How to reduce greenhouse gasses and costs in the OR – Get a ‘Karin’!

Shannon Callaham, WELL AP

Sustainability Project Manager

This is a story about reducing greenhouse gas emissions and costs in the operating room (OR) and the power of a particularly inspirational champion…

Meet Dr. Karin Zuegge, my dear friend and former colleague. She is a practicing physician anesthesiologist at the University of Wisconsin School of Medicine and Public Health. We met while I was leading sustainability at the University of Wisconsin Health system.

I’ll never forget the first time she came into my office. She explained her efforts to reduce disposable supply waste in the OR by tracking opened and unused items and educating staff about the environmental and financial impact of this waste. And, she cleverly did so in an engaging format – similar to a gameshow, she offered fabulous prizes for correct answers. (Karin  and I replicated this experience during our CleanMed talk in May this year).

We quickly became co-conspirators, performing trash audits and measuring our waste streams, improving our waste infrastructure and signage, and giving talks to departments and units across the hospital. We even traveled to Sweden together for a healthcare sustainability trip, talking about our engagement efforts.

I told Karin about the network of green teams I had been developing, and she quickly formed a multidisciplinary perioperative green team. They met quarterly at the local watering hole to talk about aspirations, challenges, and strategies for improving our environmental impact in the OR. One strategy involved reviewing the global warming potential (GWP) of anesthetic agents. Bottom line — desflurane has a far higher GWP than sevoflurane and isoflurane. We sought to educate anesthesia providers about this, in hopes that we could influence volatile agent choice and reduce our footprint.

In addition to the educational talks, Karin made continuous efforts to engage her colleagues in conversation about this choice and its impact. She worked with a graphic designer to create vaporizer labels to deploy at the point of decision-making; the less polluting gas had an image of blue skies and green trees, while the more polluting gas had an image of a dark smoky sky. The labels also contained quick response codes, scannable for more background information.

Anesthetic agent purchasing trends were tracked over time and revealed a 64% per case reduction in greenhouse gas emissions over the study period, as well as $25,000 estimated cost savings per month.

Some of the best lessons I have learned from Karin are:

  1. To not let perfect prevent progress (we could spend hours trying to craft the perfect waste signage, but ultimately we have to produce something and start getting feedback),
  2. To engage the naysayers (if someone gives you negative feedback, it means they care enough to give feedback – ask them how to make it better!),
  3. And to be persistent (if we stop giving talks, sending reminders, and doing the hard work of continuous improvement, things slide right back into business as usual).

Karin continue to plays a pivotal role as a physician champion for sustainability. She’s now officially UW Health’s Medical Director of Sustainability. Every healthcare organization needs a Karin. She challenges her colleagues to think further up and downstream to find improvements in the shared processes that lead to excellent patient care. The impact of her work is evident in the financial savings, changed attitudes, and full recycling bins. Her mission to implement greener practices has spread far beyond the perioperative environment in which she works. I am grateful to be her friend and co-author.

Learn about the Inhaled Anesthetic 2020 Challenge here, and reach out to me at [email protected] to talk about your challenges in sustainability engagement, greening the OR, and waste reduction.  


Adam Sachs, PE

Associate, Mechanical Engineer

Amy Pitts, MBA, BSN, RN

Medical Equipment Project Manager

Andy Neathery

Technology BIM Specialist

Angela Howell, BSN, RN

Senior Associate, Medical Equipment Project Manager

Anjali Wale, PE, LEED AP

Associate Principal, Senior Electrical Engineer

Austin Barolin, PE, CEM, LEED AP O&M

Senior Associate, Senior Energy Analyst

Beth Bell

Principal, Chief Financial Officer

Bilal Malik

Associate, Senior Electrical Designer

Brennan Schumacher, LEED AP

Associate Principal, Lighting Design Studio Leader

Brian Hageman, LEED AP

Associate Principal, Plumbing Discipline Lead

Brian Hans, PE, LEED AP

Associate Principal, Senior Mechanical Engineer

Brian J. Lottis, LEED AP BD+C

Associate, Senior Mechanical Designer

Brianne Copes, PE, LEED AP

Senior Associate, Mechanical Engineer

Bryen Sackenheim

Principal, Technology Practice Leader

Carolyn Carey

Medical Equipment Project Manager

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