Nick Dalesio, director of pediatric anesthesia clinical operations, is on a mission “to significantly reduce the environmental impact of waste that’s coming from the operating rooms at Johns Hopkins Children’s Center,” he says, noting that waste generated by ORs constitutes 20–33% of hospital refuse.

He has undertaken several initiatives, including recycling foam pads used to position pediatric patients for surgery. In a one-month pilot, his group collected 50 pounds of foam — enough to fill two giant tipster bins. The waste is being sent to a company that turns the foam into carpet padding.

He’s also leading efforts to embrace more reusable products, including reusable gel-filled rings to position patients’ heads during surgery, which can be sanitized and better maintain their shape than foam. And he’s launched a one-year trial to recycle the handles and blades of laryngoscopes, used to insert breathing tubes. So far, his team has shipped out seven full bins of the parts. “Each bin weighs about 50 pounds,” Dalesio says. “It’s a lot of weight of metal and batteries that are getting diverted from our regular waste into recycling.”

In the anesthesia realm, Dalesio joined an international consortium of pediatric hospitals, Project SPRUCE, that aims to achieve a 50% or greater reduction in emissions from anesthetic gases while ensuring, he says, “that patient safety is not sacrificed.”

As part of that effort, he removed the general anesthetic desflurane (which has a significantly higher — 2,450 times — global warming potential than carbon dioxide) from the pediatric ORs at the Children’s Center, the Johns Hopkins Outpatient Center and the Ambulatory Surgery Center at Green Spring Station.

He also is promoting more judicious use of nitrous oxide, which remains in the atmosphere for more than 100 years. By altering settings in anesthesia vaporizers to lower fresh gas flow and instituting an alert 15 minutes after starting anesthesia to remind clinicians to continue that practice, he’s found anesthesiologists are reducing the use and waste of these agents.

To achieve further environmental impact, Dalesio is aiming to abandon central pipes supplying the gas in favor of self-contained tanks that avoid pressure release into the atmosphere.