1. Beth Israel Medical Center’s Success in Regulated Medical Waste Reduction November 12, 2004 Janet Brown 212/941-2486 Janet.Brown@h2e-online.org www.h2e-online.org

2. 2 Regulated Medical Waste – One part of a Comprehensive Waste Program Hospital Waste (Trash) Includes 2% pathological waste

3. 3 Reduced Waste Fees Waste Fees reduced by over $1,000,000 Per year system-wide.

4. 4 Beth Israel Medical Center Petrie Campus – 930 beds (1990’s) Singer Division – 230 beds Kings Highway Division – 212 beds Phillips Ambulatory Care Center – 200,000 outpatient visits per year St. Lukes Roosevelt – 400 each Long Island College Hospital – 500 beds

5. 5 Fear of Waste → MWTA → Garbage Nightmare! April 1989 – 2,300 pounds RMW/Day $27,000/month. July 1989 – 11,000 pounds RMW/Day $130,000/month FTE’s – 15 to 26! (11 x $28K = $308K) 808 lbs. of boxes/day! (just the weight of packaging alone)

6. 6 Petrie Campus – 930 beds 1,000 doctors, 1,000 nurses 6,000 employees Operating Budget of $650,000,000 and challenged to cut $120,000,000 to $180,000,000. (20 – 25% over three years) No space, no time, no money

7. 7 Successful Programs Simplicity Economically Viable Communication/Education Support Shared Savings Buy-in from Leadership Dedicated Staff Person Employee Recognition

8. 8 RMW Reduction Reduce volume of RMW. Switch to a reusable sharps container. Switch to reusable shipping containers for RMW. Address # of FTEs handling RMW.

9. 9 Step by Step to RMW Reduction Infection Control Committee – Policy Development Gather baseline data – Project savings Reduce red bags BEFORE evaluating onsite treatment technologies Review waste contracts – non-incineration treatment of RMW. Consider on-site versus off-site. Review sharps contracts.

10. 10 What goes in a red bag anyway?* Blood, Products of Blood Anything caked, soaked or dripping in blood Tissues from surgery and autopsy Cultures and stocks of infectious agents and discarded vaccines. Suction canisters with any fluid. Hemovac and pleurovac drainage. Operating room waste saturated with body fluids as defined by OSHA. Waste from patients isolated with HIGHLY communicable diseases. ( These are CDC Class IV definitions including Ebola, Lassa Fever, Marburg and Small Pox. NOT such conditions as AIDS< Hepatitis or TB.) Sharps, including syringes and unused sharps. IV Bags, tubing, foley bags Non bloody gloves Packaging, Urine-soaked waste, feces, vomit Blood-tainted waste (Note distinction between blood-soaked and blood- tainted. A little bit of blood on an item can go in the regular waste stream.) YES! RED BAG NO! Put in Clear Bag * Check your local regulations Questions? Call Waste Manager

11. 11 Waste Segregation – Implementation Present Plan Survey Facility Develop Materials Purchase equipment, supplies. Issue Memo Container placement Properly Labeled, Signage Proper placement Training (never ends.) Monitoring and reporting Continue!

12. 12 Suction Canisters http://mntap.umn.edu/health/91-Canister.htm 40% of Operating Room Waste is from suction Canisters! Potential for occupational Exposure in transport.

13. 13 Obstacles Fear of Waste Lack of training Old habits No clear can available Overfilled clear lined can Ran out of clear bags! Housekeeper collecting clear bags into red bag. Use closest can Change of Staff No time No can available Confusion of Isolation rooms Confusion over body fluids

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17. 17 Reusable Products Supply Chain: Include waste fees when comparing disposable versus reusable products.

18. 18 Disposable vs. Reusable Sharps Containers Nurses were responsible for changing containers Containers often overfilled. Containers often removed without being closed properly. Disposable filled containers were stored in the soiled utility rooms Too many employees handling sharps containers. Beth Israel incinerated approximately 2,700 disposable sharps containers per month at one site alone! Vendor offered a full- service sharps management service. One dedicated person for handling sharps. Much fewer incidents of overfilled containers. Nicer looking container Reduced needle sticks associated with waste Elimination of 2,700 containers per month! Reduced liability Positive feedback from staff. Disposable Reusable

19. 19 10 Steps to Reducing RMW http://www.h2e-online.org/ pubs/tensteps/Rmw10steps.pdf

21. 21 For more information: Janet Brown, Partner Coordinator Hospitals for a Healthy Environment 3 West 18 th Street, 7 th Floor New York, NY 10011 Phone: 212/941-2486 Cell: 347/393-3809 Fax: 212/941-1422 Email: Janet.brown@h2e-online.org

22. 22 Toll Free Hotline: 800-727-4179 E-mail: h2e@h2e-online.org www.h2e-online.org h2e@h2e-online.org Kelly Heekin, Communications Kelly.Heekin@H2E-online.org Kelly.Heekin@H2E-online.org 202-234-9656 Emily Cronenwett, Program Assoc. Emily.Cronenwett@H2E-online.org Emily.Cronenwett@H2E-online.org 603-643-6710 Eydie Pines, Special Projects Coor. Eydie.Pines@H2E-online.org Eydie.Pines@H2E-online.org 603-643-6710 Jolie Patterson-Rosst, Awards Coordinator Jolie.Rosst@H2E-online.org Jolie.Rosst@H2E-online.org 202-234-0091 ext. 10 Laura Brannen, Director Laura.Brannen@H2E-online.org Laura.Brannen@H2E-online.org 603-643-6700 Chen Wen, Director Chen.Wen@H2E-online.org Chen.Wen@H2E-online.org 202-564-8849 Janet Brown, Partner Coordinator Janet.Brown@H2E-online.org Janet.Brown@H2E-online.org 212-941-2486, cell 347-393-3809 Sarah O’Brien, Champion Coor. Sarah.obrien@h2e-online.org Sarah.obrien@h2e-online.org (802) 479-0317 Cecilia DeLoach, State Partnership Programs Coordinator Cecilia.DeLoach@H2E-online.org Cecilia.DeLoach@H2E-online.org 800-727-4179 H2E Program Contacts