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Industry profile
According to the New York State
Department of Labor, there are more than 350,000 people who work in the healthcare industry in New York City. Almost half of them are employed by the City’s 96 voluntary, municipal, veterans’, and psychiatric hospitals, while the remainder are employed by physician offices and outpatient, nursing, and residential care facilities.
The Tellus Institute’s Healthy Hospitals: Environmental Improvements through Environmental Accounting states that hospitals in the United States generate two million tons of solid waste per year or, on average, fifteen pounds of waste per patient per day. The New York City Health and Hospital Corporation’s New York City Medical Waste Management Study (1991) estimates that NYC hospitals generate roughly 705 tons of waste per day. These figures do not account for the additional volumes of waste created by physicians, as well as outpatient and residential care facilities.
A typical healthcare facility waste stream can be broken down into two categories: non-regulated medical waste (NRMW) and regulated medical waste (RMW).
NRMW makes up approximately 85 percent of a facility’s waste stream; it consists primarily of items typically generated through administrative, shipping/receiving, maintenance, and food-service activities. It is estimated that 45 percent of NRMW is comprised of office paper, corrugated cardboard, and paper packaging, while plastic and food, respectively, account for 15 percent and 10 percent of NRMW.
RMW makes up the remaining 15 percent of a healthcare facility’s waste. RMW is normally segregated at the point of generation because it is considered potentially infectious. RMW generally includes items like laboratory cultures and stocks of infectious agents, human blood and blood products, pathological waste, sharps, isolation waste, and animal waste.
In addition to solid waste, healthcare facilities generate a small percentage of hazardous waste that must be handled differently than medical waste. Examples of hazardous wastes created in healthcare facilities include mercury, formaldehyde, spent solvent, and photographic chemicals.
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Waste prevention tips for healthcare facilities
Check out the topics below for tips on how to reduce costs and increase efficiency in your healthcare facility:
 reusable supplies and equipment
cleaners and disinfectants
mercury
medical waste
environmental management systems
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REUSABLE SUPPLIES AND EQUIPMENT
Switching from single-use to reusable supplies and equipment can substantially reduce your facility’s long-term purchasing and waste removal costs. Using reusable linens, gowns, delivery totes, sterile trays, and sharps containers, or reprocessing and reusing single-use devices for medical and surgical procedures are a just a few examples of ways that healthcare facilities across the country have taken steps to reduce their bottom line.
Prior to making a switch, a value analysis should be done to determine if there are any patient-safety, legal, or contractual labor issues that may arise. Product testing will help determine whether the new product contains the same quality, safety, and durability as the single-use item targeted for replacement. Educating medical and maintenance personnel prior to any switch in product use can provide valuable insight to the purchaser, as well as make the transition to the new product smoother.
Other issues to consider when doing a value analysis to determine if reusables will be beneficial include:
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cleaning (labor, energy, water, etc.), reprocessing, and distribution costs
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additional space requirements for reprocessing and storage
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life span of a reusable
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any increase in staff time to carry out the same task
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infection control
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patient perception of cleanliness and sterility
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regulatory constraints
ALSO SEE resources for more information on reusable products and incorporating value analysis into your purchasing decisions. Go to case studies to see how healthcare facilities have saved money through reusables and other waste reduction activities.
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CLEANERS AND DISINFECTANTS
Many cleaners and disinfectants commonly used in routine maintenance activities have the potential to have adverse impacts on indoor air quality and on employee and patient health when used improperly or for extended time periods. Less-toxic, environmentally friendly maintenance products exist for almost all cleaning and disinfecting needs. For information on safer use of cleaners, as well as information on the toxic constituents found in cleaners and a listing of vendors selling alternative products, visit cleaning products and reducing toxics in waste less at agencies & schools.
In addition to using cleaners in common areas, healthcare facilities use an array of disinfectants and sterilizing solutions on various surfaces and instruments to reduce or eliminate the risk of infection caused by microbiological contamination. Studies have shown that two of the more commonly used products, glutaraldehyde and ethylene oxide, can cause serious health effects.
Glutaraldehyde can cause skin irritation, asthma, headaches, and nausea. Anecdotal reports have also detailed some occurrences of chemical sensitization disorders.
Ethylene oxide is extremely reactive and flammable; it also has been identified by the National Toxicology Program as a known human carcinogen. Depending on the type of exposure, it can also cause nausea, vomiting, neurological disorders, damage to the central nervous system, liver, and kidneys, and it may pose reproductive hazards.
Cost-competitive alternatives exist for both products. Examples of alternatives for glutaraldehyde include Cidex OPA, Sporox, and Sterilox. Alternatives for ethylene oxide include Sterrad, Sterris, and Metrex Compliance. When comparing either product to a less toxic alternative, it is important to evaluate whether there will be any impact on:
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instrument or equipment use, wear, or warranty
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required emissions controls
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waste management practices and costs
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regulatory requirements
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other operational costs (labor, time to disinfect/sterilize, or staff training)
ALSO SEE resources for more detailed information on the benefits of switching to safer disinfectant and sterilization solutions.
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MERCURY
Mercury conducts electricity, expands and contracts with temperature, possesses anti-bacterial and antifungal properties, and readily amalgamates with other metals. It is an extremely useful substance that has many everyday applications in healthcare facilities and other workplaces. It is also a persistent bioaccumulative toxin that can be hazardous if inhaled, ingested, or absorbed dermally. There is minimal risk of exposure during normal use of mercury-containing products; however, when incinerated or improperly disposed of, mercury can be released into local waterways, air, or the environment.
Healthcare waste can contain up to 50 times more mercury than general solid waste. The American Hospital Association has entered into a partnership with the U.S. Environmental Protection Agency to eliminate the use of mercury in hospitals by 2005. Many state governments and individual healthcare facilities have established best management practices for the management of mercury-containing products.
The New York State Department of Environmental Conservation suggests the following best management practices for healthcare facilities:
Use alternatives for products that contain mercury. Alternative mercury-free products can make your workplace safer and decrease waste disposal costs. Pilot testing new alternative products in a variety of settings is important. It allows staff to provide feedback, and can help to determine the viability of a given product in your facility.
See case studies to learn how the Hospital for Special Surgery eliminated mercury-containing blood pressure machines hospital-wide.
Mercury-containing items typically found in healthcare settings include the following:
- thermometers
- sphygmomanometers
- esophageal dilators (bougie tubes)
- Cantor and Miller Abbott tubes
- feeding tubes
- dental amalgams
- various laboratory chemicals (fixatives,
stains, reagents, preservatives)
- manometers
- thermostats
- button-cell batteries
- fluorescent lamps
- switches and relays (in some lights and appliances)
Recycle mercury-containing products when they can no longer be
used. Numerous vendors across
the country accept and process Mercury for recycling. Various
vendors provide pre-paid shipping containers that can be filled with
Mercury products and shipped directly to the vendor's recycling facility.
Establish practices to handle and dispose of mercury and mercury-containing equipment correctly.
Develop policies that support best management practices.
Bar the practice of sending mercury fever thermometers home with patients. Many states have banned the sale of mercury fever thermometers.
ALSO SEE resources for more information on mercury-containing products, safer alternatives, and recycling facilities in the Northeast.
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MEDICAL WASTE
Although regulated medical waste (RMW) makes up a small portion (15 percent) of a healthcare facility’s waste stream, the costs of handling and disposing of RMW can be enormous. Waste audits at many facilities have found a substantial volume of the RMW stream to actually be regular “solid” waste or non-regulated medical waste (NRMW). Minimizing the amount of NRMW entering the RMW or “red bag” stream can be a challenge, but developing and maintaining an effective program can save your facility a considerable amount of money.
Whether you are creating a RMW minimization plan internally or using a consultant, the following are some base waste prevention strategies to consider before you begin:
Educate staff. No matter what type of strategy or policy your facility implements, if the staff is not well trained and routinely updated about what is or is not supposed to go into an RMW container, your minimization plan will more than likely fail. Create an internal publicity campaign and involve the staff from the departments most affected (such as Environmental Services, Nursing, Infection Control, and Administration) in decision making and performance tracking. Provide feedback to staff about achievements and problems.
Where appropriate, collect RMW and sharps in reusable containers. Replacing red bags and single-use corrugated boxes with a service that provides reusable RMW and sharps-collection containers with restrictive lids can work to prevent NRMW and recyclables from entering the RMW stream. These containers are cleaned and sterilized off-site by a vendor and returned for reuse, thus also lowering internal purchasing and labor costs.
The New York State Public Health Law requires hospitals and nursing homes to accept sharps, including syringes and lancets from residents provided the materials are brought in a puncture proof container.
Minimize RMW collection locations and increase NRMW and recyclable collection locations. Reducing the number of containers designated for RMW reduces the likelihood of staff discarding NRMW like wrappers, paper towels, cups, or recyclables into the closest available container.
ALSO SEE case studies to find out how NYC hospitals have reduced their RMW streams.
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ENVIRONMENTAL MANAGEMENT SYSTEMS
An environmental management system (EMS) is an organized approach to improving the immediate and long-term environmental performance of an organization’s everyday services, processes, and general business practices. This approach is applied through the consolidation of any in-place environmental, regulatory, and pollution prevention policies and practices, and any tracking mechanisms into one formal facility-wide program.
Benefits of establishing an EMS include:
ISO 14000 — a series of international standards on environmental management — provides a guideline for the development of an EMS and the supporting audit program. The main thrust for ISO 14000 came as a result of the Rio Summit on the Environment held in 1992. The International Organization for Standardization (ISO) created a group to investigate how such standards might benefit business and industry. This group recommended the creation of an ISO committee to establish an international standard.
ISO 14001 represents the cornerstone standard of the ISO 14000 series. It specifies a framework of control for an Environmental Management System against which an organization can be certified by a third party.
Although this certification is not required by U.S. law, many companies expanding globally — especially those working in Europe or with European partners — apply for ISO 14001 certification because they view it as a door-opener for European business.
See resources for more information on environmental management systems.
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