GREENING OF HOSPITALS WORKSHOP

1. GREENING OF HOSPITALS WORKSHOP Greening Healthcare Through PollutionPrevention Overview of Waste Management

2. Overview of Waste Management • Importance of Proper Waste Management • Waste Stream Segregation • Minimizing Red Bag Wastes • Blue Wrap Recycling & Reduction • E-Waste Handling • Environmentally Preferable Purchasing

3. Importance of Proper Waste Management • Impact of solid waste diversion from landfills • Segregation of solid wastes • More people handling the waste stream • More potential for needle-stick worker injuries • Load checks of wastes arriving at materials handling facilities and landfills • Greater scrutiny of solid waste stream

4. Protecting Down-Stream Waste Workers

5. Scrutiny of Solid Wastes from Medical Facilities • Landfill staff have interpreted what wastes from medical facilities they will take or reject to protect their workers • Hospitals need to work closely with their solid waste and landfill workers to educate them regarding the true health potential of the wastes

6. Is This Medical Waste or Waste From a Medical Facility?

7. Medical Waste or Not

8. Medical Waste?

9. Medical Waste or Solid Waste?

10. Impact to Hospitals • Hospitals are being made to have entire solid waste loads with medical waste contamination be retrieved and sent for medical waste treatment • Some of these incidents were violations of the Medical Waste Management Act • Others have been a landfill worker’s perspective of what they interpret medical waste to be

11. Segregation of Waste Streams • It is necessary to separate wastes into their own waste streams for disposal: • Solid waste • Medical waste • Hazardous waste • Radiological waste • Mixed wastes must be treated in the most conservative manner

12. Minimizing the Medical Waste Stream • Greening of the Red-Bag Waste Stream • Original document to reduce medical waste • US EPA Region IX encouragement to develop Hospital Pollution Prevention Programs (HP3) • Results: hospitals becoming mercury-free • H2E Making Medicine Mercury-Free • Waste reduction projects • Accomplish through a Pollution Prevention Program

13. Improving the Process • We can’t stand still, but must continuously work to improve the process • Japanese word for continuous improvement is: kaizen • Continuously making small improvements in the process • We have done that in the microfiber flat mopping process in our local hospitals

14. Launching an Improvement Strategy • Top Management “Buy-in” • Designate a project leader • Empower the leader to act on behalf of the hospital • The formation of a Green Team • Representatives from many disciplines including Purchasing Department • Collect and use data – be data driven!

15. Why Implement A Hospital Pollution Prevention Program? • Reduction of waste streams in the hospital • Improved handling of wastes reduces potential violations and fines • Better environment for workers & patients • Cost savings from improved operations • Increased staff morale • Positive recognition by the community • Increased patient satisfaction ratings

16. Medical Waste Handling & Reduction • Six Basic Intervention Strategies • Proper handling of solid and medical waste streams • Engineered controls for suction canisters • Re-usable sharps containers • Sharps containers manufactured with recycled content • Recycling single use medical devices • Implementing reusable products in surgery

17. #1 Proper Handling of Wastes • Proper handling to reduce cross-contamination and save money • Use of Self-Assessment Manual • Staff training in handling waste streams at point of generation • Reinforce with signs and posters near containers • Review placement of containers – • Location – location – location! • Use clear solid waste bags and inspect visually • Check waste during environmental rounds

18. Pollution Prevention Focus on Keeping Solid Waste Out of Medical Waste Stream

19. Document Success • Document: • solid waste reduction • medical waste reduction • materials diverted to recycling • Materials diverted from the waste stream

20. #2 Engineered Controls for Suction Canisters • Over 4,000,000 canisters used annually in California hospitals • Suction canisters represent at least 12-16% of medical waste stream • Minnesota study showed canisters represented 40% of infectious waste in operating rooms • Engineered controls allow suction canister fluids to be disposed through the sewer

21. Suction Canister Waste Reduction • At the University of Southern California their medical waste was reduced 55% by implementing engineered controls • Install a system that disposes of the waste through the sewer and then washes, rinses and sanitizes the canisters for reuse • Greater worker protection for handling fluid blood in this manner

22. #3 Install Reusable Sharps Containers • Study of a 250 bed hospital using standard sharps containers revealed that by switching to reusable sharps containers 13 tons of plastics would be diverted from the medical waste stream • Two companies providing reusable sharps containers: • Daniels Sharpsmart • Stericycle Biosystems

23. Reusable Sharps Containers • Benefits of reusable sharps containers: • Reduction of plastics into medical waste stream • Savings by not purchasing single-use containers • Medical waste reduction savings • Possible reduction in needle-stick injuries • Quantify the savings and document

24. #4 Use Sharps Containers Made of Recycled Plastic • Covidien’s new Renewable line of sharps containers are comprised of 25% recycled plastic • During 2006 Covidien used over 900 tons of polypropylene that had been reground for use in their Renewable containers and 55,000 pounds reclaimed from a diaper manufacturing process • Redesigned sharps containers resulting in weight reduction of 3-5% and reduced consumption of raw materials by 722,000 pounds

25. #5 Recycling Single-use Medical Devices • Assent (formerly Vanguard) is approved by the FDA to reprocess and recondition single-use medical devices • This process can reduce the waste stream from surgery and save the hospital money • They will assist the hospital to track savings and waste reduction

26. #6 Implementing Reusable Products in Surgery • The trend over the past several decades has been to use single use, disposable products in surgery • That trend is reversing with new options for reusable products such as: • Gowns • Sheets and drapes • Towels • Basin and instrument sets • Backtable and mayo stand covers

27. Reusable Surgery Products • SRI Surgical provides reusable products for surgery suites • Process products in FDA registered facilities • Provides a system called ReadyCaseSM that can deliver 95% of instruments and products used in surgery customized for the operating physician • SRI’s ReadyViewSM System allows analysis of supplies used for each procedure so best practices can be developed and savings achieved

28. Reusable Surgery Products • SRI achieved waste savings for their California customers in 2006 amounting to 838 tons • By implementing the ReadyCaseSM System for laparoscopy procedures at one facility a first year savings of $344,000 was achieved

29. Blue Wrap Recycling and Reduction • Two strategies to reduce blue wrap waste • Recycle the used blue wrap • Reduce blue wrap waste by using hard cases

30. Blue Wrap Recycling • Blue wrap after use generally is disposed of in the medical or solid waste streams • It is a clean waste because it has been autoclaved • A blue wrap recycling process has been developed and shown to be effective for California hospitals

31. Blue wrap isuniversally used • Blue Wrap ispolypropylene,which has a recycle number 6

32. Blue Wrap Recycling • Clean Source trucks deliver medical supplies to hospitals and then backhauls blue wrap. • Clean Source collects and compacts the blue wrap before the bails are transported to a recycling site.

33. Blue Wrap Recycling is Increasing in California • 29,846 pounds (15 tons) of blue wrap were recycled by 15 hospitals during 2002 • 73,153 pounds (36.6 tons) of blue wrap have been recycled by California hospitals during 2003 • The CalRecycle (formerly the California Integrated Waste Management Board) is working to increase blue wrap recycling

34. Use of Hard Cases Instead of Blue Wrap • Mills-Peninsula Medical Center used an estimated 14,475 pounds of blue wrap during 2006 at a cost of $35,962 • December 2006 they purchased Asculap hard cases at a cost of $34,987 • This allowed a reduction in blue wrap use of 70% • Saving $25,173 in blue wrap purchasing • Saved $26,000 in rewrapping costs for torn sets • Pay back of cost in 8.2 months that will continue

35. Using Hard Cases • Central Sterile estimated 5-10 torn blue wrap sets per week at a cost of $100/set • Benefits: • Easier to track instruments • Don’t need dust covers • Potential reduction in ergonomic wrapping injuries • In emergencies don’t have to rely on blue wrap deliveries just use hard cases • No torn sets

36. Hard cases ready for use Hard cases replacing blue wrap

37. E-Waste Handling • An important new concern of waste management • Many electronic devices contain information storage • Electronic waste must be handled properly • Electronic waste often can be reconditioned for beneficial reuse

38. Electronic Waste (E-Waste) Reuse and Recycling • E-waste represents 3% to 5% of wastes • Only 11% of e-waste recycled • Estimates of 2 million tons of e-waste yearly • Concerns: • Brominated flame retardants • Beryllium alloys • Lead and barium in cathode ray tubes • Mercury in lamps • Lead in solders

39. Electronic Waste (E-Waste) Reuse and Recycling • Hospitals are large users of electronics • Must plan for high tech electronic disposal • Hospitals often stockpile IT equipment while ordering new equipment • Hospitals can participate in programs for equipment reuse or refurbished for reuse or extended lifecycles • CHW and Kaiser are working with Redemtech to handle e-wastes

40. Electronic Waste (E-Waste) Reuse and Recycling • Redemtech has a facility in Reno, Nevada where they process electronic equipment • Upgrade and store for future use • Clean disks and prepare units for reuse by others • Clean disks and prepare units for resale • Destroy units and recycle all parts • No parts go to landfill • Nothing handled by convicts

41. Environmentally Preferable Purchasing • Hospitals starting to purchase and use cleaning products found to be less damaging to human health and the environment • Green cleaning is an effort aimed at sustainability– that critical balance of satisfying our needs today while protecting our environment for the future • Use suppliers that practice sustainability

42. Recycled Content Paper • Hospitals use great amounts of paper • Post-consumer content – completed its product life cycle and is reconstituted into recycled fiber • Pre-consumer content – generated after manufacturing process but before entering consumer stream and are reconstituted • Some suppliers can provide you with the benefits achieved through their production cycle per 100 cases of product purchased

43. Per 100 cases of 100% recycled hand towels, the following positive environmental contributions can be realized:

44. Per 100 cases of 100% recycled bath tissue, the following positive environmental contributions can be realized:

45. Environmentally Responsible Actions • One paper company regionalized its mills to reduce the miles traveled to product to the consumer • Resulting savings: 328,000 gallons of diesel fuel • Flagstaff, Arizona mill: reduced consumption of fresh water to one-third industry standard by using reclaimed water

46. DURABILITY Product life-span is a primary Sustainability measure. Products with long useful life stay out of the landfill. SustainabilityAdvantages

47. SustainabilityAdvantages RECYCLED PLASTIC Recycled plastic is material that, unless recovered, is bound for the landfill.

48. WASTE REDUCTION Products that divert waste from landfills, to recovery and reuse, are critical to customers’ sustainability initiatives. SustainabilityAdvantages