Minimizing Regulated Medical Waste - WSPPN

1 Minimizing Regulated Medical WasteMarcy YeshnowskiTetra Tech EM Home we re talking about RMW minimization, NEVER compromise safety and on what you can - let the numbers talk for you! Regulated Medical Waste (RMW) H2E 10 Steps to Reducing Regulated Medical Waste Tools to help establish benchmarks, measure, and monitor your program P2 Strategies for Safely Reducing Red Bag WasteBIOHAZARDOUS Waste IS 13 TIMES MORE COSTLY TO DISPOSE OF THAN REGULAR TRASHBIOHAZARDOUS Waste IS 13 TIMES MORE COSTLY TO DISPOSE OF THAN REGULAR TRASHH2E 10 Steps to Reducing State-specific RMW definitionsSo what goes in the Red Bag?So what should go in the Red Bag? Most infectious Waste streams DO NOT go in red bag Items that do are generally derived from this category: blood and body fluidcontaminated items that are saturated or dripping and those caked with dried blood or dried body fluids.. and what should not!Unless visibly soiled with blood , these items do not belong in red bag trash:9 Bed Pans9 Empty specimen containers9 Dressings and gauze9 Diapers/Incontinence Pads9 Splints9 Masks, gowns, gloves9 Tapes9 Cotton9 Suction tubing9 Vent tubing9 Emesis basins9 Urinals9 Paper towels9IV bags9 Casts and splints9 Packaging materials9 Foley bags and catheters9 Alcohol prepsH2E 10 Steps to Reducing State-specific RMW true Waste costs and potential costs a team to develop goals and an action planData is a Powerful ToolH2E has created a sample spreadsheet to capture Waste data: One Part of a Comprehensive Waste Program85%10-15%<5%Hospital Waste (Trash) Regulated Medical WasteHazardous WastePhoenix Indian Medical CenterRed Bag Waste Data$-$500$1,000$1,500$2,000$2,500$3,000 $3,500 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Monthly and $ per inpatient dayMonthly Costlb/inpatient day$/inpatient daySolid Waste Disposal Fee:$57/tonRed Bag Waste Disposal Fee.

2 $450 per ton($ per pound)Solid Waste Disposal Fee:$57/tonRed Bag Waste Disposal Fee:$450 per ton($ per pound)Create a Team Keep Others Involved!Create a diverse team comprised of staff from: Housekeeping Infection Control Nursing Safety Facilities Education Purchasing Laboratories Clinicians (especially those from the OR, ED, and other critical care areas)H2E 10 Steps to Reducing State-specific RMW true Waste costs and potential costs a team to develop goals and an action for Waste segregationPlan for Waste Segregation Determine container needs what s being generated and how much? 40% of OR RMW Waste is from suction canisters! Keep packaging out of red bags ! Reduction Opportunity: BioElite Red BagsBio-Elitered bags : Are Surpasses the ASTM 165 gram dropped dart test at 180 grams Uses a star seal for leak protection Weigh 32% less than conventional LDPE bags Made with 30% recycled plastic Cost lessBioElite Red BagsUC Davis Medical Center 2002 Red Bag Use(by w eight)010000200003000040000500006000040" x 48"26" x 64"30" x 46"24" x 24"Bag SizeWeight in PoundsTraditionalBio-EliteBeforeAfterBio Elite Red BagsH2E 10 Steps to Reducing placement and signageLocation, Location, Location!

3 Post Signs (since you can t be everywhere at once)Post Signs (since you can t be everywhere at once)H2E 10 Steps to Reducing placement and Training and Education Plans and PoliciesTraining What Can You Do? Waste assessments Outreach materials Formal training programsREMEMBER: Compliance and safety firstFocus on what you can controlREMEMBER: Compliance and safety firstFocus on what you can control9 New employees integrate into job description9 Communicate goals and program progress9 Can departments be accountable for RMW costs?Training is imperative to ensure proper segregation of Medical aren t the only QUIZ: Where to throw? IV bags are not considered red bag wastes Items containing non-infectious body fluids generally not considered red bag Waste Used food service items ARE NOT red bag wastes Soiled vs tainted SAMPLE QUIZ: Where to throw? Used gloves, masks, and gowns that are not blood soakedare not red bag Waste Syringes, needles, blades, scalpels, lancets, broken glass, and any other contaminated sharp object should be placed in sharps containersSAMPLE QUIZ: Where to throw?

4 blood containing items capable of being poured or spilled and other items visibly soiled with blood are considered red bag wastes Used paper towels and tissue are not red bag wasteH2E 10 Steps to Reducing placement and Training and Education Plans and Identification and Resolution PlanH2E 10 Steps to Reducing treatment and Waste progress, report successes, and reward staff!RMW Reduction Case Study:University Medical Center, Tucson Stericycle provides RMW disposal: sharps & red bag Waste are autoclaved chemo & pathology Waste are incinerated May 2004: Initiated Red Bag Waste reduction training program:9 Reduced number of red bins in some areas9 Stericycle conducted a Medical Waste audit9 Posted signs describing proper disposal of red bin Waste , yellow bin Waste and regular waste9 Saf-T-Grams sent to staff educating on new program and Case Study: University Medical Center, Tucson, AZReusable Sharps Container Program Containers processed at a permitted off-site treatment facility Containers opened by a robotic mechanism and emptied for processing Containers washed and sanitized and returned to hospital for reuse2005 Case Study: University Medical Center, Tucson, AZJuly 2004: UMC Implemented Biosystems Reusable Sharps Container ProgramBiosystems is a Service Case Study.

5 University Medical Center, Tucson, AZ Installed 1,000+ reusable sharp container lock boxes throughout the hospital and in satellite clinics Conducted comprehensive facility audit to determine proper container size and service frequency9 Biosystems service staff on campus 3 days per week$8,600 per month1000 containers==$ container/month~ or ~~$ container/dayService Contract Displaces Other Costs No longer purchase disposable sharps containers Purchase nearly 14,500 per year, costing $89,250!91-quart containers = 225/year92-gallon containers = 694/year93-gallon containers = 11,901/year97-gallon containers = 1,655/yearService Contract Displaces Other Costs2005 Case Study: University Medical Center, Tucson, AZ Cost of disposing of sharps containers ~$30k/year Associated labor costs from managing sharps program in-house9 Purchasing, warehouse, environmental services, nursing, hazardous Waste staff9 Handling, receiving, inventory, collection, transport, packing, monitoring, distribution~$15,000 LABOR and displaces OSHA risk2005 Case Study: University Medical Center, Tucson, AZ Biosystems fully manages sharps wastes, including handling and moving containers.

6 Therefore Minimizing OSHA needle stick risk 9 University Medical Center estimated 8 incidents per year, $1,200 eachESTIMATED ~$12,000 AVOIDED OSHA COSTS RMW Disposal:The Big Picture0100002000030000400005000060000 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Autoclave Waste GenerationInc inerated Waste GenerationReusable Sharps Container Program Implemented2005 Case Study: University Medical Center, Tucson, AZAutoclave: sharps & Red Bag Waste Incinerated: Chemo & Pathology WasteReusable Sharps Containers:Achieve ~35% Reduction by Weight20,00025,00030,00035,00040,00045,0 0050,000 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 PoundsAutoclave WasteGenerationAverage Before TrialAverage After FullInstallationReusable Sharps Container Program Implemented2005 Case Study: University Medical Center, Tucson, AZReusable Sharps Containers:Significantly Affects the Bottom Line$0$2,000$4,000$6,000$8,000$10,000$12 ,000 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05$ $ $ $ $ $ $ $ $ $ $ Cost$ Per Adjusted Patient DayReusable Sharps Container Program Implemented2005 Case Study: University Medical Center, Tucson, AZRMW Reduction Case Study:University Medical Center, Tucson Autoclave Waste was reduced from 41,154 lbs/month to 27,353 lbs/month lbs/patient day to lbs/patient day $ per patient day to $ per patient dayCASE STUDY RESULTS:13,000 POUNDS (~ TONS)DIVERTED AND SAVINGS OF OVER $3,000 PER MONTH!

7 CASE STUDY RESULTS:13,000 POUNDS (~ TONS)DIVERTED AND SAVINGS OF OVER $3,000 PER MONTH!2005 Case Study: University Medical Center, Tucson, AZAnnual Costs: Sharps Mgmt. Comparison+Purchase: $89kfor sharps containers +Disposal: ~$36kadditional disposal costs (sharps containers as RMW)+Labor: $15kfor managing sharps program+OSHA: $12kin needle stick related OSHA costs2005 Case Study: University Medical Center, Tucson, AZDISPOSABLE REUSABLE +Service: $103k($ ) for Biosystems service-Disposal savings: $36kdisposal costs ($3k per month)-Labor savings: $15kreduced labor costs-OSHA savings $12kfrom reduced risk.$40k PROGRAM COST$152k PROGRAM COSTR eusable Sharps Containers:Implementation Considerations Buy-in:Significant process change must get buy-in from nurses, environmental services, purchasing, health and safety, etc. Contracting:Added service contract additional costs to one department, but greatly reduces cost in others Containers: New Container transition period (slightly different shape, size, function) Variety of mobile or fixed sharps lock boxes.

8 2005 Case Study: University Medical Center, Tucson, AZTake Home we re talking about RMW minimization, NEVER compromise safety and on what you can - let the numbers talk for you!