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Hospital waste: how to properly implement

and maintain a successful program

Today’s speakers

Gary ZuckermanVice President, Supply Chain & Facility Operations

University of Pittsburgh Medical Center (UPMC) Altoona

About Gary• Over 35 years of experience in the healthcare industry

• Served 28 years as a medical service corps officer in the Navy including positions as executive officer and commanding officer of Navy hospitals and clinics throughout the United States, Europe, and Southeast Asia

• Responsibilities include contracting, material management, engineering, environmental services, and biomedical engineering

• Received bachelor’s degree in Health Planning and Administration from Penn State University and MBA in Hospital Administration from the University of Florida

Today’s speakers

Ed BarrProgram Manager, Waste Stream Management

Stericycle

About Ed

• Over 25 years of recycling and medical waste management experience and has lead recycling initiatives recognized by EPA, AHA, Practice Greenhealth, and the Greater Philadelphia Recycling Council

• Oversees waste stream solutions in Pennsylvania, New Jersey, and Delaware

• 12 years as President of the Greater Philadelphia Commercial Recycling Council

• 13 years as the Greater Philadelphia AHE President

All about:

University of Pittsburgh Medical Center Altoona, PA

• 380-bed facility governed by a volunteer community board of directors

• Offers more than 130 years of health care experience with over 300 physicians, over 2,000 caregivers and 500 volunteers

• Serves more than 20 counties throughout Central Pennsylvania

• A top-three employer in Blair County

Learning objectives:• Outline and discuss the top waste stream management efforts to minimize waste generated to protect the environment and your bottom line; to stay ahead of the compliance curve, which can include civil and criminal penalties that directly affect hospital leaders and practitioners.

• Detail implementation and management methods to outline an approach that you can customize to your own facility to create a facility-wide culture of sustainability that permeates business practices and drives your healthcare model.

• Educate hospital leaders and staff on the most effective methods for implementing and managing a sustainable program and how to best manage waste streams through collaboration, communication and a shared vision.

To be covered today:

• Methods for a hospital to diminish environmental footprint

• Potential human health risks associated with improper waste disposal

• Relevant regulations and legislation

• On-boarding tactics for developing a leadership team

• Educational and training methods for implementing a hospital-wide waste stream sustainability solution at your facility

Current issues facing leadership

Healthcare impacts our environment.• Healthcare accounts for 8% of the U.S. Carbon

Footprint (JAMA, 2009)

• Organic Wastewater Contaminants (OWCs) were found in 80% of streams tested (U.S. Geological Survey)

• 13.2M pounds of hospital-generated waste go to the landfill each day (Building Operating Management)

• Healthcare facilities are 2.5x more energy intensive than other facilities due to 24/7 operation (Department of Energy)

• Hospitals manage up to 12 regulated waste streams (Stericycle)

Hospitals face numerous pressures.

Going Green

8%The average hospital today is recycling only 8%

of its waste. Industry leaders recycle 35%. Reduce, reuse and recycle.

Financial Pressure

90%The percentage of hospitals that could NOT readily pull together cost and weight data for their waste streams.

Compliance Issues

15The average number of regulatory compliance issues uncovered during a typical hospital compliance review.

Waste streams are interconnected.

No single department is responsible for managing all hospital waste streams. Waste affects everyone.

Understanding regulations and

compliance issues

Managing waste has many layers.Regulations have led to hospital leaders to focus on the various waste streams and their complexities in order to manage appropriately:

• Municipal Solid Waste (MSW)• Regulated Medical Waste (RMW), including trace chemotherapy• Pharmaceutical (RCRA and Non-RCRA)• Sharps waste (syringes, scalpels, needles, blades)• Universal Waste (oils, batteries, bulbs, mercury)• E-Waste• Confidential documents that must be disposed without violating

HIPAA• Radioactive waste

Understand the regulatory factors.

Regulatory Standards set by:• Resource Conservation & Recovery Act (RCRA)• Clean Water Act (40 CFR Parts 122 and 403)• Safe Drug Disposal Act of 2009 (HB 5809)• Hospital Medical Infectious Waste Incinerator Rule• The Joint Commission• Department of Transportation• EPA• OSHA/NIOSH• DEA

Failure to comply and properly manage issues leads to

higher risk for the hospital and its employees.

Play an active role in managing your waste stream sustainably.

• Visit EPA, DEA, DOT, TJC, OSHA, EPA

and other sites to know when updates

come out• Share the new information with peers

and leadership• Be knowledgeable about your facility’s

current practices to stay ahead of the

compliance curve

It is important to know the risks.

Financial Risk:• Penalties incurred (fines, civil & criminal charges, etc.)• Hospital leaders do not “know”• Decreased customer satisfaction, hospital ratings

Environmental Risk:• Non-compliant disposal of waste (Rx, Hazardous, MSW, RMW) can

pollute and damage watersheds, ecosystems, communities

Community Risk:• Increased chance of workplace injury (i.e. sharps sticks)• Can negatively impact perception in the surrounding areas

Proper management benefits the bottom line.

Integrating the process hospital-wide results in:• Implementing systems to track and document waste stream

management • You can’t change what you can’t measure• Determine processing and transportation timelines

• Decreased disposal costs• Regular waste ends up in red bag resulting in higher disposal

costs • Only 20% of waste streams are actually regulated and < 5% of Rx

streams are hazardous• Strive for a cleaner, safer environment

Understanding your impact on the

community

Identify ways to reduce your waste.(% total waste)

AVERAGE HOSPITAL

TOP GREEN HOSPITAL

Recycled 27% 35%

MSW 68% 56%

RMW (of MSW)

15% 8%

Other 5% 9%

• Question your vendors and analyze your supply chain for environmentally preferred purchasing (less mercury, silver in products, better packaging, air, land and water quality services).

• Explore Practice Greenhealth’s Environmentally Preferred Purchasing initiative

Redirect your waste.

Waste diversion drives better economics and sustainability.

RMW

Solid Waste

Recycling

A case study analysis: UPMC Altoona

UPMC Altoona

Throughout the system:

• Reusable pharmaceutical waste containers have helped

manage 39,160 pounds of drugs from January 2011 to July

2014• Reusable sharps containers result in:

• 70,826 lbs. of CO2 emissions prevented• 3,647 gallons of gas not burned• 1,340 BBQ propane tanks not used

By using the Sharps Management Service &

reusable sharps containers annual emissions

are prevented from:

• 121,440 pounds of plastic kept out of landfills • 5,311 pounds of cardboard kept out of landfills

Carbon emissions savings

Recycling at UPMC Altoona

• <10% of total waste recycled before

2010• 24% of total waste recycled in 2013 • 28% of total waste recycled in year-

to-date June 2014• 35% of total waste recycled is a

best practice according to Practice

Greenhealth

Waste reduction efforts at UPMC Altoona

• 40% of total waste was RMW at

end-of-year 2010• 9% of total waste was RMW at end-

of-year 2013 as a result of recycling

more

Training & education• Understand the importance of ongoing training:

• Competency fairs held annually to train all staff and review materials

• Utilize online training: Net Learning

• Keep training records for OSHA, especially for regulated and hazardous waste

• Specialists must be trained on DOT; OSHA, RCRA standards and proper handling of shipping manifests

• 2260 hospital staff trained including examples such as 12 trained on DOT manifests

Sustainability & green initiatives• Green Team committee includes cross-functional departments (nursing, staffing, medical, clinical, OR, ER, housekeeping etc.)

• Meets quarterly to discuss upcoming initiatives• Includes community representative, member of the

Intermunicipal Relations Council, which represents the four communities of Altoona

• Is part of Earth Day celebration with community-based presentations

• Includes a uniform initiative to clean/disperse used uniforms for those seeking employment in the healthcare industry

• ‘Clean Out Your Files Day’ every six months to recycle paper• An on-site Farmer’s Market supports local/sustainable food and

healthier lifestyles• Outsourced waste management• Removed on-sight autoclave, redesigned dock

Sustainability & green initiatives

Community-based presentations during Earth Day

Green Team member Drew Appleman with Gary and Ed

Operational effectiveness• Removed autoclave in order to create more efficient, sustainable practices

• Nearly all waste prior to waste stream management system went into the red bags and was treated as RMW

• Through training and awareness, the amount of RMW has decreased 31% since we started the program

• Waste no longer needs to be handled twice by the hospital (once for treating the waste in the autoclave and then again for the transportation to a landfill)

• Outsourcing the waste allows for a more efficient handling of the waste and reduces the carbon footprint for the hospital

• The redesigned dock provides a much better working environment for those who handle trash and use the dock

Redesigned hospital dock

Left: autoclave used prior to implementation of waste stream management systemAbove: Redesigned dock without autoclave

Have an education plan to get hospital teams on board for proper segregation and

proactive disposal.

Include all key stakeholders.

Process Improvement Team

Full Participation Leads To ComplianceFull Participation Leads To Compliance

Senior Leadership

Education

Pharmacy

Nursing / Patient Care

Service Provider

Infection Control

Materials Management

Program Champion

Safety / Environment Services Hospital-wide Green

Team

Risk Management(Clinical and Enterprise)

Quality Compliance

Properly segregating waste is critical.

Non-RCRA Pharmaceutical

Waste

RCRA Pharmaceutical

Waste

Syringes with

Medication

Identifying disposal options can reduce cost and increase compliance.

Implementing sustainable waste

stream practices at your facility

Step 8:• Facility Executive

Leadership• Communicate

across entire organization

• Celebrate big wins

Step 7:• Performance vs.

expected outcome• Is there additional

room for improvement

• Lessons learned

Step 6:• Are we on track?• What adjustments

need to be made?• Communicate back

to key department directors

Step 5:• Complete regular

walk throughs• Seek feedback• Solve problems

Step 4:• Place equipment• Communicate in

advance• Ensure SOPs are

in place• Complete training

Step 3:• Key departments

directors• Seek their ideas• Customize to meet

their needs• Get their team

involved

Step 2:• Program Design• SOPs• Required assets• Implementation

schedule• Expected outcome

Step 1:• Prioritize based

on facility input• Coordinate with

other initiatives

Continuous Improvement

Cycle

1. Identifyimprovementopportunity

2. Present opportunity to

leadership/ sustainability team

3. Gain Unit Leadership

Buy-in

4. LaunchInitiative

6. MeasureResults

7. Review results with leadership

8. Publish results & recognize key contributors

5. MonitorProgress

Assess your facility’s current efforts.

• Visualize from your floors to your dock the flow of managing

waste streams and then determine where to start• Evaluate current green team initiatives• Understand what waste is currently being generated and

assess current practices• Examine all waste-related invoices from all vendors• Assess practices in relation to compliance, regulatory

standards and legal requirements

Consider what it will cost.

Direct Costs• Staff• Dock pick-up• Transport / waste hauling• Equipment• Training• Fines• Data collection / record

retention• Infrastructure / IT• Insurance

Regulatory Compliance• Staff• Training

Indirect Costs• Cost containment• Cost of improper segregation• Potential risk costs (exposure,

spills, etc.)• Increased labor costs• Increased time to manage

multiple steams / vendors• Workers compensation costs• Community Image

Make sustainable practices part of daily life.

• Create a culture for change; rethink how you view waste• Make it part of the culture and establish a Green Team• Educate all departments and establish a point of contact• Implement hospital-wide initiatives that involve

streamlining waste• Coordinate all communications (Internal & External)• Track, manage & measure all waste streams

Integrate the “3 Rs.”

Start by reducing waste• Appropriate segregation and diversion of waste streams

decreases cost & waste• Reduce waste that goes to landfills• Educate employees on proper waste disposal practices• High efficiency transportation fleet • LEED certification and other high efficiency projects

Then reuse & recycle where possible.

Switch to reusable products• Reusable containers (disposable sharps containers are each

reused 600x)• Minimizes use of virgin materials to make new products• Use reusable products in the OR (can reduce RMW generated

by 65%)

Start and increase your recycling efforts• Implement a comprehensive recycling program & educate staff• Be creative on what can be recycled (blue wrap, etc.)

Know where to look for more resources and information.

• Environmental Protection Agency - www.epa.gov

• The Joint Commission - www.jointcommission.org

• Healthcare Plastics Recycling Council - http://www.hprc.org

• Commission on Air & Water Quality - www.glc.org/airwater.html

• Practice Green Health (green teams / greening supply chains)

• http://practicegreenhealth.org/

• Product Stewardship Institute - http://www.productstewardship.us/

• Local and State regulations - http://www.envcap.org/statetools

• Office of Inspector General -

• https://oig.hhs.gov/compliance/compliance-guidance/index.asp

Questions?