Hospitals face growing operational challenges as they balance the delivery of excellent health care services with a changing economy, tight regulations and large volumes of waste requiring proper management. Since hospitals pay for waste in three different ways – when they purchase materials, handle these materials and then dispose of these materials – best practices in waste reduction and management are essential to keep operational costs real and manageable. A resource management system can help hospitals effectively implement high-impact yet simple waste stream reduction best practices while also allowing for the planning and implementation of more complex or expensive initiatives. A resource management system can provide a model and framework for implementation of these best practices that ensures program visibility, waste volume reduction and regulatory compliance.
Preventive Measures
So why do we worry about waste? Preventing environmental contamination, disease transmission, and worker injury is key to maintaining a safe and compliant health system. Medical waste can carry and potentially transmit an array of diseases including HIV and Hepatitis.
Regulations have been put into place to prevent this waste from harming workers, patients and the community. These regulations address the full spectrum of waste handling including waste segregation, transportation, storage and treatment.
Next, waste handling and disposal is expensive. Healthcare facilities pay for waste three different ways. Facilities first pay when the products are purchased, then in the material handling and operations (such as labor, equipment and maintenance), and finally after the product is used and thrown away (such as the transportation and disposal of the waste).
These costs quickly add up simply due to the sheer volume of infectious, hazardous, and solid wastes generated. According to Practice GreenHealth, 6,600 tons of waste is produced every day in the health care industry. All of this waste requires proper management and disposal which can get quite costly for facilities.
Since hospitals and health systems are large organizations with multiple departments, facilities and additional offsite clinics and offices, it is typical for each location to have their own unique set of procedures for handling their waste and recycling materials. This unique situation makes the job of any healthcare facility, sustainability coordinator or green champion difficult for the following reasons.
- Educational messages on waste handling methods is not consistent requiring customized training for each site or department
- Risk of non-compliance is a common threat as program implementation and training often does not reach all sites or departments
- Data is usually not collected so tracking trends in volumes and costs is non-existent making sustainability goals hard to set and achieve
- Without a holistic view of what comes in and what goes out, programs are not optimized for efficiency and cost
Hospital Resource Management Programs
A ‘resource management’ program at your hospital takes all the incoming and outgoing materials as well as wastes into account and manages each waste stream as part of a system. Some examples of how this works include moving waste to recycling, removing non-regulated waste from the red bags and assuring hazardous waste is properly handled.
A resource management program includes the tracking of volumes and costs as you manage for compliance. By auditing processes, tracking data, overseeing vendor services and invoices, ‘right-sizing’ carts and containers, and training waste generators and handlers, program volumes and costs can be managed.
A resource management program often works with purchasing to incorporate green purchasing best practices and protocols and also works with facilities to track energy usage and implement green building and alternative energy programs.
A good resource management program will begin with a baseline waste evaluation. This evaluation will include an analysis of the following waste streams:
- General waste
- Recycling (cardboard, office paper/confidential, scrap metal, specialty plastics, single stream recycling, compostables)
- Regulated medical waste (RMW)
- Sharps
- Hazardous wastes
- Pharmaceutical wastes
- Used oil and aqueous lab waste (LIW)
- Universal wastes (batteries, lamps, mercury devices, lead, electronic equipment)
- Chemotherapy and pathological wastes
- Construction wastes
Using Evaluations to Improve Procedures
A successful baseline evaluation will accomplish several things. First, it will take inventory and assess your current waste generation volumes and costs. This can be through surveys, audits, and reviewing invoices. The inventory will help you evaluate your waste management procedures and provide a better understanding of your recycling logistics.
Second, you will be able to profile the cost and environmental impacts of these waste streams in order to appropriately represent the true cost of disposal. This information will allow you to establish a benchmark for your facility allowing you to compare your data with other facilities and prioritize areas of focus.
Once your baseline is complete, it is time to review and evaluate your results. In reviewing your results, ask yourself two key questions. First, what do you throw away? The answer to this question will help you decipher the low hanging fruit – easy waste reduction goals that are very attainable – and more difficult goals that you might consider for a long-term plan. The second question, what does your waste cost? Once you look at your disposal costs, it will be very easy to identify opportunities for cost savings and track your progress.
With a good understanding of the amount of waste your facility generates and the total cost of disposal, your facility is ready to put together the project team to develop the waste reduction program goals and action plan.
Involving a multi-disciplinary project team including staff from Environmental Services, Infection Control, Nursing, Safety, Facilities, Employee Education, Employee Health, Laboratory, Critical Care Areas and Clinicians is critical.
This team can help develop, implement and assess facility-wide program goals and action plan. Some waste reduction and recycling goals that can be considered include:
- Comprehensive Recycling (bottles & cans, paper)
- Food Waste Composting
- Disposable Dishware and Tray Elimination
- Enhanced Cardboard Recycling
- Recycle Construction/Renovation Waste
- Durable Goods Reuse, Donation
- Medical Device Reprocessing
- RMW Reduction in the OR
- Reusable Sharps Containers
- Reusable Products (gowns, sterilization containers)
- Solvent recycling
Prioritizing Initiatives
Scoring and ranking individual initiatives (or groups of initiatives) are good ways to get started with identifying priorities. A report card by group is a nice visual to share with the leadership team and a way to track progress.
As you work to create a waste reduction action plan, make sure that your priorities, goals, timelines, costs and resources are simple to make the changes easy to implement and follow.
To ensure that your programs are successful and your goals are achieved, it is important to include the following aspects to your action and implementation plans.
- Regular audits of accumulation areas
- Audit recycling vendor processing facility
- Train and re-train users
- Provide the proper tools for employees to easily implement waste segregation
- Determine container, placement and training needs
- Develop educational information including posters, receptacle labels, newsletters and employee training
- Recruit “champions” on each units to help with monitoring
It is important to show the impact of your program over a fixed period of time including the operational benefits through cost savings, volume reduction and improved safety and compliance.
You will want to monitor your waste data from vendor invoices in a “scorecard” format for each location in the program, measuring equipment efficiency and recycling rates. You can use this data to track the reductions in your waste volumes and costs, reward staff for their efforts, let the community know about your successes and share cost-savings information with leadership.
In conclusion, since we are committed to “first do no harm”, hospitals have an obligation to do all that it can to lighten their impact on their community through their waste reduction and recycling opportunities.
A resource management program can help develop action plans for reducing the volumes and costs for a variety of hospital waste streams. By implementing these programs, training our staff, monitoring and reporting on our successes, we can together make a significant impact on reducing our healthcare waste impact.
About the Author
Nicole Chardoul, a licensed professional engineer, is a Principal and C.O.O. of Resource Recycling Systems. She manages the consulting operations and is a senior member of the RRS engineering team. Currently, Nicole is Project Director for RRS’ healthcare and university-based waste reduction, resource management and contract management sustainability programs and waste assessments. The goals of these programs are to review and redesign the corporate and institutional waste, recycling and organics programs to reduce costs, improve operational efficiencies and increase awareness and compliance.
