.com/ajcp/article/158/3/372/6612919
“New Wadena Hospital Qualifies for Over $51,000 in Energy Rebates,” Wadena Pioneer Journal. Published May 26, 2023. Retrieved from: https://www.wadenapj.com/news/local/new-wadena-hospital-qualifies-for-over-51-000-in-energy-rebates
Protz, Jessica. “Windham Hospital Receives $324,277 in Energy Incentives,” ESC Controls. Published March 3, 2018. Retrieved from: https://esccontrols.com/news?id=1066272/windham-hospital-receives-324-277-in-energy-incentives