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Welcome. Disclaimer The opinions presented do not necessarily reflect the opinions or practices of AHE. Hospital waste: how to properly implement and maintain a successful program. Today’s speakers. Gary Zuckerman Vice President, Supply Chain & Facility Operations

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  1. Welcome

  2. DisclaimerThe opinions presented do not necessarily reflect the opinions or practices of AHE.

  3. Hospital waste: how to properly implement and maintain a successful program

  4. Today’s speakers Gary Zuckerman Vice President, Supply Chain & Facility Operations University of Pittsburgh Medical Center (UPMC) Altoona

  5. Over 35 years of experience in the healthcare industry • Served 28 years as a medical service corps officer in the Navy including positions as executive officer and commanding officer of Navy hospitals and clinics throughout the United States, Europe, and Southeast Asia • Responsibilities include contracting, material management, engineering, environmental services, and biomedical engineering • Received bachelor’s degree in Health Planning and Administration from Penn State University and MBA in Hospital Administration from the University of Florida About Gary

  6. Today’s speakers Ed Barr Program Manager, Waste Stream Management Stericycle

  7. Over 25 years of recycling and medical waste management experience and has lead recycling initiatives recognized by EPA, AHA, Practice Greenhealth, and the Greater Philadelphia Recycling Council • Oversees waste stream solutions in Pennsylvania, New Jersey, and Delaware • 12 years as President of the Greater Philadelphia Commercial Recycling Council • 13 years as the Greater Philadelphia AHE President About Ed

  8. 380-bed facility governed by a volunteer community board of directors • Offers more than 130 years of health care experience with over 300 physicians, over 2,000 caregivers and 500 volunteers • Serves more than 20 counties throughout Central Pennsylvania • A top-three employer in Blair County All about:University of Pittsburgh Medical Center Altoona, PA

  9. Outline and discuss the top waste stream management efforts to minimize waste generated to protect the environment and your bottom line; to stay ahead of the compliance curve, which can include civil and criminal penalties that directly affect hospital leaders and practitioners. • Detail implementation and management methods to outline an approach that you can customize to your own facility to create a facility-wide culture of sustainability that permeates business practices and drives your healthcare model. • Educate hospital leaders and staff on the most effective methods for implementing and managing a sustainable program and how to best manage waste streams through collaboration, communication and a shared vision. Learning objectives:

  10. Methods for a hospital to diminish environmental footprint • Potential human health risks associated with improper waste disposal • Relevant regulations and legislation • On-boarding tactics for developing a leadership team • Educational and training methods for implementing a hospital-wide waste stream sustainability solution at your facility To be covered today:

  11. Current issues facing leadership

  12. Healthcare accounts for 8% of the U.S. Carbon Footprint (JAMA, 2009) • Organic Wastewater Contaminants (OWCs) were found in 80% of streams tested (U.S. Geological Survey) • 13.2M pounds of hospital-generated waste go to the landfill each day (Building Operating Management) • Healthcare facilities are 2.5x more energy intensive than other facilities due to 24/7 operation (Department of Energy) • Hospitals manage up to 12 regulated waste streams (Stericycle) Healthcare impacts our environment.

  13. Going Green Compliance Issues Financial Pressure Hospitals face numerous pressures. The average hospital today is recycling only 8% of its waste. Industry leaders recycle 35%. Reduce, reuse and recycle. The percentage of hospitals that could NOT readily pull together cost and weight data for their waste streams. 8% 90% The average number of regulatory compliance issues uncovered during a typical hospital compliance review. 15

  14. Waste streams are interconnected. No single department is responsible for managing all hospital waste streams. Waste affects everyone.

  15. Understanding regulations and compliance issues

  16. Regulations have led to hospital leaders to focus on the various waste streams and their complexities in order to manage appropriately: • Municipal Solid Waste (MSW) • Regulated Medical Waste (RMW), including trace chemotherapy • Pharmaceutical (RCRA and Non-RCRA) • Sharps waste (syringes, scalpels, needles, blades) • Universal Waste (oils, batteries, bulbs, mercury) • E-Waste • Confidential documents that must be disposed without violating HIPAA • Radioactive waste Managing waste has many layers.

  17. Regulatory Standards set by: • Resource Conservation & Recovery Act (RCRA) • Clean Water Act (40 CFR Parts 122 and 403) • Safe Drug Disposal Act of 2009 (HB 5809) • Hospital Medical Infectious Waste Incinerator Rule • The Joint Commission • Department of Transportation • EPA • OSHA/NIOSH • DEA Understand the regulatory factors. Failure to comply and properly manage issues leads to higher risk for the hospital and its employees.

  18. Visit EPA, DEA, DOT, TJC, OSHA, EPA and other sites to know when updates come out • Share the new information with peers and leadership • Be knowledgeable about your facility’s current practices to stay ahead of the compliance curve Play an active role in managing your waste stream sustainably.

  19. Financial Risk: • Penalties incurred (fines, civil & criminal charges, etc.) • Hospital leaders do not “know” • Decreased customer satisfaction, hospital ratings • Environmental Risk: • Non-compliant disposal of waste (Rx, Hazardous, MSW, RMW) can pollute and damage watersheds, ecosystems, communities • Community Risk: • Increased chance of workplace injury (i.e. sharps sticks) • Can negatively impact perception in the surrounding areas It is important to know the risks.

  20. Integrating the process hospital-wide results in: • Implementing systems to track and document waste stream management • You can’t change what you can’t measure • Determine processing and transportation timelines • Decreased disposal costs • Regular waste ends up in red bag resulting in higher disposal costs • Only 20% of waste streams are actually regulated and < 5% of Rx streams are hazardous • Strive for a cleaner, safer environment Proper management benefits the bottom line.

  21. Understanding your impact on the community

  22. Identify ways to reduce your waste. • Question your vendors and analyze your supply chain for environmentally preferred purchasing (less mercury, silver in products, better packaging, air, land and water quality services). • Explore Practice Greenhealth’s Environmentally Preferred Purchasing initiative

  23. Waste diversion drives better economics and sustainability. Redirect your waste. RMW Solid Waste Recycling

  24. A case study analysis: UPMC Altoona

  25. Throughout the system: • Reusable pharmaceutical waste containers have helped manage 39,160 pounds of drugs from January 2011 to July 2014 • Reusable sharps containers result in: • 70,826 lbs. of CO2 emissions prevented • 3,647 gallons of gas not burned • 1,340 BBQ propane tanks not used UPMC Altoona

  26. Carbon emissions savings • By using the Sharps Management Service & reusable sharps containers annual emissions are prevented from: • 121,440 pounds of plastic kept out of landfills • 5,311 pounds of cardboard kept out of landfills

  27. <10% of total waste recycled before 2010 • 24% of total waste recycled in 2013 • 28% of total waste recycled in year-to-date June 2014 • 35% of total waste recycled is a best practice according to Practice Greenhealth Recycling at UPMC Altoona

  28. Waste reduction efforts at UPMC Altoona • 40% of total waste was RMW at end-of-year 2010 • 9% of total waste was RMW at end-of-year 2013 as a result of recycling more

  29. Understand the importance of ongoing training: • Competency fairs held annually to train all staff and review materials • Utilize online training: Net Learning • Keep training records for OSHA, especially for regulated and hazardous waste • Specialists must be trained on DOT; OSHA, RCRA standards and proper handling of shipping manifests • 2260 hospital staff trained including examples such as 12 trained on DOT manifests Training & education

  30. Green Team committee includes cross-functional departments (nursing, staffing, medical, clinical, OR, ER, housekeeping etc.) • Meets quarterly to discuss upcoming initiatives • Includes community representative, member of the Intermunicipal Relations Council, which represents the four communities of Altoona • Is part of Earth Day celebration with community-based presentations • Includes a uniform initiative to clean/disperse used uniforms for those seeking employment in the healthcare industry • ‘Clean Out Your Files Day’ every six months to recycle paper • An on-site Farmer’s Market supports local/sustainable food and healthier lifestyles • Outsourced waste management • Removed on-sight autoclave, redesigned dock Sustainability & green initiatives

  31. Sustainability & green initiatives Community-based presentations during Earth Day Green Team member Drew Appleman with Gary and Ed

  32. Removed autoclave in order to create more efficient, sustainable practices • Nearly all waste prior to waste stream management system went into the red bags and was treated as RMW • Through training and awareness, the amount of RMW has decreased31% since we started the program • Waste no longer needs to be handled twice by the hospital (once for treating the waste in the autoclave and then again for the transportation to a landfill) • Outsourcing the waste allows for a more efficient handling of the waste and reduces the carbon footprint for the hospital • The redesigned dock provides a much better working environment for those who handle trash and use the dock Operational effectiveness

  33. Redesigned hospital dock Left: autoclave used prior to implementation of waste stream management system Above: Redesigned dock without autoclave

  34. Have an education plan to get hospital teams on board for proper segregation and proactive disposal.

  35. Pharmacy Service Provider Program Champion Materials Management Senior Leadership Include all key stakeholders. Process Improvement Team Nursing / Patient Care Education Hospital-wide Green Team Safety / Environment Services Infection Control Risk Management (Clinical and Enterprise) Compliance Quality Full Participation Leads To Compliance

  36. Properly segregating waste is critical. Syringes with Medication Non-RCRA Pharmaceutical Waste RCRA Pharmaceutical Waste

  37. Identifying disposal options can reduce cost and increase compliance.

  38. Implementing sustainable waste stream practices at your facility

  39. 1. Identify improvement opportunity • Step 8: • Facility Executive Leadership • Communicate across entire organization • Celebrate big wins • Step 7: • Performance vs. expected outcome • Is there additional room for improvement • Lessons learned 8. Publish results & recognize key contributors 2. Present opportunity to leadership/ sustainability team • Step 2: • Program Design • SOPs • Required assets • Implementation schedule • Expected outcome • Step 3: • Key departments directors • Seek their ideas • Customize to meet their needs • Get their team involved • Step 1: • Prioritize based on facility input • Coordinate with other initiatives 7. Review results with leadership 3. Gain UnitLeadership Buy-in Continuous Improvement Cycle 6. Measure Results 4. Launch Initiative • Step 4: • Place equipment • Communicate in advance • Ensure SOPs are in place • Complete training • Step 6: • Are we on track? • What adjustments need to be made? • Communicate back to key department directors • Step 5: • Complete regular walk throughs • Seek feedback • Solve problems 5. Monitor Progress

  40. Visualize from your floors to your dock the flow of managing waste streams and then determine where to start • Evaluate current green team initiatives • Understand what waste is currently being generated and assess current practices • Examine all waste-related invoices from all vendors • Assess practices in relation to compliance, regulatory standards and legal requirements Assess your facility’s current efforts.

  41. Regulatory Compliance • Staff • Training • Indirect Costs • Cost containment • Cost of improper segregation • Potential risk costs (exposure, spills, etc.) • Increased labor costs • Increased time to manage multiple steams / vendors • Workers compensation costs • Community Image • Direct Costs • Staff • Dock pick-up • Transport / waste hauling • Equipment • Training • Fines • Data collection / record retention • Infrastructure / IT • Insurance Consider what it will cost.

  42. Create a culture for change; rethink how you view waste • Make it part of the culture and establish a Green Team • Educate all departments and establish a point of contact • Implement hospital-wide initiatives that involve streamlining waste • Coordinate all communications (Internal & External) • Track, manage & measure all waste streams Make sustainable practices part of daily life.

  43. Start by reducing waste • Appropriate segregation and diversion of waste streams decreases cost & waste • Reduce waste that goes to landfills • Educate employees on proper waste disposal practices • High efficiency transportation fleet • LEED certification and other high efficiency projects Integrate the “3 Rs.”

  44. Switch to reusable products • Reusable containers (disposable sharps containers are each reused 600x) • Minimizes use of virgin materials to make new products • Use reusable products in the OR (can reduce RMW generated by 65%) • Start and increase your recyclingefforts • Implement a comprehensive recycling program & educate staff • Be creative on what can be recycled (blue wrap, etc.) Then reuse & recycle where possible.

  45. Environmental Protection Agency - www.epa.gov • The Joint Commission - www.jointcommission.org • Healthcare Plastics Recycling Council - http://www.hprc.org • Commission on Air & Water Quality - www.glc.org/airwater.html • Practice Green Health (green teams / greening supply chains) • http://practicegreenhealth.org/ • Product Stewardship Institute - http://www.productstewardship.us/ • Local and State regulations - http://www.envcap.org/statetools • Office of Inspector General - • https://oig.hhs.gov/compliance/compliance-guidance/index.asp Know where to look for more resources and information.

  46. Questions?

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