Medical Waste Management for Facilities Managers


Minimize that Waste!

The bigger your facility or organization, the more you need a waste minimization program. Without one, you are almost surely producing more waste than you need to. Facilities without a formal program are usually inefficient and can make great gains when they start. These gains show up all over: less waste means lower disposal costs, purchasing and inventory costs are often lower, operational efficiency often is improved, and there is less clutter in the facility.

Your employees might bristle at a waste minimization program Getting them on-board and participating is a people management challenge.

To develop and maintain a waste minimization program, you need accurate information on historical and expected generation rates by waste type as well as cost information on storage, treatment, and disposal.

A watchphrase among the recycling and green communities is 3R. This encourages people to think:

Reduce
Reuse
Recycle

when considering both workflow design and day-to-day operations.

Some evangelists have expanded to 6Rs, although there is no agreement about what all 6 Rs stand for. Some say

Recognize
Reconsider
Repair
Redce
Reuse
Recycle

Another list is
Refuse (to buy or take in what you do not need)
Reduce
Reuse
Recycle
Recover
Rot (let waste go to landfill, the least desirable option)

Or
Reduce
Rethink
Refuse
Recycle
Reuse
replace

Other Rs you can insert include replenish and respect.

Buzzwords, yes, but buzzwords can be given meaning and help people remember the mission. However you cut it, these admonitions call upon the operating manager to examine processes leading to production and management of waste throughout the facility.

Identification and Segregation

It is important to determine which materials are waste and what classification they fall into early (e.g. right after the waste is generated). Segregating the waste by type (e.g. pharmaceutical, pathological), can be useful in reducing the load on the treatment processes and reducing total cost of waste management.

Workforce Exposure

One of the occupational risks faced by healthcare workers is from exposure to infectious diseases at work. The World Health Organization estimates that there are at least 85,000 healthcare workers infected with hepatitis, and another 500 infected with HIV each year. While these are serious and well-known diseases, risks can suddenly arise from new diseases such as the recent Ebola epidemic in Africa. In addition to diseases spread by body fluids, there are respiratory illnesses such as tuberculosis, influenza, and severe acute respiratory syndrome (SARS).

Healthcare workers who can potentially encounter blood or body fluids, including laboratory personnel and cleaning staff, need to practice universal precautions. Selection of PPE should be based on a risk assessment of exposure. Gloves and facial protection are the most common types of PPE used in healthcare work.

Disinfectants

Is medical waste hazardous waste?

No. Most waste produced at healthcare facilities is not hazardous, and might be called “general non-hazardous waste” similar to that produced at non-medical office buildings or retail stores. It can be considered municipal solid waste for disposal purposes.

Some waste is considered healthcare risk waste - this is hazardous in the everyday use of the word hazardous - it can hurt people and animals and degrade the environment.

We have to be careful about what we call “hazardous waste”, The waste management community in the US at least, reserves and phrase “hazardous waste” for material defined as hazardous under RCRA. This encompasses listed wastes (waste that contains constituents specifically enumerated by the federal government, and characteristic wastes (materials that by their nature make them hazardous in at least one of four enumerated ways.

Plenty of healthcare facilities produce RCRA hazardous waste - almost all hospitals do. But other regulated waste produced at healthcare facilities is also of concern: pathological waste, radioactive waste, infectious or biohazardous waste.

Source reduction

Reducing production of waste is - other things being equal - almost always a good idea. It saves money on treatment and disposal costs and it reduces liability risk.

Healthcare facilities can reduce their waste costs by choosing wisely in purchasing and by proper inventory management. It takes some thought, but supplies that produce a less hazardous waste product and using as much as possible (preferably all) or the material in a container benefits your overall waste management profile. Possible techniques:

Use the oldest batch of a supply first and using all the contents of each container.

Use physical rather than chemical cleaning methods (e.g. steam disinfection instead of chemical disinfection).

Centralized purchasing and storage of hazardous chemicals also has benefits. It makes overall storage costs lower and risk lower, too,

Another purchasing technique is more frequent ordering of smaller quantities rather than larger but fewer purchases. This can often result in reduction of quantities used (applicable in particular to unstable products).

Checking of the expiry date of all products at the time of delivery, and refusing to accept short-dated items from a supplier.

Management Techniques

Containment - keeping medical waste from exiting to the environment and keeping facility occupants and visitors from exposure

Accounting - tracking waste items and batches through the facility and after it exits to the facility until it gets to final disposal

Segregation - using defined waste categories and keeping waste physically separated from waste in other categories.

On-site Treatment

Small facilities are almost always better off paying a contractor to handle their medical waste - haul it off, treat it, and dispose of it.

An exception is if your waste is exotic or unusual - so unusual that treatment processes - that tend to be blunt - may not be effective.

The originator of the waste retains some legal liability for it. You can’t necessarily wash your hands of problems for harm your waste may cause by paying for someone else to take it away.

Economy of scale matters for treatment and to a large extent for storage and packaging for disposal. A good rule of thumb is less than 500 lb/month is too small to merit any on-site treatment system. The break-even calculation depends on classification of waste types.

The Triple Bottom Line

The Triple Bottom Line is a useful construct that helps waste managers stay out of trouble. Activists try to apply this paradigm in many industries and encourage stakeholders to see a broader view of the effort. The components of the triple bottom line may be (1) profit (conventional bottom line), (2) environmental, and (3) social. For medical waste management, the “social” can be replaced with health and safety of facility personnel.

How to score these elements is a difficult question, if you want to be quantitative. The financial profit is the most straightforward and can be figured with accounting rules, if you are sure of the numbers. Environmental and health & safety "profits" or benefits are harder to calculate. Some management consultants may want to set up a system for you but any half-competent waste manager can probably do just as well. Even if you don’t attempt to run numbers on the impact of waste generation and your efforts to manage and treat it, keeping the triple bottom line in mind can help you weigh environmental and safety concerns.

Answering questions from the public in the case of an accident.