How to Reduce Waste Bags in Healthcare Facilities

Transcription

1 Reducing Waste in Irish Healthcare Facilities Results, guidance, and tips from a waste prevention programme. FACT SHEET Food Waste in Irish Hospitals

2 The Green Healthcare Programme (GHCP) aims to help healthcare facilities become more resource efficient, prevent/ reduce waste and cut costs. The Green Healthcare Programme is an initiative of the Environmental Protection Agency under the National Waste Prevention Programmme and the BeGreen umbrella. The programme was run on a pilot basis in the Southern region in 2009 and rolled-out across the country in To date the GHCP has provided more than 100 individual surveys to over 30 healthcare facilities, including acute hospitals and primary community continuing care (PCCC) facilities, both public and private. The acute hospitals involved in the programme represent 50% of the total acute beds in Ireland. Detailed surveys that assess waste management, food provision and utility provision were undertaken in the participating facilities. Through these surveys, and the follow-up work directly with the hospitals, the GHCP has developed an in-depth knowledge of how best to reduce waste and save money in healthcare facilities and has achieved impressive results. The GHCP continues to support participating facilities and has developed a number of guidance documents, which are combined in this booklet, including: Benchmarks - providing hospitals with valuable information upon which they can rate themselves and act Case Studies - based on actual work done in Irish hospitals, to reduce costs and waste Best Practice Guides - providing hospitals with valuable assistance in achieving best practice in waste reduction How-To Guides - giving step by step instruction to hospitals to reduce costs and become more resource efficient Factsheets - offering valuable information on an range of waste-related topics in Irish hospitals Staff can use this guidance on a day-to-day basis in their work, to prevent waste and reduce costs. Two separate booklets have been developed for the subject areas of food waste and all other waste (healthcare risk waste, recycling, mixed general landfill waste). This is intended to allow distribution of the information to the most appropriate staff members e.g. food waste booklet to the catering department, and other waste booklet to facility managers, waste management or environmental personnel. GHCP also facilitates the Green Healthcare Network, an online forum whereby healthcare professionals can share best practice and support each other (see website for details on how to join.) REDUCING FOOD WASTE IN IRISH HEALTHCARE FACILITIES TABLE OF CONTENTS FACT SHEETS Overview of Programme & Main Findings 4 Healhcare Risk Waste 10 General Landfill Waste 12 BEST PRACTICE Waste Bin Provision & Placement 18 Healthcare Risk Waste Reduction in the Theatre 20 Maximise Recycling and Reduce Landfill Waste 24 Healthcare Risk Waste Reduction 30 HOW-TO GUIDES Set up a Waste Prevention and Improvement Programme 36 Undertake a Detailed Waste Survey 42 Undertake a Bin Placement Survey 48 CASE STUDIES Midlands Regional Hospital - Tullamore 54 Cork University Hospital 56 St. Vincent s Private Hospital 58 University Hospital Galway 60 Temple Street-Children s University Hospital 63 All the guidance documents contained herein and more information about the programme can be found at 2

3 FACT SHEETS 3

4 Overview of Programme & Main Findings The Green Healthcare programme (GHCP) aims to improve resource efficiency and help prevent and reduce waste and emissions from healthcare facilities in Ireland. To date, the programme has worked with 30 healthcare facilities, including acute hospitals and primary community continuing care (PCCC) facilities, with almost 100 individual surveys undertaken. The acute hospitals involved in the programme to date represent 50% of the total acute beds in Ireland - a very representative profile of Irish hospitals. This comprehensive programme has been able to provide answers to the following: What is the average quantity of waste generated in Irish hospitals? How much of this waste can be prevented or better managed in a more sustainable and cheaper route? What potential cost savings can be made by preventing and better managing this waste? Outcomes from the Green Healthcare Programme IN THE 30 PARTICIPATING FACILITIES ESTIMATE FOR ALL ACUTE HOSPITALS NATIONALLY FOOD WASTE - Reducing food prepared but not consumed FOOD WASTE - Reducing food prepared but not consumed Potential tonnage Estimated costs Potential tonnage Estimated costs 1700 p.a. 2.8 million million p.a p.a. 5.2 million million p.a. HEALTHCARE RISK WASTE - Diverting non risk-items from healthcare risk waste HEALTHCARE RISK WASTE - Diverting non risk-items from healthcare risk waste Potential tonnage Estimated costs Potential tonnage Estimated costs p.a. 400, ,000 p.a p.a. 800,000-1,300,000 p.a. MAXIMISING RECYCLING - Diverting recyclables from general landfill waste MAXIMISING RECYCLING - Diverting recyclables from general landfill waste Potential tonnage Estimated costs Potential tonnage Estimated costs 1,900-2,800 p.a. 190, ,000 p.a. 3,700-5,400 p.a. 370, ,000 p.a. 4 BeGreen PREVENTING WASTE & SAVING MONEY The values identified in this table are costs. The actual savings that can be achieved will be a sub-set of these, and are dependent on the materials accepted for recycling by waste contractors, commitment of management, involvement of staff, and the provision of resources to assist in waste prevention measures.

5 Average waste generation benchmark A waste benchmark expresses the quantity of material used or generated per unit of hospital activity, in an average facility. Waste benchmarks (kg waste per in-patient bed day) have been generated for each waste stream for both acute and PCCC facilities. These benchmarks allow a healthcare facility to identify if they produce more or less waste than the average GHCP facility. If a hospital greatly exceeds these benchmarks, it may need to consider the reasons for this and implement improvement options. kg waste generated per in-patient bed day TOTAL WASTE: 7.7 kg Total non-risk waste: 5.8 kg 1.9 Healthcare risk waste Food waste Mixed Recycables TOTAL WASTE: 3.7 kg Total non-risk waste: 3.5 kg 0.2 General landfill waste Acute PCCC The GHCP undertook detailed work to determine what unit of activity was best to use in the generation of a waste benchmark. Units such as staff numbers (WTE), bed numbers and in-patient bed days were included in a statistical analysis.the best correlation or relationship between waste and activity was observed where the benchmark was expressed in terms of in-patient bed days. Food waste The GHCP carried out a number of detailed food waste surveys in both acute hospitals and PCCC facilities to determine the type and quantity of food waste generated in Irish healthcare facilities. The surveys recorded the quantity and type of food that was provided to patients, disposed of as waste, and by correlation eaten by patients. This allows an overall assessment of the effectiveness of the food delivery system. Key outputs in relation to food waste include: Waste benchmark An average acute hospital generates approximately 0.73 kg food waste per in-patient bed day, while the average PCCC facility generates a similar value of approximately 0.77 kg food waste per in-patient bed day. FACT SHEET Overview of Programme & Main Findings 5

6 Cost of food waste Certain food waste has no monetary value e. g. chicken bones. Other food waste, which could be avoided through better management of food provision does have a value - if it was not prepared the hospital would not have to purchase the food! Work undertaken in a number of Irish healthcare facilities found, that on average, this valuable food waste costs 2.15 per kg to purchase. If food waste with no value is included, a cost of 1.30 per kg applies to overall food waste (as collected by your waste contractor). These costs are just the costs to purchase the food. It does not include the staff costs to prepare the food, the utilities to cook the food and the cost of disposal. If these are included the true cost is much higher. Preventable food waste The surveys found that a significant proportion of the food that is prepared is not provided to or consumed by patients. Instead it is disposed of as valuable food waste (unserved, uneaten or untouched). The proportion that is eaten varied slightly between the different types of food provision system used. Between 45% and 51% of the food provided was eaten by the patients in acute hospitals, with the value increasing to 63% in PCCC facilities. This graph shows the breakdown between the different types of food waste generated. The associated cost of this food waste is also included. The graph is based on the findings from a select number of GHCP facilities, accounting for the variation with the total food waste benchmark. kg food waste per bed day Valuable food waste: 1.30 per bed day 0.03 (4%) Valuable food waste: 1.30 per bed day Valuable food waste: 0.08 (9%) 1.10 per bed day 0.28 (34%) 0.06 (8%) 0.28 (34%) 0.21 (31%) Untouched food waste Uneaten food waste Unserved food waste Valueless food waste How to read the graph: (39%) 0.19 (23%) Acute - bulk 0.27 (39%) 0.15 (22%) PCCC - bulk 0.28 (34%) 0.2 (23%) Acute - plated On average, bulk food systems in acute facilities generated 0.32 kg of unserved food waste per bed day, representing 39% of the total food waste generated. Uneaten food was generated in the next largest quantity with 0.28 kg of uneaten food waste generated per bed day, followed by valueless food waste representing 23% of total food waste. As expected, untouched food waste represented the smallest proportion of food waste, with 0.03 kg of untouched food waste generated per bed day. 6 BeGreen PREVENTING WASTE & SAVING MONEY

7 Healthcare Risk Waste The large cost difference between the disposal of waste as general landfill and healthcare risk waste ( 700 per tonne), means there is real potential to make cost savings by ensuring that only material that is healthcare risk waste is disposed of in this waste stream. The GHCP reviewed the contents of the healthcare risk waste bags to determine the type of materials within the bags. The surveys observed that, on average, only 66% of the waste in the bags was comprised of materials contaminated with bodily fluids, 19% of the bag was clean packaging, with the remaining 15% of the bag being clean non-contaminated materials that may not be risk waste. Other key information determined from the programme includes: Healthcare risk waste benchmark: Acute hospital kg per in-patient bed day PCCC facility kg per in-patient bed day In acute hospitals, average savings in the region of between 15,000 and 27,000 per annum in each hospital could be achieved by diverting non-risk and potentially may not be risk material from the healthcare risk waste stream. For PCCC facilities, which produce much lower levels of healthcare risk waste, the average savings could be in the region of up to 2,000-6,000 per annum in each facility. Typical costs for different waste disposal routes ( /tonne, 2012) Healthcare risk waste incineration 1,849 Healthcare risk waste sterilisation 813 How much does it cost to incorrectly dispose of non-risk waste in the healthcare risk waste stream? The graph to the right shows that it costs nearly 700 more per tonne to dispose of waste as healthcare risk waste, rather than as landfill waste. It costs over 1,000 more to dispose of waste as special (incineration) healthcare risk waste. Putting non-risk waste incorrectly into the healthcare risk waste stream can cost your facility a lot of money! Landfill Recycling FACT SHEET Overview of Programme & Main Findings 7

8 General landfill waste General landfill waste accounts for 61% of all waste (excluding food waste) generated in acute hospitals in Ireland, while it accounts for 69% in Primary, Community and Continuing Care (PCCC) facilities. So it is an important area to look at when trying to improve waste management and make cost savings. Other key information determined from the programme includes: Waste benchmark: Acute hospital kg per in-patient bed day PCCC facility kg per in-patient bed day On average, 32% of the general landfill waste bags surveyed in acute hospitals was recyclable material. In PCCC facilities only 16% of the waste was recyclable material. In acute hospitals, average savings in the region of 7,500 per annum per hospital could be achieved by diverting commonly accepted recyclables from the landfill stream. If the waste contractor accepts additional recyclable material, commonly generated in the healthcare sector, the potential average savings increase to 11,500 per annum. For PCCC facilities the average savings could be in the region of up to 1,000-1,500 per annum. What makes up general landfill waste? The graphics below outline the five most common items found in general landfill waste bags. ACUTE HOSPITALS PCCC FACILITIES Recyclables (combined materials) 32% Nappies & Incontinence wear 29% Tissues 18% Tissues 18% Food waste 17% Food waste 15% Nappies & Incontinence wear 6% Plastic disposable gloves 5% Recyclables (combined materials) 16% Non risk clinical type materials 4% Significant savings can be made by implementing measures to prevent or reduce the generation of such materials, and by improving waste segregation; to ensure the material is put in the correct waste stream. 8 BeGreen PREVENTING WASTE & SAVING MONEY FACT SHEET Overview of Programme & Main Findings

9 FACT SHEETS

10 FACTSHEET Healthcare Risk Waste Soft clinical waste bags (51% of total clinical waste) Rigid and sharps bins (46% of total clinical waste) Anatomical and cytotoxic bins (3% of total clinical waste) This factsheet provides an outline of the healthcare risk waste generated in Irish acute hospitals - where healthcare risk waste is generated, what is in healthcare risk waste, and what savings can be made through better management of healthcare risk waste. The information within this factsheet is based on the results of waste surveys carried out in over 50% of acute hospitals in Ireland. What materials should be disposed of as healthcare risk waste? Items contaminated with blood Items contaminated with body fluids other than faeces, urine or breast milk, e.g. pus, sputum or perinatal fluid Contaminated waste from patients with transmissible infectious diseases Incontinence wear - only from patients with known enteric pathogens e.g. salmonella, rotovirus Other healthcare infectious waste from treatment areas as covered by definition of infectious waste (Department of Health Guidelines) Nationally, savings of between 800,000 and 1,300,000 per annum could be made in acute hospitals, by ensuring that only healthcare risk waste is put into the healthcare risk waste stream. Two types of healthcare risk waste is generated in Irish healthcare facilities: Regular healthcare risk waste (soft yellow bags, sharps & rigid bins) - sterilised and disposed of in Ireland (2010: 9,171 tonnes) Cytotoxic and anatomical healthcare risk waste (sharps bins & rigid bins) - sent for incineration abroad (2010: 712 tonnes) Main sources of healthcare risk waste OPD 1% X-Ray 2% A & E 3% Other small areas combined, 34% Labs, 16% Wards, 26% Theatre, 17% Combined, the in-patient wards, theatre and labs account for 60% of the healthcare risk waste generated in acute healthcare facilities. 10 BeGreen PREVENTING WASTE & SAVING MONEY

11 How much does it cost to incorrectly dispose of non-risk waste in the healthcare risk waste stream? Putting non-risk waste incorrectly into the healthcare risk waste stream can cost your facility a lot of money! The graph below shows that it costs nearly 700 more per tonne to dispose of waste as healthcare risk waste, rather than as landfill waste. It costs over 1,000 more to dispose of waste as special healthcare risk waste. An example of clean composite packaging in a clinical risk waste bin Approximate costs for different waste disposal routes ( /tonne, 2012) Healthcare risk waste incineration Healthcare risk waste sterilisation Landfill!1,849!813!130 Recycling!0 What is in soft healthcare risk waste bags? As part of the Green Healthcare Programme, healthcare risk waste bags from over 50% of national acute facilities were surveyed to determine their contents. The contents were grouped into three categories: Non-risk waste: non-clinical material, which is clean and not contaminated with blood or bodily fluid, e.g. cardboard, plastic packaging, magazines, paper, etc.* May not be risk (uncontaminated): clinical material which may not, in fact, be risk waste as it is clean/ uncontaminated, e.g. clean table covers, clean gowns, unused medical materials, etc.* Healthcare risk waste: All other contaminated waste. * While some materials may be from isolation rooms, and thus classified as clinical risk waste, it is unlikely that this accounts for all of this average level of 19% across all bags surveyed. Non-risk material may also be placed into the rigid healthcare risk waste bins. These bins could not be examined as part of the surveys, as they are sealed in the medical area, before disposal. NON-RISK WASTE 19% MAY NOT BE RISK (UNCONTAMINATED) 15% HEALTHCARE RISK WASTE 66% FACT SHEET Healthcare Risk Waste 11

12 FACTSHEET General Landfill Waste This factsheet outlines what is in the general landfill waste (also known as household or domestic waste) generated in Irish hospitals. This information is based on a series of waste surveys carried out under the EPA s Green Healthcare Programme. Some simple facts about general landfill waste produced in Irish hospitals: It is estimated that all hospitals in Ireland combined produce 17,000 tonnes of general landfill waste per year. General landfill waste accounts for 61% of all waste (excluding food waste) generated in acute hospitals in Ireland, while it accounts for 69% in Primary, Community and Continuing Care (PCCC) facilities. On average in acute facilities 32% of the general landfill waste bags was found to be recyclable material. In PCCC facilities 16% of the waste is recyclable material. This is despite segregated recyclable collection being carried out in the majority of hospitals. Approximate costs for different waste disposal routes ( / tonne, 2012) Healthcare risk waste incineration Healthcare risk waste sterilisation Landfill Recycling ,849 Ranges from 105 to 148 Ranges from 0 to 85 You can save on your waste disposal costs by separating recyclables from the general landfill stream and segregating for recycling. It is nearly always cheaper to dispose of materials as mixed dry recyclables rather than as landfill waste (as shown in the figure above). The Green Healthcare Programme found, that on average, the acute hospitals participating in the programme could make savings of up to 7,500 by diverting commonly accepted recyclables from the landfill stream. If the waste contractor accepts additional recyclable material, commonly generated in the healthcare sector, the potential average savings increase to 11,500 per annum. For community hospitals the savings could be in the region of up to 1,000 to 1,500 per annum. Nationally, savings of between 380,000 and 550,000 per annum could be made in acute hospitals, by ensuring that recyclables are kept segregated from general landfill waste. 12 BeGreen PREVENTING WASTE & SAVING MONEY

13 5 Main sources of general landfill waste Combined, the in-patient wards, catering (canteen & kitchen), theatre and A&E account for nearly 60% of the general landfill waste produced in acute healthcare facilities. So its important to focus waste improvement options on these areas. Labs 2% OPD 1% X-Ray 2% A&E 3% Theatre 7% Other smaller areas combined 36% Canteens & Kitchen 16% Wards 32% What happens to general landfill waste when it leaves your healthcare facility? The majority of general landfill waste from hospitals is sent to landfill, although in recent times waste contractors have been required to process waste through materials recovery facilities. This separates some materials for recycling or energy recovery. Remember landfill charges per tonne still apply to all of the waste placed in your landfill/general waste compactor or wheelie bin. Food waste is the most preventable of all types of waste. General landfill waste bags contain on average 15% food waste. This waste should be segregated for composting or other recovery. For more information on food waste prevention visit the food waste section on the Green Healthcare website. Want to determine if you produce more general landfill waste than other acute hospitals or PCCC facilities? Have a look at the waste generation benchmarks in the FACTSHEET: Overview of Programme & Main Findings FACT SHEET General Landfill Waste 13

14 What makes up general landfill waste? These graphics outline the five most common items found in general landfill waste bags ACUTE HOSPITALS Recyclables (combined materials) 32% Tissues 18% Food waste 15% Nappies & Incontinence wear 6% Plastic disposable gloves 5% PCCC FACILITIES Nappies & Incontinence wear 29% Tissues 18% Food waste 17% Recyclables (combined materials) 16% Non risk clinical type materials 4% 14 BeGreen PREVENTING WASTE & SAVING MONEY FACT SHEET General Landfill Waste

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17 BEST PRACTICE 17

18 BEST PRACTICE GUIDE Waste Bin Provision & Placement Ensuring that your healthcare facility provides the right type of bin, in the right location, is essential to reduce the quantity of waste being incorrectly managed. Systematically looking at the number, type and location of bins in your facility, area by area, can help identify improvements. This Best Practice Guide outlines measures which should be observed in the provision of waste bins. Are the correct types of bins provided? Talk to relevant staff in the area and determine the type and quantity of waste that is normally generated in the area. Only provide a waste bin if that waste is generated. Try not to consider just in case scenarios. For example, don t provide a healthcare risk waste (HCRW) bin, if healthcare risk waste only needs to be disposed of occasionally. If there is the possibility of reasonable quantities of recyclable materials being generated, consider providing a recycling bin. Is the right number of bins provided? Is more than one of each type of bin, particularly landfill bins provided? This may be the case in large rooms. Waste bins are regularly emptied, usually once a day or more, so consider if one bin is enough? Multiple bins require cleaning staff to spend more time emptying bins, lining bins with bags and cleaning bins. Provide the right sized bin If only small quantities of healthcare risk waste and general landfill waste are generated, then it may be sufficient to provide a small bin. Bulky recyclable material cannot then be incorrectly placed in the general landfill bin or HCRW bin. Place the bin in the right location The general landfill waste and recycling bins should be placed as close to the main area of waste generation as possible. This is to limit the distance that staff have to travel with waste. Use clear instructional signage Staff are often willing to recycle, just like at home, but are unsure what can be recycled in a healthcare facility. Signage should be used to highlight to staff what can and cannot be placed in each type of waste bin. All instructional signage should be simple and use pictures or symbols rather than words. People recognise pictures quicker than words; making it easier to recognise suitable materials. Pictures are also helpful to overcome language barriers with international staff. All signage should be consistent across the different areas of the hospital, especially where staff move between different departments. All signage should be developed in line with infection control requirements. Have a look at the sample signage, as shown here, on the Green Healthcare Programme website. 18 BeGreen PREVENTING WASTE & SAVING MONEY

19 Focus on the position of the Healthcare Risk Waste (HCRW) bin Specific observations apply to the position of the HCRW bin, as follows: Good practice in provision of bins: HCRW bin positioned away from hand wash sink (left); small HCRW bin used in area with small level of healthcare risk waste generation (right). DO place the HCRW bin: Next to a general landfill waste or recycling bin. Staff have to make a decision on which bin to use. Make sure to place the general landfill or recycling bin closer to the main source of waste generation. Bad practice in provision of bins: Clockwise from top left: HCRW bin used as a doorstop; HCRW bin nearest hand wash sink; HCRW bin in multi-bed public access ward. DO NOT place the HCRW bin: Next to a hand wash sink as paper towels are usually thrown into the nearest bin, whether it is the correct bin or not. Place a general landfill bin or recycling bin next to the sink instead. Near the entrance to a room, especially where the door is continually open - it may be used by someone in the corridor. This does not apply in an isolation room, where the bin is used for the collection of PPE (gloves, gowns, aprons, etc). For similar reasons do not use a HCRW bin as a door stop. If retained in publicly accessible areas e.g. multi bed rooms, do not place within easy access of patient beds. Patients and visitors will generally place waste into the nearest bin. BEST PRACTICE Waste Bin Provision & Placement 19

20 BEST PRACTICE GUIDE Healthcare Risk Waste Reduction in the Theatre The EPA s Green Healthcare Programme (GHCP) found that, on average, 20% of the healthcare risk waste bags generated in acute hospitals come from the theatre. So it is an important location to look at when trying to reduce the quantity of healthcare risk waste generated in a healthcare facility. This Best Practice Guide outlines actions to minimise the quantity of waste, particularly healthcare risk waste, generated in the theatre. How do you reduce the quantity of healthcare risk waste generated in your theatre? The measures can be classed into three groups: u Prevent the generation of waste The best option for managing waste, recyclables and healthcare risk waste, is to prevent the waste being generated in the first place. Prevention options will not only reduce the quantity of waste produced and the associated cost, but may also provide additional costs savings e.g. through reduced purchasing. v Review the healthcare risk waste classification policy Waste may be unnecessarily classified as healthcare risk waste. w Increase the segregation of recyclables and minimise the non-risk waste content in the healthcare risk waste A significant proportion of the waste generated in the theatre is in the form of recyclable materials, mainly packaging. There is a big potential to increase recycling levels in the theatre, and so reduce the associated waste management costs. The healthcare facility should try to maximise the quantity of material segregated in recycling bags. 20 BeGreen PREVENTING WASTE & SAVING MONEY

21 u Prevent the generation of waste Generation of unused materials In theatres a set list of material and instruments (a surgical kit) is prepared for each procedure. Certain materials may no longer be used due to a change in the procedure or the instruments used. Additionally, a number of a material may be provided just in case. For hygiene reasons, any material that is not used in a theatre procedure cannot be removed for subsequent use, and is disposed of. To prevent the generation of these unused materials, the theatre should consider the following: Consult with anaesthetists, nursing and other staff who manage the waste, to determine the common items that are unused after procedures. Review the unopened material left after a procedure. Include clean material which may have been removed from its packaging, but not actually used. Start with the most common procedures first. Review a number of the procedures to determine if the material is commonly unused. Do different surgeons have different preferences for instruments in the surgical kit? Can a standardised list be generated for each procedure? Is sterile water for irrigation provided in larger volumes than is needed for a procedure? The unused liquid must be disposed of, representing a double cost to the facility. Can smaller containers of fluid be provided for the procedure? A list of materials that may be suitable for removal from each surgical kit can then be produced. Remember to look at surgical kits that are bought in pre-prepared by suppliers. Consult with the suppliers to remove the unwanted materials and review costs accordingly. Staff may be uneasy with the removal of a material from the surgical kit. Any materials removed from the surgical kit, can be provided in a nearby location within easy access if needed. The review of the materials in kits and what actually is used, should also be applied to minor procedure kits and suture kits used in wards and clinics. Tried and Tested! A hospital in the US reviewed the materials provided in their surgical kits. By removing the materials that were no longer used, the hospital reduced waste by 2.4 tonnes and saved the equivalent of 64,000 per annum. v Review the healthcare risk waste classification policy Sterilised and prepared theatre kits In general, for the majority of hospitals, all waste that has been in contact with the patient on the operating table, but may not be contaminated with blood or bodily fluid, is automatically classified as clinical waste. This includes table covers, gowns, etc. This automatic classification should be reviewed to determine if this type of material could instead be classified as non-risk waste. This automatic classification may reduce the time staff spends on managing waste. Materials are often left on the cover, the cover gathered together and it and its contents placed into the healthcare risk waste (HCRW) bin. However, this practice significantly increases the cost of waste disposal. Reduce use of disposable materials Where possible, the hospital should try to replace disposable single-use instruments, gowns, aprons and covers used in the theatre, with reusable alternatives. Single-use materials are heavily packaged. Reducing the usage of single-use instruments will also reduce the quantity of packaging to be managed. Disposable gowns and covers are bulky and fill up waste bags quickly. Studies carried out in other countries, have found that staff members can prefer the comfort of reusable gowns and aprons*. Reusable instruments are cleaned and sterilised in-house or externally. The cost of sterilising instruments in the Central Sterile Services Department, or externally should be considered when reviewing the use of disposable instruments. * CliniCum; The magazine for Managers in the Hospital, December 2010 Waste prevention measures in other juristictions: Use of reusable rigid sterilisation cases Sterilisation wrapping (plastic and paper) is generated in large volumes in the theatre. This wrapping (often blue) is bulky and quickly fills up waste bags. Reusable aluminium cases are used for the sterilisation of instruments in a number of US facilities. The system significantly reduced the cost of purchasing and disposing of wrapping, with a number of additional benefits (reduced tear or puncture of kits and subsequent re-sterilisation need, storage container for used materials). The payback period for the cost of purchasing equipment was in the region of only 2.5 years. BEST PRACTICE Healthcare Risk Waste Reduction in the Theatre 21

22 w Increase the segregation of recyclables and minimise the non-risk waste content in the healthcare risk waste Level of recycling in theatres 40% 11% Mobile recycling bin (centre of photo) - brought to theatre preparation area to encourage segregation of recyclables. Pedal operated mobile bins with lids also avaiable. GHCP facilities that actively segregate recycables Average for GHCP acute facility Remove the clinical bin from the area when not needed Prior to the commencement of the procedure, when instruments and materials are being prepared, remove the HCRW bin from the area or move to a position where it is not readily accessible. If the bin is not available, staff cannot incorrectly place material in the bin. Provide enough recycling bins Recycling bins should be provided in all areas where recyclables are generated (operating theatre, preparation rooms, etc.). A GHCP facility with a high level of recycling in the theatre, uses a mobile recycling bin (stand with open bag). The stand can be moved close to the area(s) where preparation of materials takes place. Having the bin closer to the staff makes segregation easier, as staff do not have to carry loose packaging to a fixed bin. Where space is limited in the theatre during the procedure, the mobile stand can be removed prior to the start of the procedure. Another option is to line one of the HCRW bin or general landfill waste bin with a clear bag. All packaging is placed into this bag during preparation, with the clear bag removed prior to the start of the procedure. Maximise the segregation of recyclable materials before the start of the procedure Maximising the quantity of packaging on materials that is removed and segregated before the start of a procedure, reduces the potential for packaging to be contaminated and treated as healthcare risk waste. Unpacking material before the procedure also reduces the time that staff have to spend preparing materials during the procedure (when their time is most valuable). In those GHCP facilities that actively segregated recyclables in the theatre, 40% of the total theatre waste was recycled. In other GHCP facilities, on average, only 11% of the waste was recycled. Large volume of packaging on materials stored in a theatre scrub room 22 BeGreen PREVENTING WASTE & SAVING MONEY

23 EASE OF THE SEGREGATION OF NON-RISK MATERIALS INTO GENERAL LANDFILL AND RECYCLING BAGS BEFORE THE PROCEDURE DURING THE PROCEDURE AFTER THE PROCEDURE EASY Material is definitely not contaminated. All waste should only be placed into the recycling or general landfill bins. MEDIUM Large number of staff in the theatre, and work requirements, may restrict the ability of relevant staff to move waste to the correct bin. The relevant bins should be placed in the vicinity of the staff most likely to manage the waste. DIFFICULT Staff are usually under time pressure to empty and clean the theatre. Generally, all disposable waste is left on the operating table or instrument stand covers. The covers are gathered up and all waste is disposed of as healthcare risk waste. Instead staff should quickly review the materials to determine if contaminated and dispose of in the correct bin. SEGREGATE RECYCLABLES: Ensure staff know what can be placed in the recycling bags. Following consultation with the facility s waste contractor and/or suppliers, a list of what can be placed in the recycling bags should be generated and provided to all staff. Materials (once clean) which are generally suitable for inclusion in mixed recycling bags in theatres include: Packaging, including - plastic and paper composite packaging (both hard plastic and plastic film) e.g. peel pouch plastic film - rigid plastic packaging - cardboard - paper packaging Plastic containers from surgical kits e.g. graduated containers, trays, etc. Selected facilities only: CSSD wrapping T able coverings and gowns in line with the theatre s clinical waste classification policy BEST PRACTICE Healthcare Risk Waste Reduction in the Theatre 23

24 BEST PRACTICE GUIDE Maximise Recycling and Reduce Landfill Waste This BEST PRACTICE guide outlines actions to reduce the quantity of recyclables disposed of in the general landfill and clinical risk waste streams. These best practice measures have been observed in a number of healthcare facilities, which have corresponding low levels of recyclables in the landfill/ clinical waste streams. How do you reduce the quantity of general landfill waste generated in your facility? General landfill waste (a.k.a. general waste, mixed waste, or residual waste) is generated in all areas of the hospital. It is usually the type of waste produced in the largest quantity in healthcare facilities. So it is an important type of waste to look at in terms of reducing waste generation and costs. General landfill waste bags were surveyed or characterised in the majority of Green Healthcare Programme (GHCP) participating acute hospitals. The figure to the right shows that, on average, across all facilities, nearly half (47%) of the landfill waste stream was composed of recyclables and food waste. Your facility can reduce the quantity of landfill waste generated, by removing or diverting the recyclable materials and food waste from the landfill waste bins.these materials should instead be placed into a separate recycling bin, or food waste bin for composting or other such recovery. Generally, recycling and food waste streams cost less to manage per tonne than disposing of in the landfill waste stream. How much of the landfill waste stream can be removed and managed better elsewhere? 35% 30% 25% 20% 15% 10% 5% 0% 32% Recyclables 15% Food Waste Poportion of the general waste bags that was attributable to recyclables and food waste (across all facilities surveyed) The Green Healthcare Programme found, that on average, the acute hospitals participating in the programme could make savings in the region of 7,500 by diverting commonly accepted recyclables from the landfill stream. If the waste contractor accepts additional recyclable material, commonly generated in the healthcare sector, the average savings increase to 11,500 per annum. For community hospitals the average savings could be in the region of 1,000 to 1,500 per annum. 24 BeGreen PREVENTING WASTE & SAVING MONEY

25 First thing to do - review your current recycling policy & system Is there a clear recycling policy in place in your facility? Is there a recycling policy in place in your facility, and is it supported by management? If the policy is supported by hospital management it will provide greater impetus for areas of the hospital to actively segregate recyclables. Are mixed recycling bags used in your facility? Cardboard is generally segregated in all facilities, as it is produced in large volumes and is easily recognised as recyclable. By separately collecting and baling cardboard a revenue can also be received. Lots of other materials generated in your facility may also be recycled (e.g. paper, plastics, composite packaging). By using a mixed recycling bag for such materials, you can place all recyclables in one bag, reducing the space needed for multiple bins. What resources for recycling are available in your facility? If you plan to increase recycling, ensure that you have enough space in your waste holding area to hold a compactor or extra bins, to store the recyclables. Determine what can be placed in mixed recycling bags Consult with your waste contractor, and suppliers where necessary, to determine what materials are suitable for inclusion in mixed recycling bags. Everyday recyclable materials, which are recycled at home, are accepted in recycling bags (cardboard, plastic containers, newspaper, office paper, etc.). There are a number of additional materials generated in healthcare facilities which may be accepted in the recycling bag, composite packaging (peel pouch type packaging. Look at the table below for an outline of what is generally accepted in mixed recycling bags from healthcare facilities. Materials generally accepted in mixed recycling bags from healthcare facilities Packaging (clean and uncontaminated) Other materials (selected facilities) Rigid plastic e.g. milk & drink bottles, irrigation fluid bottle Paper packaging, newspaper, magazines and office paper Composite packaging Comprised of more than one type of material e.g. paper and plastic. Plastic may be rigid or film Cardboard e.g. glove box Plastic film Metal packaging e.g. aluminium cans, tin cans Plastic containers e.g. graduated bowls, suture kit trays Composite coverings Comprised of more than one material (paper and plastic). Paper covers with heavy plastic coating may not be accepted CSSD wrapping Wrapping used on sterilised kits. Wrapping can be paper based or paper/plastic composite BEST PRACTICE Maximise Recycling and Reduce Landfill Waste 25

26 Look at the type of waste generated and review the general landfill and clinical waste bins provided. If no landfill or clinical waste is generated in an area, make sure to remove these bins. The more bins you provide in your facility, the more work needed to empty, re-line, and clean bins. If only small quantities are generated, then provide a small bin. If the waste is only generated in one area of the room then move the bin to this location. For example, if only hand towels from the handwash sink are disposed of in the landfill waste bin, then place the bin next to the handwash basin. For example, in one facility, the anaesthetist produces small quantities of clinical waste, but is not provided with a clinical waste bin. The waste is removed by nursing staff and placed in another bin. This reduces the work associated with emptying and replacing the bag in a barely filled bin. Example of the correct provision of bins in the corridor of a ward. A large quantity of recyclables and a small quantity of general landfill waste are produced in the area. The corridor is thus provided with a large recycling and small general landfill waste bin. Undertake a waste bin placement survey Do this in the different areas of your facility, to determine if the right bins are provided in the right location. See the How-To: Undertake a bin placement survey on the Green Healthcare website for more information. Important steps to ensure your recycling bins are properly used Make it clear what can be placed in the recycling bags: Compile a clear list of the materials that are accepted in the mixed recycling bags, and provide this to staff ahead of the roll-out of the bags and campaign. Outline that all other material should be placed in the general landfill waste bag. Particular types of recyclable materials may be found in large quantities or only in certain areas, e.g. large plastic containers in dialysis, CSSD wrapping in theatres, paper table covers in clinics etc. So you may only have to outline these materials on the list for these areas. At the start of the programme, instructional signage may need to be placed on or above bins. As staff become used to the recycling system and what is acceptable in the bins; the signage may be removed from medical areas, in line with infection control best practice. University teaching hospitals may need to retain signage due to the high turnover of students. The signs should be retained on bins in areas with high public footfall (e.g. waiting rooms, corridors) to assist the public to correctly use the bins. 26 BeGreen PREVENTING WASTE & SAVING MONEY

27 Important steps to ensure your recycling bins are properly used - continued Ensure recycling bags are placed in the right location: Ensure a recycling bin is provided in those areas where large volumes of packaging are generated (e.g. clean preparation rooms in wards, store rooms, etc.). Within the room or area, position the bag where the recyclable material is generated (e.g. near workbench or near storage cupboard), rather than at the entrance to the room. Staff won t then have to carry the bulky recyclables a distance to the bin. Use different colour bins for each type of waste: Where possible use different coloured bins for each type of waste. People recognise colours and symbols quicker than reading words - so by using different colours staff can quickly recognise what type of waste should be placed in the bin. Suggested colours are: CLINICAL: Yellow (clinical bins are generally always provided in yellow) Make the recycling bins easy to use: Consider using mobile bins where high volumes of recycling are generated in different areas at different times. For example, in a theatre, packaging is generated in the preparation area before the procedure and in the vicinity of the operating table during the procedure. The mobile bin can be moved to another area when needed. Mobile bins are also beneficial if space is limited in connecting rooms (e.g. theatres, out-patients clinics and preparation rooms), and it is not possible to provide a recycling bin in each room. The mobile bin can be moved between the rooms, as needed. This also reduces the investment required for the purchase of bins. GENERAL LANDFILL: White RECYCLING: Green Ideally general landfill and recycling waste bags should be clear plastic to allow staff to view the contents of the bag. They can then determine if the bag could be recycled. If available and economically viable, consider using clear green waste bags for recyclables. The use of coloured bags makes it easier for portering staff to identify the type of waste, especially when they manage different waste bags. Segregating all recyclables on the ward is only worthwhile if porters place the waste bags into the right compactor. A mobile recycling bin in use near an equipment preparation area. Where budgets for the purchase of different coloured bins are restricted, or a stockpile of bins are available, then consider using different colour identifying signs for each type of bin. For example the recycling bin sign should have green colouring and the general landfill a white or black colouring. Commercial facilities can also recondition bins (spray paint) for other use, e.g. yellow HCRW bin to green recycling bin. BEST PRACTICE Maximise Recycling and Reduce Landfill Waste 27

28 Important steps to ensure your recycling bins are properly used - continued Prevent contamination with liquid and food: Food or liquid waste (e.g. coffee) can easily contaminate a mixed recycling bag so badly that it has to be disposed of as landfill waste. In areas where quantities of food or liquid waste are generated (e.g. areas providing food, waiting rooms with drink facilities, etc.), consider providing a food waste bin or liquid waste bin, to prevent the contamination of the mixed recycling bags. The segregation of the food and liquid waste will also reduce the contamination of general landfill waste bags. These bags can leak during transport, resulting in possible cleaning and slippage issues. In general, segregated food waste is also cheaper to dispose of than when the food is disposed of in the landfill waste stream. Did you know... Recyclables have a value. Recyclables can be traded as resources on the open market, with waste contractors selling recyclables to recycling processors. The value of these materials varies, but can range from around 50 per tonne for low grade plastic film, to 850 per tonne for aluminium (March 2012). For those materials with a high value, the waste contractor may offer a rebate (or money back) for clean, segregated material. For example, clean cardboard can attract a rebate in the region of 30 per tonne. As recyclables have a value, waste contractors may collect recyclables for no charge per tonne, but charge for collecting the material (charge per lift of bin or compactor). So, where possible, it is important to maximise the segregation of each type of material. For example, if cardboard is segregated, the hospital will receive money, but not if the cardboard is placed in the mixed recycling bag. Keep this in mind when negotiating charges in your waste management contract. Skips waste money! Skips have been found to encourage the mismanagement of waste. Due to their size, recyclables can easily be thrown into the skip. Open skips allow rainwater to enter the skip, which is then absorbed by absorbent materials (e.g. cardboard). As skips are charged by weight, this can significantly increase your costs. Example of a badly used skip containing WEEE and recyclables (cardboard, metal and plastic) - significant proportion can be recycled Important to note is that WEEE should not be landfilled by law. The waste management contractor may sort out the materials at their own facility, but you will still get charged landfill rates for all of the weight of the skip. 28 BeGreen PREVENTING WASTE & SAVING MONEY BEST PRACTICE Maximise Recycling and Reduce Landfill Waste

29 BEST PRACTICE

30 BEST PRACTICE GUIDE Healthcare Risk Waste Reduction This Best Practice Guide outlines actions to reduce the quantity of non-risk waste disposed of as healthcare risk waste. The information has been gathered through work undertaken with a number of Green Healthcare Programme hospitals, who have been observed to operate best practice measures. Can you reduce the quantity of healthcare risk waste generated in your hospital? The correct management of healthcare risk waste minimises the risk of the spread of infection. Consequently, healthcare risk waste is sterilised or incinerated when disposed of, at a much higher cost than that for landfilling the waste. Healthcare risk waste bags were characterised in a number of Irish acute healthcare facilities which participated in the Green Healthcare Programme. These surveys found, that on average, 19% of the healthcare risk waste bags was obvious non-risk material (packaging and non-clinical items). An additional 15% of the bags was comprised of materials, which were uncontaminated, and may not be healthcare risk waste. Simply put, your facility can reduce the quantity of healthcare risk waste it generates, by avoiding non-risk waste being incorrectly placed in the healthcare risk waste stream. What is healthcare risk waste (HCRW)? Healthcare risk waste is waste from healthcare facilities, which poses a risk due to its potentially infectious nature. It includes wastes such as sharps, anatomical waste, blood, and items contaminated with blood or other bodily fluids (excluding faeces & urine). Cytotoxic drugs (used in cancer treatment) or other pharmaceuticals are also handled as healthcare risk waste. Healthcare risk waste is generated in the treatment of patients isolated with infectious or transmissible conditions. Healthcare risk waste is also generated in the everyday treatment of patients e.g. dressings, alcohol wipes, tissues, etc., that are contaminated with blood or other bodily fluids. 30 BeGreen PREVENTING WASTE & SAVING MONEY