A Closer Look at Waste Management

Managing volume, toxicity and disposal of waste can save a medical facility hundreds of thousands of dollars in disposal services and reduce the likelihood of fines, on-the-job injuries, lawsuits and environmental degradation.

The federal government has announced it will be scrutinizing hospital emissions more closely, and penalties can be severe. In 2003, various violations among 10 New York state hospitals ranged from $2,000 up to $500,000.

Waste management 911
Many hospitals and medical centers are partnering with Hospitals for a Healthy Environment (H2E), a non-profit organization, to access free voluntary waste management programs, information and networking. The organization, backed by the American Hospital Association and funded primarily by the U.S. Environmental Protection Agency (EPA) is dedicated to helping the health-care sector save money, maintain safer standards of operation and perform as better environmental stewards.

The organization’s director and co-founder, Laura Brannen, who works with medical facilities around the country to jump-start waste-stream management programs, says it begins with allocating manpower and conducting the initial assessment.

“We have problems because we’re not paying attention or dedicating the small amount of resources that are needed to pay attention,” Brannen says, adding that “waste-stream managers” are not in most organizational charts. “We’re trying to get hospitals to figure out that if they put these resources into managing compliance and environmental issues, these programs and positions pay for themselves. If you’re not watching, you’re tossing resources — guaranteed,” she says.

Take tabs of trash
“When you ask how much waste is going out the back door or going into red bags (infectious waste) versus clear bags they say they ‘don’t know;’ Brannen says. “They just pay the bill.

“The difference is that red-bag waste costs $800 per ton to dispose of while clear is $60 per ton. If more than 15 percent of your waste is going into red bags you’re spending too much on your waste. Hospitals can literally save $100,000-$200,000 per year for a 300-bed hospital,” she adds.

Brannen remembers a collective “aha!” moment at the hospital where she worked. The entire staff went into “emergency red-bag minimization mode,” cutting down on red-bag usage. In two months they reduced red-bag waste from 45 percent of the waste stream to 14 percent, saving $250,000 in annual costs. Some hospitals save even more. New York’s Beth Israel Medical Center saves $600,000 annually due to its reduction of regulated medical waste.

“Once you get it into the right bins, data is much easier because haulers supply that information,” says Bob Paine, resource manager for Sodexho, a large food and facilities management company. Paine recently collaborated with the 500-bed Cambridge Health Alliance and H2E.

To get staff in the habit of using the right bins, he and Brannen implemented color coding and created posters, tips and training tools.

“Our primary focus was to find out how much of the total was regulated waste,” he says. “We were a little over 15 percent initially, under 10 percent the first year and the goal after that was 6 percent.”

Ensuring staff knows the difference between “reusable” and “disposable” also can reduce waste. Pre-wrapped office and surgical packs may be disposable, but if they’re unused they can be sterilized and put into service. “Companies are promoting programs called ‘Open But Unused’ — where items are taken back and sterilized,” Brannen says. “Just because a person touched it, we don’t throw it away.”

Itasca Medical Center, a 130-bed hospital in Grand Rapids, Minn., saves $16,000 annually after switching from disposable to reusable items.

Paper by the pounds
Paper is a major waste contributor, and Brannen says that many hospitals, confused by HIPAA (Health Insurance Portability & Accountability Act) laws, are paying to shred documents that could easily go with the regular recycled paper.

She says that one hospital saved $267,000 per year by working with their local paper hauler to ensure regulatory confidentiality compliance, instead of shipping documents to a shredding outfit.

“Paper destruction companies were making out, but HIPAA doesn’t say they’re needed at all,” Brannen says.

She recommends hospitals incorporate HIPAA into their recycling programs. One such hospital hires a person to ensure the paper is driven inside the recycling facility and keep his eyes on the paper while it’s dumped in case any of it flies.

Brannen says that sharing vendor resources with other hospitals, especially in rural settings where resources may be scarcer, is another best practice, and also recommends asking delivery drivers if they will take recyclables to recycling plants on the return trip. “But they can’t take trash,” Brannen warns. “It’s regulated by the [U.S. Department of Transportation].”

The University of Rochester Medical Center sorted out a million pounds of paper last year, says Marvin Stillman, manager of environmental compliance. Workers set up separate trash bins for paper, scrap metal, normal trash and pallets. He says a lot of the sorting takes place off site, and they pay a little extra for the hauler to separate the big stuff; being in the city means less room for trash bins. Stillman’s haulers give him quarterly reports, allowing him to track compliance and program success.

Don’t forget equipment
On the chemical side, Stillman says automation is driving a lot of medical waste reduction. Thermal imaging is replacing X-ray film. Half of the University of Rochester Medical Center’s radiology suites have been converted. When the transition is complete they’ll no longer be dependent on 250 gallons of costly, toxic silver fixer.

Paine says that finding the funding to replace the old equipment that produces toxic chemicals is the real challenge. Many 2003 fines were related to ethylene oxide sterilizers — which utilize a gas so toxic it kills tissue. He says he was focused on eliminating the sterilizers at Cambridge Health Alliance, working with budget makers to move it up on the priority scale.

“Equipment becomes capital intensive,” he explains. “In today’s health care, every nickel counts. It’s a very tight world in health care. We’re being asked to reduce our budgets, staffing … and squeeze every nickel out. You need funding — hundreds of thousands of dollars to change equipment.

“To share best practices makes so much sense,” Paine concludes. “H2E provides a really good network of resources. Doing the self assessment with the steps and measurements, we were stunned … We hadn’t broken it down this way. Now we won’t do it any other way ever again.”