The health care industry has a garbage problem.

It's not just that hospitals, doctors' offices, clinics and other health facilities generate several billion pounds of garbage each year: Buried in that mountain of trash are untold numbers of unused disposable medical devices as well as used but recyclable supplies and equipment, from excess syringes and gauze to surgical instruments.

The problem, fueled by a shift toward the use of disposables that made it simple to keep treatment practices sterile, has been an open secret for years, but getting the health care industry to change its habits has not been easy. No organization currently tracks how much medical trash the United States produces — the last known estimate, from the early 1990s, was 2 million tons a year.

Only recently has the industry begun grappling with the amount of waste it generates, and one reason is that financially stressed hospitals are seeking ways to cut costs.

"We've just seen a sea change," said Cecilia DeLoach Lynn, director of sustainability education at Practice Greenhealth, a nonprofit group in Reston, Va., that is working to shrink the environmental footprint of health care institutions.

"Once upon a time, you had to do a lot of door-knocking to get anybody to pay attention," Lynn said. "These days, folks are asking us not whether or not they should be doing it, but how."

Now, a new movement is taking aim at one of the biggest sources of medical refuse — the operating room, which churns out roughly 20 to 30 percent of a hospital's waste.

At a symposium in Baltimore in May, Practice Greenhealth announced an initiative called Greening the O.R., to vet the best sustainable practices for reducing operating room garbage, energy consumption and indoor air quality problems — while lowering expenses and improving safety, Lynn said.

Eliminating the squandering of medical supplies and equipment can save on new purchases as well as incineration and landfill fees. Some institutions have turned to interventions such as reducing their use of materials, recycling what they do use, and donating leftover but still usable items to developing nations. In a commentary published in March in Academic Medicine, Dr. Martin A. Makary, a gastrointestinal surgeon, and colleagues at Johns Hopkins School of Medicine called for more medical centers to "go green" by recycling disposable single-use medical devices. Several reprocessing companies take certain disposables — such as orthopedic drill bits and heart-monitoring catheters — and clean, recalibrate, repackage and resterilize them, then sell them back to hospitals and medical suppliers for 40 to 60 percent of the price of new ones.

Some single-use devices can be reused after reprocessing, but a decade ago there was great consternation that inadequately decontaminated products might cause infections. Or that cleaning and sterilization might erode their less durable components, leading to malfunction.

Original-equipment manufacturers and their trade group, the Advanced Medical Technology Association, warned that it was unsafe to recycle devices designed to be used only once. But since 2000, the Food and Drug Administration has required that reprocessing companies meet the same stringent regulations for their products that original-device makers do.

Lingering safety concerns slowed the adoption of reprocessing. To investigate those fears, Gifty Kwakye, then a graduate student at Hopkins, worked with Makary and a colleague, Dr. Peter J. Pronovost, in combing the medical literature for evidence that patients were harmed by recycled devices.

They found none.