Not only are we squeezing natural resources from every corner of the earth, but the planet is also buckling under the weight of our mounting trash - and the U.S. healthcare system is one of its biggest offenders. The good news is that healthcare facilities are starting to wake up to their waste, which accounts for more than 5.9 million tons annually.
"Hospitals generate a whopping 29 tons of total waste per staffed bed per day or 86 pounds per OR per year," said Janet Howard, Director of Member Engagement, Practice Greenhealth, a nonprofit member organization.
Brian Bravo, Corporate Procurement Officer and Director of Materials Management, Broward Health, a large integrated delivery network, says in 2011 he realized it was time to rethink the way the facility was handling its waste and explore options for improvement.
"We have such a big impact here in our county that we should strive to really be responsible with everything that we do," said Bravo. "That, if anything, was probably the biggest push. Let’s be good stewards and let’s get an environmental program in place that we can really report on and show data that we are actually working a responsible program."
Broward always had some type of waste management protocol in place but it was fragmented across facilities and lacked structure and consistent compliance.
"Everybody was doing their own thing. We had certain things with various vendors, whether it be red bag with one and municipal waste with another, recyclable with another or records management destruction with another," explained Bravo. "Those were the things we were looking at … we said if we’re really going to make this work, how can we consolidate, how can we achieve greater savings by standardizing with one company and will they be able to report on everything they’re doing for us?" The answer was yes.
Consolidate and save
Bravo sought counsel from a veteran waste management company, which lead to the adoption of an Integrated Waste Stream Solution (IWSS), a growing SUD reprocessing program, and a laser-focused effort to reduce operating room (OR) waste. As a result, Broward Health has diverted 6,322,690 pounds of waste from landfills and saved $3,366,113 to date.
"We engaged the other facilities and said OK, let’s start putting these programs together," said Bravo. "It took off right away. If one facility was doing something and another wasn’t, they caught on right away and started implementing the program immediately."
Trevor Rotondo, Manager, Environmental Contracting Services, HealthTrust, believes going green definitely translates into savings.
"If a healthcare facility reduces the amount of waste it produces, the environment isn’t the only beneficiary," he asserted "The facility also spends less per adjusted patient day ― just what every CFO wants to hear."
Rotondo says consider a typical hospital with 100,000 patient days per year generating 20 pounds of solid waste a day. If that hospital pays 4 cents per pound for removal but diverts 25 percent of its solid waste into a single-stream recycling program, where items are sorted offsite at a materials recovery facility, for example, they could save $20,000 annually.
On the other hand, Rotondo says sorting certain items onsite can also improve the bottom line. Leasing or buying a bailer to separate cardboard is one example.
"I’ve seen one facility lease a commercial shredding machine, in lieu of outsourcing destruction of confidential documents, and then sell the shred to the leasing company to make recycled paper," he said. "Between money saved and earned, the facility turned a decent profit even after labor and load costs. Electronic waste also has resale value, as does X-ray film for silver extraction."
Knowing how to identify and implement the right waste management strategy is key. In some cases, selecting a single-point oversight plan - consolidating all waste using one vendor - is the best option.
"The challenge in healthcare waste is multi dimensional - the multiple types of plastics, for one, challenge recycling for both identifying the type of plastic and marketing the plastic successfully," said Howard. "Hospitals look to turn-key solutions, vendors that can help them maximize opportunities for segregation, recycling, refurbishment and responsible disposal."
Rotondo says when one client implemented a single point oversight initiative they increased recyclables significantly and saved $15, 0000 per year after required equipment costs. "Another client, a large teaching hospital, saved $400,000 (40 percent) using this same approach," he said.
Data is the decision-driver
Bravo is quick to point out that one of the crucial drivers behind Broward’s success was having strong, legitimate data to support the new waste management initiatives, distribute effective education, and influence change - whether it was in board meetings or in the environmental services and clinical atmosphere, where success hinges on compliance.
Howard says when hospitals involve staff early and often in waste reduction efforts, changes in "on-the-job behavior" are easier to achieve. Waste management companies that are positioned to provide the data can help make it happen.
"As data collection and analysis techniques have matured over the past several years, it’s become increasingly clear that providing the right data at the right time to the right people can have a significant effect on waste reduction, "Howard said.
Rich D’addario, Corporate Vice President, Stericycle Inc., says 50,000 sites are using its new waste management education and compliance software, SteriVantage, which Stericycle launched in 2013. The add-on is a customizable portal designed to help managers improve off-site safety and compliance at multiple locations, a burgeoning trend.
"2015 is on pace to notch the most U.S. hospital deals since 1999, with 71 announced through the end of August," said D’addario, citing statistics from Irving Levin Associates. "In 2010, there were 72 hospital acquisitions. Last year, there were 100. Healthcare is increasingly being delivered more in outpatient and non-acute centers. As hospitals began buying family practice clinics, specialty practices, and other non-acute care offices, this led to a need to standardize compliance training across multiple offices and to document when staff completed it."
SteriVantage provides Department of Transportation training for employees who have to sign shipping manifests when transporting regulated medical waste (RMW); bloodborne pathogen training for staff that may come into contact with or be exposed to blood; and modules for handling pharmaceutical waste, HIPPA training, and more.
"The tool is only sold to healthcare facilities so unlike other generic training programs it focuses on healthcare practices that are affected by a litany of regulations," D’addario said.
DIY - managing RMW onsite
More hospitals are also moving away from incineration and haul and dump services in lieu of healthier, more sustainable options. One way is to process and dispose of medical waste onsite using newer, cleaner technologies that do the job efficiently, economically, and with less harm to the environment.
"Haul and dump disposal models have become increasingly expensive and have become laden with extraneous fees and add-on charges making them more expensive; this is problematic in the environment of cost containment in healthcare," said Michael P. Smith, Regional Sales Director, Red Bag Solutions.
"The EPA is closing down aging incinerators and not recertifying many other incinerators to burn waste. This will drive up the cost for vendors who haul the waste to the remaining incinerating sites as they travel greater distances to handle the waste," Smith continued. "President Obama has issued an Executive Order (EO#13514) to aid the environment which requires governmental agencies and hospitals to reduce and divert the volume of waste being sent to the landfill by 50 percent."
Red Bag Solutions offers a closed system that simultaneously macerates and sterilizes regulated medical waste onsite using steam and hot water, transforming it into an airy, confetti-like material that reduces volume and weight up to 90 percent and 30 percent respectively. The remaining waste, now sterile, can be disposed of as municipal waste rather than contaminated waste - good for the wallet and the environment.
Food for thought
Frank E. Celli, CEO of BioHitech America, says healthcare facilities also seek ways to reduce and/or better manage their food waste. Some will have no choice as more states and counties pass laws to reduce the amount of organic food waste in landfills.
"We are encouraged by the continued regulatory growth we are reading about throughout the country and find that hospitals are the most proactive in getting ahead of these legislations," said Celli. "Hospitals understand the financial, operational, and social benefits of managing their food waste more efficiently and sustainably."
BioHitech America’s Eco-Safe Digester converts solid food matter into a disposable earth-friendly liquid that won’t cause harm to municipal sewer systems and wastewater treatment facilities. Celli says on an annual basis, a 1,000-bed facility that uses the Eco-Safe Digester can divert 180 tons of food waste (enough to fill 18 garbage trucks), eliminates 126 metric tons of carbon, avoids the deforestation of 3,230 mature trees, preserves 4,860 cubic feet of landfill space, and decreases fuel use by 14,178 gallons. The data capture and analytics component is also a huge help to those who want to see where their waste efforts and dollars are going.
“The missing component in a successful waste management strategy is the data, something that has long been ignored by waste haulers and now being requested by customers,” said Celli. “By utilizing our Eco-Safe Digester, hospitals can measure their waste in real-time and compare across a number of locations driving efficiencies and creating a safer environment for their employees.”
Kicking Less Waste to the Curb
October 23, 2015