Hospital Assessment Tool (HAT 1.0)

1. Hospital Assessment Tool(HAT 1.0)

2. Objectives • The purpose of the project is to create a pollution prevention tool for the assessment of a hospital • This tool categorizes the hospitals based on the wastes produced, treatment methods used and suggests suitable remedial measures to be adopted by the hospitals to reduce the harmful effects of the wastes • It awards an index to the hospitals which helps in understanding the different avenues for improvement • It provides cleaner alternatives and also easily compares the sustainability of one hospital with other

3. Methodology • A comprehensive literature review on the types of pollutants produced, types of treatment methods adopted, types of recycling techniques used and on the facilities of the hospitals is done • Evaluation is done on various existing tools, which inferred that those tools just gave scores to the hospitals based on the amount of pollution produced • This formed the validation in the creation of a sophisticated tool which not only grades the hospital but also suggests necessary remedial measures to be undertaken by the hospitals • A questionnaire is prepared and based on that the pollution prevention tool is built

4. Input Required

5. Tool Development • A pollution prevention tool has been created which gives a performance index to the hospital and also provides suggestions on how to overcome the problem of waste • The tool consists of eight sections namely storage, wastes, training, acts, equipment, mercury, treatment and red bag waste • Each section has a set of questions and for each question a score of either “1” or “0” is awarded • Total scores in each section are tabulated and the sectional performances are evaluated

6. Home Page of the Tool

7. Questions on Storage • Separate waste storage areas: • Are all wastes stored in separate storage areas? • Are the waste storage areas clearly identified? • Waste carrying containers • Are all the waste carrying containers kept closed except filling waste? • Are all waste containers in good condition? • Labeling of wastes • Are wastes stored in labeled containers? • The date on the container stored in storage • Inspection of wastes • Is the area inspected weekly for signs of spills or container deterioration? • Are these inspections documented? • Material Safety Data Sheets • Are MSDS maintained and made readily available to all employees?

8. Screenshot of Questions under Storage Section

9. Questions on Waste • Types of waste • What are the types of wastes produced by the hospital? • Does your hospital handle universal waste separately from other hazardous waste? • Non-toxic alternatives • Does your hospital use non-toxic or less toxic alternatives for janitorial chemicals? • Have you evaluated the alternatives for Ethylene Oxide? • Handling of waste • Are biohazardous wastes protected from contact with water, precipitation, wind, or animals? • Do you know what persistent, bioaccumulative toxics are and what the connection is to healthcare?

10. Screenshot of Questions under Waste Section

11. Questions on Training • Areas where hospital training is required • Green Purchasing? • Environmental Management Systems? • Solid Waste Recycling? • Waste management system • Does your hospital follow a waste management plan and strictly follow the plan? • Doses your facility have a waste management policy that includes: • Hierarchy of waste management • Goals of waste management program • Handling and disposal procedures for all waste streams • Pollution prevention/ Source reduction • Employee Training • Are all employees trained to identify infectious and hazardous materials and dispose of them according to safety and disposal regulations? • Does your staff know the procedures for handling and disposal of low level radioactive wastes?

12. Screenshot of Questions under Training Section

13. Questions on Acts • Purchasing Policies • Green products • Energy star products • Mercury • Low VOC products • Less toxic materials • Accreditation of Hospital • Joint Commission on Accreditation of Hospital Organization (JCAHO) • American Osteopathic Association • Community Health Accreditation Program

14. Screenshot of Questions under Acts Section

15. Questions on Equipment • Type of equipment • Biphenyl containing electrical equipment • PCB containing equipment • Reusable or disposable instruments • Maintenance of equipment • Repair time and cost of equipment • Functions of equipment

16. Screenshot of Questions under Equipment Section

17. Questions on Mercury • Mercury Audit • Have you conducted a mercury audit of your hospital, including an inventory of all mercury devices/sources? • Replacement of mercury containing instruments • Have you replaced mercury thermometers? • Have you replaced mercury blood pressure units? • Have you replaced lab chemicals using mercury? • Disposal of mercury • Is the mercury disposed in accordance with state and federal law? • Do you still purchase any equipment containing mercury?

18. Screenshot of Questions under Mercury Section

19. Questions on Treatment • Various treatment technologies • Heating/Ventilating upgrades • Air side cooling economizer cycle • Programmable thermostats • Energy efficient lighting upgrades • Lighting occupancy sensors • Recycling techniques • Do you recycle batteries, fluorescent lamps, paints and mercury? • Do you capture and recycle silver and X-ray film from radiology? • Are you disposing of lead containing items in aprons and lead packaging?

20. Screenshot of Questions under Treatment Section

21. Questions on Red Bag Waste • Disposal methods • How does the hospital dispose off the medical red bag waste? • Incineration (off site) • Autoclave (offsite) • Incineration (onsite) • Autoclave (off site) • Amount of red bag waste • How much percentage of your hospitals waste is medical red bag waste? • Packaging techniques • Is the red bag packaging leak resistant? • Is the red bag packaging impervious to moisture? • Is the packaging of sufficient strength to prevent tearing or bursting?

22. Screenshot of Questions under Red Bag Waste Section

23. HAT 1.0 Specifications • To run HAT 1.0 Microsoft Excel is needed • HAT 1.0 can be downloaded from http://p2tools.utoledo.edu/ppistools.htm • NOTE:” Development of a Pollution Prevention Tool for the Assessment of Hospital Waste Management Systems” to be published in Environmental Progress

24. Evaluation Method • The overall hospital evaluation score is obtained by adding sectional scores and the hospital is graded based on the total score • Cumulative score for 218 points is given at the end of the questionnaire SCORING METHOD FOR SECTIONAL AND OVERALL SCORE

25. Suggestions for Storage Section

26. Suggestions for Waste Section

27. Suggestions for Training Section

28. Suggestions for Acts Section

29. Suggestions for Equipment Section

30. Suggestions for Mercury Section

31. Suggestions for Treatment Section

32. Suggestions for Red Bag Waste Section

33. Application of Tool • The HAT 1.0 was applied on a group of Connecticut hospitals • This case study was obtained from “2003 Hospital Assessment Tool”, University of New Hampshire Final Score Card from Hospital Assessment Tool 1.0

34. Results The final score obtained from the HAT 1.0 is 158 which implies that the hospital falls under “good” category. The following are the assessment results of HAT 1.0 • Waste management techniques need further attention • More employee training is required • Further work is needed to follow the laws related to hospital waste management • Maintenance of hospital equipment needs special attention • Hospital system is handling storage, mercury, treatment and red bag waste effectively

35. Conclusion • The sectional score helps in the detailed assessment of the hospital • The tool allows necessary changes in management practices related to each section to improve the overall quality of the hospital

36. Future Work • This tool will be applied on the University Medical Centre, University of Toledo for its validation. • The tool will be revised with more comprehensive suggestions to improve on waste management techniques