Waste Management. at Providence St. Vincent s Medical Center

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1 Waste Management at Providence St. Vincent s Medical Center

2 Providence Recycles

3 What s in Your Garbage Paper Cardboard Plastic Sterile Wrap The equivalent of 5.5 Volkswagens of trash leave St. Vincent s Campus 6 day a week Medical Waste Food Scrap Disposable Dishware

4 Composition of Hospital Waste

5 Providence St. Vincent Waste Sort Waste Sort Trash Collection for Waste Sort

6

7 Commingled Recycling Material diverted from Trash Chutes Recyclable material waiting to be sorted at Warehouse

8 Material being sorted at the warehouse

9 Issue: Contaminates in the recycling

10 Issue: Hazardous items in Recycling

11 Warehouse improvements 2005 processed 35 Supersacks per week 2008 processed 110 Supersacks per week 2008 added 3 vocational staff 2008 purchased a new baler to process additional recycling. All this being done with down turn in recycling markets.

12 What else can be recycled???

13 What else can be recycled??? Cardboard Paper, shredded onsite and recycled by Iron Mountain Glass, Tin cans, Block Styrofoam, Used cooking oil. Food waste & Compostable Fiber

14 Providence Composts

15 Setting the Stage Started as byproduct of a project with Wash. County Recycle at Work program Waste sort revealed 23% was food waste and compostable fiber Food waste compactor was required to comply with regulatory environment. Grant funding was made available by the Portland Metro region. Funded 75% of total project cost.

16 Project Costs

17 Composting Program Team formed: Nutrition, EVS, Garden and Grounds. Hands-on training + signage Currently putting 3+ tons of pre and post consumer food waste, compostable fiber and yard debris per week in our compactor.

18 Composting Benefits Increased recycling Financial gains, savings on disposal cost of $47 per 3 tons per week = $564 per month. Reduction of material going to a landfill that creates methane (a green house gas).

19 Program Impact: 2008 Waste Stream Costs SUMMARY YTD lbs. YTD Tons % Costs* $/lb $/Ton Solid Waste 2,774,880 1, % $164,919 $0.06 $ Recycling 2,576,831 1, % -$167,914 -$0.07 -$ Reg Med Waste 663, % $317,129 $0.48 $ Haz W % $1,500 $2.50 $5, Total 6,016,156 3, % $315,634 $0.05 $104.93

20 Program Impact: Practice GreenHealth & H2E Environmental Awards 2005 Partner Recognition 2006 Partner for Change 2007 Partner for Change and Making Medicine Mercury Free 2008 Environmental Leadership Award 2009 Environmental Leadership Award Check out Practicegreenhealth.org

21 Lessons Learned: Development of Administrative Support Understanding and communicating program impact on environmental sustainability is critical. Found that the business case (although compelling) is often secondary motivation for administration. Real support for innovative and system wide sustainability efforts came when the decision makers were brought to the table. Sustainability Council, created 2006 Composed of managers, administrators and green team chairs.

22 Lessons Learned: Communication is Key to Success Communicating to staff Staff education In-service Presentations Video Employee Forums Newsletter Green Teams Community Outreach BBQs, Zero Waste events Media spots, KATU news segment

23 Staff Training Make staff aware of facility s RMW reduction goals. Retrain current staff with agreed upon definition of RMW. Train new employees about waste segregation procedures as part of employee orientation. Consider making compliance with hospital waste management policies part of every job description.

24 In-services & Communication Collections & Shipping

25 WASTE and BIOHAZARD DISPOSAL GUIDELINES DISPOSAL COST = 3 cents per lb TRASH EMPTY: IV Tubing IV Bags WITHOUT patient information DISPOSAL COST AFTER STEAM STERILIZATION = 3 cents per lb RED Tub SATURATED = Any item with blood/body fluids (when squeezed will drip) JP & other small drains with fluid Empty blood transfusion bags & tubing Items containing Patient Information DISPOSAL COST = 48 cents per lb BLACK Tub Sharps containers Glass slides & vials Syringes BULK Body Fluid filled containers OTHER: Unsaturated sponges/drapes contaminated with blood or body fluids EXAMPLES: IV bags WITH patient information Patient ID Bands & plastic admit cards Empty plastic medication bottles Plastic specimen tubes & transport bags EXAMPLES: Questions? Contact Environmental Services at x62201 Suction canisters Hemovacs Pleurovacs

26 Problem Identification & Resolution Plan You WILL encounter mistakes. Conduct tours of trash areas monthly. Take a digital camera! Develop a mechanism to report concerns or issues (e.g. photo along with written report of issue and responsible floor/dept/unit.) Re-educate promptly. Hold in-service with responsible unit to explain problem and proper segregation technique. Engage a nurse leader to help communicate program.

27 Training: Where does it go!

28 Training: Where does it go!

29 Training: Limit free flowing liquids

30 Signage

31 Lessons Learned Setting the Stage for Success Importance of Effective Signage Post signage above or on RMW containers outlining types of waste are to be disposed of as RMW Use large font and bullet format, preferably in color Consider MULTIPLE LA GUAGES to ensure optimal communication. Importance of Container Size and Placement RMW containers should be covered to reduce solid waste. Remove red bags from under hand-washing sinks, non-critical care patient areas, hallways and other areas where people are likely to dispose of solid waste. Remove red bags from patient rooms where possible Where there ARE red bags, locate a solid waste container directly adjacent so staff make conscious disposal and segregation decisions.

32 New Trends and Technologies

33 Benefits Reusable Sharps Container Reduce waste Programs Improve worker safety through decreased needle-sticks Save money Eliminate purchase cost of new containers; Decrease waste costs by not paying for container weight Decrease labor costs associated with collecting and replacing containers More timely pick-up Tips Service Includes Check out hauler ask for Audit recommendations Container installation Work with hauler to adjust pick-up timing/container replacement On-site pick-up and replacement See if you can include final disposal cost Mechanical mechanism to empty for old sharps containers in contract Reused 500 times w/ proper disinfection Work with hauler to determine staging area 10-30% potential reduction in needle-sticks for sharps containers

34 Reusable Containers Boulder Community Hospital Case Study Invested in hard cases - $120,000 one time cost. Reduced disposable blue wrap purchase from $250,000 in 2003 to $60,000 in 2005 or $190K in savings. This does not include reduction in waste costs. Manufacturers of surgical equipment are now required to provide the durable container as part of the equipment purchase.

35 Single Use Device Reprocessing Benefits Increasing # of disposable products in healthcare Formulation hasn t necessarily changed, but profit margin has. Hospitals used to sterilize onsite through CSR then FDA cracked down. Third party preprocessors emerged. Nearly half (45.2 percent) of all hospitals with more than 250 beds reuse SUDs, compared to only 12.3 percent of hospitals with fewer than 50 beds. How Third Party Reprocessing Sterilize used, unused but open or expired materials for reuse in patient care settings Strictly regulated by FDA TPRs incur liability from faulty devices No reported deaths from using reprocessed devices per FDA database. Single-use is a labeling designation determined by original equipment manufacturers (OEMs) and not required by the FDA

36 Hospital Waste Management Tracking and Measurement Tool Demonstration of Excel Tracking Tool Getting good data from vendors/service Getting good data from vendors/service providers

37 Why Should Hospitals Track Waste Data? Establishes baseline to measure success Helps identify inefficiencies Helps identify potential cost reductions Helps set priorities for waste reduction Helps identify procurement priorities Provides justification for environmental programs

38 Analyze 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 to calculate the amount (weight or volume) and cost of each waste stream

39 Hospital Waste Management Planning & Goal Setting Using Green Teams, Sustainability Councils and other employee teams to develop annual sustainability goals Accountable individuals and departments to implement On-going measurement and tracking Reporting annually, written and presentation to top administrators

40 Providence Portland Area Sustainability Goals Areas of Focus Solid Waste Diversion Goal: Increase recycle rate to > 50% Strategies: Landfill avoidance through programs addressing red bag, haz waste, e-wste (cost savings) Supply Chain Initiatives Goal: Increase environmental Friendly purchasing when cost and quality components line up Strategies: Reprocessing initiatives including surgical services, sharps containers; Partner with PHS system supply chain initiatives and Novation (GPO) Environmental Management Plan Goal: Department level assessment of process, waste stream and impact Strategies: Conduct assessment

41 Providence Portland Area Sustainability Goals Areas of Focus, Continued Healthy Food Initiatives Goal: More local and organic food sourcing Greening the Built Environment Goal: Incorporate best practices in green healthcare design & construction Energy Conservation Goal: Develop system initiatives partner and raise local awareness Communications Plan Goal Internal: Endorsement of statement of goals, annual report, internet site Goal External : Reporting and media opportunities

42 Hospital Waste Management Policies to Support Environmentally Preferred Purchasing Policies That address reduced packaging less waste to handle That address material composition of packaging or devises recyclable, compostable, etc. That address reuse and remanufacturing That address issues of cost differential for preferred products by including total life cycle cost of products (including those externalized) in analysis.

43 Contact Information Mike Geller Regional Sustainability Coordinator Providence Health &Services

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