1. Performing Hospital Waste Audits Presented by Peggy Harlow, WM Healthcare Solutions, Inc. April 2, 2012

2.  Protection of the environment;  Compliance with regulation and waste minimization goals set by federal, state and local governments;  Benchmark existing waste volumes/costs;  Identify waste minimization opportunities/ potential cost savings, program improvements, employee training needs, justify budget needs Why Audit Your Wastes? Page 2 ©2011 Waste Management.

3. From Segregation to Minimization Your facility probably generates at least seven types of waste, most of which can be recovered or recycled. 80% of hospital waste is regular, non-infectious solid waste. Regulated medical waste is far more expensive to handle. Proper segregation can mean savings. Training your employees to segregate waste correctly can help create savings. Page 3 ©2011 Waste Management.

4. Determine What Level of Audit 1)Baseline waste audit - Benchmark current waste disposal volumes and costs 2) Facility walk-through –Identify where wastes are generated and how they flow through the facility –Identify current practices and compliance with policies and regulations 3)Waste stream analysis - Gain a better understanding of what is currently in your waste streams Page 4 ©2011 Waste Management.

5. Baseline Waste Audit  Identify waste types generated, locations generated  Identify quantities of waste generated  Identify current waste disposal costs  Identify current waste reduction, reuse and recycle activities  Analyze for opportunities for waste reduction and cost savings Page 5©2011 Waste Management

6. Analyze Your Waste Streams  List all categories and subcategories of a specific waste stream.  Determine who is responsible for each waste stream category – who manages it and who pays the bills.  Use waste bills, manifests to calculate the volume and cost of each waste stream. Page 6©2011 Waste Management

7. Waste Categories and Sub-categories Page 7©2011 Waste Management

8. Benchmarking Data  Data sources: – Invoices – Manifests – Contracts – Haulers – Purchasing  Challenges: – Data housed in multiple departments – Incomplete data /lack of transparent billing May not have volumes Lump sum billing May need to estimate data Page 8©2011 Waste Management

9. Assess/Understand Your Fees Do you understand your fees/contracts? How are you charged? Per pound? Per container/tub? Per pick up/haul? Flat fee? Are you being charged other fees? –Fuel/environmental, energy charges, per stop charges? –Does your contract allow it? What is allowed in the contracts for price increases? –Increase in services, annual CPI increase, fuel fluctuation charges? Do your contracts have provisions that allow you to terminate the contract before its expiration date? Do your contracts have an automatic rollover provision at the end of the contract term, if you don’t notify vendor? Page 9©2011 Waste Management

10. Assess Your Service Levels  What is your pick up frequency?  What are your container sizes?  Are your containers going out full?  Look to see if you should adjust service levels or internal practices, if not being maximized.  Do you know where your waste goes and how they are treated? Autoclave/RMW incineration, landfill/waste-to-energy, recycling, HW incineration Page 10©2011 Waste Management

11. Facility Walk-Through Conduct general observations Observation of container placement and content, signage, compliance by staff Best management practices Interview staff Discussion of waste practices Knowledge of waste procedures, training received Concerns, recommendations for improvements Page 11 ©2011 Waste Management.

12. Locations to Visit/Observe Environmental Services: Compactors, RMW storage, recycling areas Material Management: Purchasing, receiving dock, storeroom(s) Facilities/Maintenance: Power plant, maintenance shops Safety: HazMat storage areas, satellite accumulation OR/Surgical services Patient Care Floors ICU/CCU areas Radiology Laboratory Pharmacy Kitchen/food service areas: Food prep, patient tray lines, waste collection areas, dining room Administrative Areas Page 12©2011 Waste Management

13. Departmental Analysis  Document the services carried out by the department - Types of services, # staff, # cases, # meals, etc.  Identify types of waste generated in the department.  Observe how the different waste groups are segregated and collected. - Query staff on waste practices, training received.  Identify equipment available for the waste management and disposal. - Observe container contents where feasible.  Commend staff on good waste management practices and seek recommendations for program improvements. Page 13©2011 Waste Management

14. Conduct a Waste Stream Analysis Gain a better understanding of what is in your waste 1) Random Sampling 2) Detailed Waste Stream Analysis Page 14 ©2011 Waste Management.

15. Waste Stream Analysis Prep  Determine the type of analysis and identify the waste streams which will be surveyed  Establish the time period of the analysis (>7 days + 1 trial day in a row),  Identify the sample areas (which departments)  Identify and reserve the needed equipment (e.g. scale, containers, etc.)  Purchase any additional equipment (bags, labels, etc.)  Plan waste collection points  Inform the waste collection staff about the temporary changes to collection in the sample areas

16. Waste Stream Analysis Collect the waste from the sample areas and transportation to a fixed storage point, separate from the normal storage places. Utilize proper PPE. Measure the different waste streams by volume and by weight, or percentage composition(once per 24 hours – fixed measurement time for the complete research period) Record /document data (quantitative, photos) Gather and include performance data of the sample areas (e.g. patients treated per day, number of X-rays carried out, number of meals prepared, etc.)

17. Audit Results  Summarize waste volumes, cost data -Compare results with known industry data  Summarize observations  Make and prioritize recommendations - Waste minimization strategies for specific areas of the facility - Practices/policy improvements - Budgetary requirements Page 17©2011 Waste Management

18. Moving Forward Track the waste minimization efforts and compare the results with the waste data gathered during the assessment phase of the program Document results and study the system for continuous improvement Evaluate the waste minimization process to document success, determine training efficiency and needs Institute policy directives incorporating improved waste minimization processes Plan new waste minimization pilot projects for further waste reduction Page 18©2011 Waste Management

19. Questions? Page 19 ©2011 Waste Management.