Medical Waste Reduction Kate Konkova PUBH-6165-2 The presentation is for Hospital Chiefs and managers who would be the decision makers in implementing and approving new procedures and policies for the hospital. Every hospital should have a recycling program, especially here in the U.S. where going “green” is being constantly stressed and brought to light. My employer, Dewitt Army Hospital, currently does not have any recycling program and one of my goals is to point out to the Dewitt Hospital and any other Hospitals that do not have a recycling program how important it is to recycle and what recycling entails. The goal is also to provide information on what can be recycled and how the recycling process takes place.

Introduction Source Reduction Proper Segregation Recycling Reusing The reduction of hazardous medical waste can have dramatic effects on improving human health and protecting the environment. Finding ways to use less resources and thus reducing hazardous materials’ use right from the “get go” would be considered source reduction. Designating an area(s) for collecting items that are used frequently, thus segregating them, would make recycling easier and more efficient. Proper segregation also includes convenient location of the recycling sites. The hospital will be collecting more recycling materials if recycling bins were to be placed on every floor and in every ward versus having a one recycling location out of the user’s way. Recycling itself should clearly be in place at every hospital. Reusing the materials such as transportation bags, service materials (dining ware, linen, lab coats) would also make a difference. The hospitals should deviate from the single use products and concentrate on reusing materials as much as possible. Of course, it is more convenient to just through away the disposable lab coat at the end of the week or sooner instead of turning it in to be washed for instance. However, if the system is set up properly, where turning it linen or lab coats would be easy and convenient, people would be more likely to do it and the environment would clearly benefit from it.

Source Reduction Source reduction, what is it? Waste increase Lack of waste tracking in the hospitals 1. Environmental Protection Agency (EPA). (2009). Reduce & Reuse. www.epa.gov Chen, I. (05 July 2010). “In the world of throwaways, making a dent in medical waste.” The New York Times. www.nytimes.com Source reduction refers to any change in the design, manufacture, purchase, or use of materials or products (including packaging) to reduce their amount of toxicity before they become municipal solid waste. Between 1960 and 2008 the amount of waste each person creates has almost doubled from 2.7 to 4.5 pounds per day.1 No organization currently tracks how much medical trash the U.S. produces – the last known estimate, from the early 1990s, was 2 million tons a year.2

Source Reduction Reducing the amount of toxic medical waste Xylene Alternatives (Histosolve, Clear-Rite3) Product substitution with recycled content Use of alternate technologies Sustainable Hospitals Project. (2003). Pilot study of alternatives to the use of xylene in a hospital histology laboratory. www.sustainablehospitals.org Reducing toxic waste at the source will have a great impact on the problem of medical waste. If less hazardous materials are used in first place, less will be disposed of through processes such as incineration. Replacing hazardous materials with less hazardous ones is also very important. According to Sustainable Hospitals Project (2003), exposure to xylene can cause renal failure, respiratory failure, hemmorrhage, and necrosis of the brain, liver, kidney, and heart. Replacing xylene with alternative solutions, such as Histoslave or Clear-Rite3, will not only reduce exposure to hazardous material of histology staff, but eliminate its output into the environment.

Proper Segregation Non-hazardous waste mixed with hazardous waste constitutes hazardous waste. Disposing medical waste ~ $480 per ton Disposing non-medical (municipal) waste ~ $24 per ton Earth911. (2010). Tips for recycling medical waste. www.earth911.com In a busy hospital setting it can become a challenge ensuring that hazardous and non-hazardous waste are not mixed together. Staff education and awareness of the fact that if non-hazardous waste is mixed with hazardous, all that waste becomes hazardous, should be one of the ways to ensure proper segregation. Letting the staff know of the cost differences between hazardous and non-hazardous waste should also aid in compliance.

Recycle Recycling turns materials that would otherwise become waste into valuable resources. Benefits of Recycling: Protects U.S. manufacturing jobs and increases U.S. competitiveness Reduces the need for landfilling and incineration Prevents pollution Saves energy Decreases emissions of greenhouse gases Conserves natural resources Helps sustain the environment for future generations Environmental Protection Agency (EPA). (2010). Recycling. www.epa.gov Recycling involves processing materials back into a raw ingredients they were made out of initially and used to make something new. The majority of hospital waste is similar to that found in offices, hotels, and restaurants. Recycling can make an impact in reducing costly medical waste and diverting resources from the landfills, thus helping the environment. One thing to keep in mind though is that recycling is a business and costs of collecting and processing material must be factored in. Nevertheless, recycling is essential in hospital waste management and environmental protection. Some of the benefits listed by the Environmental Protection Agency (EPA) are protecting US manufacturing; decreasing landflling; preventing pollution caused by the manufacturing of products from virgin materials; saving energy; decreasing green house gases which contribute to global climate change; conserving natural resources such as water, timber, and minerals; ensuring we have a safe and clean environment for our posterity. Recycling should not be considered as extra work, it should be incorporated in the current waste disposal, making it different, but essential.

Recycle Recycle materials in the hospitals: Paper Corrugated Boxes Batteries Ink Cartridges Aluminum Cans Steel cans Electronic Equipment Pallets Textiles Mercury Fluorescent Lamps The list on the slide shows the basic items that any business, including the hospital should recycle. Every ward should have a recycle container that is picked up on regular basis. The recycling bins should be brought into a designated disposal area a pick up be recycling services. Recycling should be easy and convenient in order for it to take place. Designating one central area in each ward and educating staff on what needs to be recycled should make the process feasible.

Recycle - Paper The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules  Shred Use double-sided paper The issue with recycling is to ensure that patient information does not get released and that the facility remains in compliance with HIPAA. When recycling paper, special attention must be paid to what information is visible; getting a shredder is an excellent solution in that case.

Recycle - Electronics Computers Monitors TVs Cell phones Fax Machines The issue of patient privacy (HIPAA) applies to electronic equipment too – all the patient information must be erased from the equipment before it can be recycled. EPA provides resources for data distraction and electronic equipment recycling.

Reuse Donating Reprocessing Reusable equipment and supplies Reuse is where a product is used for the same or different purpose without any reprocessing required. With a scarcity of medical equipment in the third world countries, donating medical products that may not be needed or useful in the US to the developing countries is one way to control medical waste. Reprocessing is another way to reuse medical equipment.

Reuse - Donating Unused hospital beds Unused medical equipment Pharmaceuticals Extra hospital supplies With so much poverty in the world and so many countries in dire need of medical supplies, anything unused should be donated instead of being thrown away. Unused beds, equipment, pharmaceuticals, and other supplies are very welcomed in the third world countries and would be of great benefit to them.

Reuse - Reprocessing The American Society for Healthcare Central Service Professionals (ASHCSP) says it includes all operations performed to render a used reusable or single-use device patient-ready or to allow an unused product that has been opened to be made patient-ready. In-house program Third-party reprocessor. An estimated 1,800 hospitals diverted 2,650 tons of garbage from landfills in 2009. Selvey, D. (2001). Medical Device Reprocessing. Infection Control Today. www.infectioncontroltoday.com The main concern with reprocessing is to ensure the devices are properly decontaminated and would not pose a threat to the patient or employee. There are two ways to conduct reprocessing: through in-house program or a third-party reprocessor. Hospital Corporation of America, which owns 163 hospitals, estimated 94 tons of waste saved through reprocessing.

Reuse – Equipment / Supplies Transport plastic bags Transport containers Linen Dishware Hundreds of plastic bags get thrown in the trash a day just by having a specimen in it during the transport for a brief moment. The specimens are usually in tubes, although the plastic bags would be considered contaminated after the specimen transport, there is a potential to transport specimens in those bags a few more times instead of discarding them immediately. With proper markings notifying the staff that the plastic bags are contaminated and should be used for specimen transport should save not only money to the hospitals but hundreds of plastic bags going into the landfills. The same with transport containers – the containers should be washed and reused. Linen can be laundried and reused as well.

Conclusion Source Reduction Proper Segregation Recycle Reuse Every institution should have a Reduce-Reuse-Recycle program. It is something that should not be done just because the government or regulators insist on, but something we should want to do for our planet, for ourselves. So many businesses are great at maximizing their profits through innovation, new technology, efficiency, and constant motivation to continue thriving forward. The same mentality should be applied to recycling. We should use new technology, innovations and be motivated to help the environment, help our next generations. One may not receive instant gratification; however, big changes will be noted in the future. Living lavishly will only deplete the resources leaving us and our children at a serious environmental threat. The planet is our home and should be treated as such!

References Chen, I. (05 July 2010). “In the world of throwaways, making a dent in medical waste.” The New York Times. www.nytimes.com Earth911. (2010). Tips for recycling medical waste. www.earth911.com Environmental Protection Agency (EPA). (2009). Reduce & Reuse. www.epa.gov Selvey, D. (2001). Medical Device Reprocessing. Infection Control Today. www.infectioncontroltoday.com Sustainable Hospitals Project. (2003). Pilot study of alternatives to the use of xylene in a hospital histology laboratory. www.sustainablehospitals.org The following references were used for this presentation.