1. Improving Environmental Performance From A Healthcare Perspective Steven A. Waderich National Environmental Partnership Summit Atlanta GA May 10, 2006

2. Introduction Minnesota treasures its water, not only for consumption, but also for recreation. Healthcare produces enormous volumes of hazardous waste, which, if not handled properly, threaten our rivers, stream and lakes. Healthcare produces enormous volumes of hazardous waste, which, if not handled properly, threaten our rivers, stream and lakes. Reducing the amount of pharmaceutical & other waste from hospitals that goes to sewers and landfills diminishes the risk of surface water contamination.

3. Minnesota Hospitals Minnesota hospitals are committed to being good stewards of the environment and understand the important correlation between public health and protecting the environment. Minnesota hospitals are committed to being good stewards of the environment and understand the important correlation between public health and protecting the environment. Hospitals are driven by the mission of caring for patients 24/7. Hospitals are driven by the mission of caring for patients 24/7. -Ann Gibson, Minnesota Hospital Association

4. Allina Hospitals and Clinics Allina consists of 11 hospitals and over 50 clinics Allina consists of 11 hospitals and over 50 clinics Abbott Northwestern Hospital Abbott Northwestern Hospital 646 beds 646 beds 38,170 Inpatient admissions 38,170 Inpatient admissions 37,462 Emergency visits 37,462 Emergency visits 192,890 Outpatient visits 192,890 Outpatient visits 40 hospital based clinics 40 hospital based clinics 5300 employees 5300 employees

5. The Challenges Little expertise within the healthcare community in handling hazardous waste Little expertise within the healthcare community in handling hazardous waste Decentralized management of waste streams Decentralized management of waste streams Healthcare is highly regulated Healthcare is highly regulated JCAHO (Joint Commission Accreditation of Healthcare Organizations) JCAHO (Joint Commission Accreditation of Healthcare Organizations) OSHA OSHA MPCA/EPA/County MPCA/EPA/County DOT DOT DEA DEA

6. Pharmaceutical Waste Data 2005 Total collected, 40,932 pounds Total collected, 40,932 pounds Total Hazardous, 12,785 pounds (31%) Total Hazardous, 12,785 pounds (31%) RCRA Haz, 4771 pounds, 12% RCRA Haz, 4771 pounds, 12% P-listed, 379 pounds, 1% P-listed, 379 pounds, 1% Dual Haz/infectious, 10% Dual Haz/infectious, 10% Controlled Substances, 1% Controlled Substances, 1% MN lethal, 8% MN lethal, 8% Total Non-haz, 24,373 pounds (60%) Total Non-haz, 24,373 pounds (60%) Total trash, 3772 pounds (9%) Total trash, 3772 pounds (9%)

8. Pharmaceutical Waste Data First Quarter 2006 Total collected, 22,410 pounds Total collected, 22,410 pounds Estimated Annual 89,640 pounds Estimated Annual 89,640 pounds Total Hazardous, 5947 pounds (26%) Total Hazardous, 5947 pounds (26%) RCRA Haz, 4592 pounds, (20%) RCRA Haz, 4592 pounds, (20%) P-listed, 119 pounds P-listed, 119 pounds Dual Haz/infectious, 2154 pounds (9%) Dual Haz/infectious, 2154 pounds (9%) MN lethal, 1354 pounds (6%) MN lethal, 1354 pounds (6%) Total Non-haz, 12,925 pounds (58%) Total Non-haz, 12,925 pounds (58%) Total trash, 3600 pounds (16%) Total trash, 3600 pounds (16%)

10. Waste Projection Costs Based on current data we estimate annual waste disposal at Abbott Northwestern Hospital to be: Based on current data we estimate annual waste disposal at Abbott Northwestern Hospital to be: $350,000 - $375,000 $350,000 - $375,000 Includes Haz, Haz/Dual & Non-Haz pharm. disposal Includes Haz, Haz/Dual & Non-Haz pharm. disposal Includes Lab waste disposal Includes Lab waste disposal Includes containers & vendor charges Includes containers & vendor charges Includes outside vendor sorting fees Includes outside vendor sorting fees Does not include Does not include Additional staff time commitment (est. 2.3 FTE’s) Additional staff time commitment (est. 2.3 FTE’s) Training (est. $66/employee) Training (est. $66/employee) Off site clinics Off site clinics Evaluation processes Evaluation processes

11. Positive Outcomes Recycling (Information provided by Lynn Montgomery, Allina Labs) ABBOTT NORTHWESTERN SITE ONLY January - December, 2005 Amount Recycled Product $/Gal $Purchase $ Dispo/Gal $Disposal Cost Savings 679 Gallons Alcohol 7.04 4,7802.80 $ 1,901 $ 6,681 610 GallonsXylene12.00 7,3202.80 1,708 9,028 1519 GallonsFormalin11.3417,2252.80 4,253 21,478 $37,187 Waste Disposal fees$ 3,679 Savings $ 33,508

12. Recycling Success (Information provided by Lynn Montgomery, Allina Labs) Allina Metro Hospitals Allina Metro Hospitals Recycled 5057 gallons of reagents (92 drums) Recycled 5057 gallons of reagents (92 drums) Alcohol Alcohol Xylene Xylene 10% formalin 10% formalin Reduction in Reagent Reduction in Reagent Purchases Disposal fees Freight and handling Employee safety 2005 Savings at four metro hospitals $ 62,988

13. Positive Outcomes MnTAP Intern Project 2005 MnTAP Intern Project 2005 $8000 - $11,000/year $8000 - $11,000/year Lab chemical reduction Lab chemical reduction Eliminated 400 chemicals and processes Eliminated 400 chemicals and processes Vile Crusher Project ($500/week, $26,000/year) Vile Crusher Project ($500/week, $26,000/year) Successful Recycling program ($33,500/year) Successful Recycling program ($33,500/year) Pharmaceuticals (proper management) Pharmaceuticals (proper management) Evaluated 4100 formulary drugs Evaluated 4100 formulary drugs Epi Irrigation process changes Epi Irrigation process changes

14. Positive Outcomes Standardization Allina Hospitals and Clinics Allina Hospitals and Clinics Regulated & Hazardous Waste Committee Regulated & Hazardous Waste Committee Standardized Training material Standardized Training material Standardized collection & handling processes Standardized collection & handling processes Data gathering Data gathering Waste streams and profiles Waste streams and profiles RFP & resource management initiatives RFP & resource management initiatives Drafted an Environmental Policy Drafted an Environmental Policy

15. Regulatory Consensus Most often regulators and the community that they are regulating only meet in an enforcement arena. Most often regulators and the community that they are regulating only meet in an enforcement arena. Minnesota hospitals appreciate the willingness of the Solid Waste Coordinating Board and Minnesota Pollution Control Agency to come to the table to discuss approaches for hospitals to achieve compliance with hazardous waste regulations while keeping in mind our important mission of quality patient care. Minnesota hospitals appreciate the willingness of the Solid Waste Coordinating Board and Minnesota Pollution Control Agency to come to the table to discuss approaches for hospitals to achieve compliance with hazardous waste regulations while keeping in mind our important mission of quality patient care. Encouraged communication with local regulators Encouraged communication with local regulators

16. Summary Healthcare will do the right thing to ensure the proper disposal of pharmaceutical, lab and other hazardous wastes to protect employees, our patients and the environment of the communities we serve.