Reuse has long been identified as the top of the sustainability pyramid because reusing products avoids the energy and resources that otherwise would have been required to produce more of the products that were only used once.

Over time, for instance, the use of reprocessed, single-use devices has become commonplace, saving considerable environmental impact and financial resources. But we would never think of taking a pharmaceutical compound that had been used by one person, and giving it to another. Would we?

During the early days of World War II, processing capacity of penicillin for soldiers was limited, so scientists found a way to collect the urine from patients who had received penicillin, and extract the completely unchanged drug so it could be cleaned using distillation and reused. But once the capacity to manufacture penicillin grew sufficiently, the practice faded.

It's the same with the pharmaceuticals we now flush down the drain as waste or through urination, where they enter into the local water stream.

Our wastewater treatment plants are not equipped to manage the unchanged drugs that are sewered, so we rely mostly on dilution to minimize any impacts. And the problem is, minute traces of waterborne pharmaceuticals are now showing up in our fish and other aquatic life as well as in the water we drink. Imagine if someday we could recapture those drugs as we did with penicillin.

Interestingly, two new companies have developed technologies that once again allow expensive drugs to be recaptured and reused, this time in the form of exhaled anesthetic gas. When a patient undergoes surgery, more than 95 percent of the inhaled anesthesia is immediately exhaled, chemically unchanged from its original form, though now mixed with various other components from the patients' exhalation.

These companies, Blue-Zone Technologies Ltd. in Concord, Ont., Canada, and Anesthetic Gas Reclamation in Nashville, Tenn., use different technologies to collect and store the waste anesthetic. At present, both have approved technologies for collection and storage, while their purification processes are being perfected to the point that they can be Food and Drug Administration (FDA)-approved to produce gas that can be resold and reused. Today, there is no FDA process available to allow the use of reprocessed pharmaceuticals but as the technology is developed and tested, that likely will change.

Currently, most waste anesthetic gases are emitted directly to the outside air. Even though these gases are in concentrations too small to cause a direct impact to individuals, they are very potent greenhouse gases and ozone-destroyers that have been unregulated to date. Now that new technologies exist to capture anesthetic gas, waste anesthetic gases likely will not remain unregulated forever.

Today's health care environment demands innovation to reduce costs and provide equal or better care. When the day comes that we can combine the elimination of an environmental threat with the ability to significantly reduce costs by repurchasing high-quality reprocessed drugs, it will be a game changer.

By Laura Brannen, senior sustainability consultant at Mazzetti, San Francisco.


AHE insight

Valuable resources available

AHE is the membership organization of choice for a wide variety of professionals caring for the health care environment. Here are a few of the many resources that AHE offers.

• EXCHANGE 2013. Attend the industry's premier conference and trade show at the Indiana Convention Center in Indianapolis on Sept. 15–18. New ideas for this year include a poster presentation session and an educational focus. More information is available at

• Employee Engagement: Myth Busters. Examining both myth and reality, AHE's experts take professionals on a hunt for the truth to uncover what works and what doesn't in the world of employee engagement. Access this prerecorded webinar, which is free for AHE members and $139 for nonmembers, through Dec. 31. For more information, go to

• AHE Seal of Review and Recognition Program. Designed to be a comprehensive review and formalized recognition process that promotes quality and safety, this program allows a company's or organization's cleaning procedures, in-service training or programs to receive AHE's seal for content excellence. For more information on the program, go to