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Effective disposal of medical waste goes hand in hand with infection prevention, and efficient disposal goes hand in hand with fiscal responsibility. Taking a green perspective to medical waste is good for the environment, the bottom line, and can benefit infection control too.
An environmentally-friendly approach to regulated medical waste (RMW) supports universal precautions, says Janet Brown, partner program manager at Hospitals for a Healthy Environment (H2E). H2E is a national education organization that supports environmental sustainability in healthcare. H2E was founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.
Recycling is the most obvious way to dispose of healthcare waste in a “green” manner, but clearly, some regulated waste should never be recycled.
RMW refers to contaminated sharps and items that are caked or soaked with blood or other potentially infectious fluids such as semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid and saliva. RMW can also include tissue, organs, tissue and organ cultures.¹
Green Choices Equal Green Dollars
According to H2E, disposing of RMW is at least five times more expensive than disposing of non-regulated medical waste. It is therefore vital to keep recyclables and standard trash out of RMW collections. Only 6 percent to 15 percent of a facility’s total waste should go into RMW containers.¹
Business-oriented hospitals are making great strides in waste reduction, says Karl Krupp, medical waste group leader for Health Care Without Harm (HCWH). HCWH is a global coalition of 443 organizations in 52 countries that work to reduce pollution in the healthcare industry.
“Just a few years ago an average hospital might have generated more than 11 pounds of regulated medical waste per bed,” Krupp says. “Now, most are below 5 pounds a bed and the best hospitals are as low as 3 pounds. It’s really a question of economics. Disposing of regulated medical waste is a large expense. Proper minimization and segregation can save a larger hospital hundreds of thousands of dollars each year.”
A majority of the waste in hospitals is paper, food and cardboard – similar to the waste found in any hotel or school – yet many healthcare facilities throw between 50-70 percent of their waste into the bio-hazardous waste stream.
According to H2E, studies prove that hospitals can decrease red bag waste to 6-10 percent of their overall waste. Several types of inappropriate items end up in RMW, including coffee cups, packaging, paper towel waste, clean blue wrap and even pizza boxes, H2E representatives say. Staff should make certain that these items are recycled, or thrown in standard trash.
The first step to a medical waste reduction plan is to figure out how much waste the facility produces, and then review the facility’s RMW disposal policies.
Staffs should check with state regulatory authorities to get copies of state specific regulations. Next, they should meet with infection control staff to refine facility guidelines. A strong partnership with infection control will lead to a much stronger program, H2E officials say. It is a good idea to include RMW reduction information and goals in bloodborne pathogens exposure control manuals, they add.
All of this will be much easier if carried out by a team. The team should be diverse and should include staff from nursing, housekeeping, infection control, education, purchasing, and operating rooms.
Once formed, the team members should write an action plan that will help everyone stay focused and productive. The plan should revolve around health and safety, cost reduction, and pollution abatement. It may be effective to appoint a leader of the team, or at least a leader for every meeting.
A liaison from the team should contact department heads and nurse managers to figure out the type and amount of waste their departments produce. Then, the team will better be able to determine container needs. An oncology unit may need more chemotherapy containers, for instance, than other departments need.¹
The first fact that staff members need to know in terms of waste reduction education is that facilities pay up to 10 times more to dispose of RMW than to dispose of solid waste.
Disposal education is widely needed, Krupp says.
“We are trying to educate people about what’s appropriately handled as red bag waste,” he adds. “It’s all about education. I think most nurses simply need more information about appropriate segregation.”
It is possible that in an effort to be environmentally conscious, some staff members will get overzealous and put what should be red-bag waste into standard waste containers, Brown says.
It can certainly be mitigated, however. “There has to be a quality control protocol in place, which includes ongoing training and monitoring of waste containers,” she says. “Clear bag waste can also be visually inspected for bloody waste before being placed into the compactor. But, we are human and whether-red bagging everything in site or not, there will be mistakes. We need to understand that and educate landfill owners so if there is a contaminant, it can be addressed without fear. Good segregation practices need good education.”
Staff members aren’t the only ones who need education; stakeholders do too.
“We need to get these issues ... out of the basement and into the board rooms,” Brown says. “Often, high level executives think waste is below them and don’t concern themselves with the details and don’t realize how many resources are literally going out in the trash. We need to continue to raise awareness and get executives to address environmental issues at their level.”
If a staff member is not sure where they should throw an item, they should always err on the side of caution and dispose of the waste in a red bag.¹
A successful waste reduction plan is the culmination of many small steps. One recommended step is to color code all containers. Labels should be consistent throughout the institution.
A sign should be placed on all standard, red bag, sharps, and hazardous containers, and should include a clear list of what gets thrown in. The signs should employ a large, readable font and a bullet format. Use multiple languages if necessary.
There should always be a regular waste container next to infectious waste containers, because without ample regular waste containers, staff member might be compelled to throw standard trash into RMW containers.
All new employees should be trained on these points early in their orientations. “Staff should understand that improper disposal of their waste has potentially serious safety threats to waste haulers and increased liability for the hospital,” H2E documents state. “Make it clear to them that it is part of their job to manage waste safely.”
Current staff members should be re-trained on waste disposal through in-services, and should be held accountable through observation and annual reviews. Operating room (OR) staff members should be included, since they usually generate the most RMW.
It is also smart to consider using a reusable sharps container system if a hauler of one is available in your area.¹ This often saves money and reduces worker exposure to sharps.
On the Look-out
Keeping standard waste away from RMW receptacles is not hard, but does take consistency and perseverance. And there will be pitfalls along the way, experts say. It is important to handle problems as they come up, otherwise, old habits will arise.
Team members should monitor each other, and should maker certain that the following stays out of RMW:
Staff members should also try to minimize the amount of waste that is incinerated, as the incineration process depletes public health. Some haulers let customers choose between incineration and non-incineration technologies.¹
Awards and Rewards
Intrinsic motivation is invaluable, and many staff members will be spurred by it. To reward these people (and to inspire the rest), team leaders and/or administrators should applaud efforts by offering praise and rewards.
“Often, (the first waste changes) are met with resistance, but that is why employee recognition and taking the time to say thanks is such a huge part of this initiative,” Brown says.
H2E provides awards such as pizza parties, recognition, movie tickets etc., and encourages hospital administrators to follow suit.
When staff members feel empowered to make these changes and feel they are a necessary part of the process, they will be more likely to stay involved. Even at this point, oversight is necessary, Brown says.
“Ongoing training, monitoring and reporting are a requirement for success,” she says. “There are still many hospitals, though, that continue to overuse red bags and it’s like putting dollars in the trash can, which hospitals cannot afford to do. Red bag reduction is the first thing that hospitals should do in any environmental program, due to the huge potential for cost savings.”
Support for programs must start at the top, according to Krupp.
“I think the biggest challenge is convincing staff that the organization is committed as a whole to RMW,” he says. “This is a communications and management issue – helping all employees to understand how RMW is important to the institution.”
Overall, it makes sense that healthcare workers will embrace an environmental and cost effective stance toward waste disposal.
“There are amazing healthcare workers all across the country who take their own personal time to improve the environmental practices of the institutions they work in,” Krupp says. “People who work in healthcare settings are typically very committed to issues concerning health, and that definitely includes the environment.”
1. Regulated medical waste reduction: 10 steps to implementing a regulated medical waste reduction plan. Hospitals for a Healthy Environment. www.h2eonline.org/pubs/tensteps/Rmw10steps.pdf.