H2E -- Cost Savings Through Red Bag Reduction

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H2E -- Cost Savings Through Red Bag Reduction

• Janet Brown, Medical Waste Manager
• Beth Israel, New York, NY - February 2003

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NO SPACE - NO TIME - NO MONEY
REALITY
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Awards

• 2002 AHA/EPA H2E Partners for Change Award
• 2001 US EPA Region 2 Environmental Quality Award
• 1999 Health Care Without Harms Honors for
  Contribution to a Mercury-free Environment
• 1999 - AHA/EPA Waste Minimization Work Group
• 1998 Health Care Without Harm Environmental
  Health Award
• 1998 Citizens Environmental Coalitions Activist
  Award

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Commitment to Environmental Management -- Why
bother?

• Saves Money
• Ethical Responsibility
• Public Health Impact
• Environmental Impact
• Liability/Regulatory Compliance
• Safety/Employee Engagement
• Press Coverage/Awards
• Patient Satisfaction
• Corporate Identity

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RMW Reduction Cost Savings in Dollars Per Year
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Environmental Impact

• The EPA has reported that medical waste
  incinerators are major sources for both mercury
  and dioxin in the environment.
• Health Care facilities generate double the amount
  of plastics than other municipal institutions.

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Liability/Regulatory Compliance

• Occupational exposure
• Perception -- Fear of hospital waste
• Cradle to grave responsibility
• Implications of Fresh Kills Landfill closure and
  export of waste to other states.
• JCAHO, OSHA, EPA, DEC and DOH.
• Negative press.

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Safety

• Staff Knowledge
• Compliance
• Reduced Occupational Exposures
• Reduced lost
• work days
• Reduced liability

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Employee Engagement

• Environmental commitment is everyones
  responsibility.
• incentive for proper segregation and waste
  prevention initiatives.
• Development of corporate identity.
• Employees are part of the solution and feel
  positive that their work is appreciated.
• Safe environment shows we care.

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Why Reduce Red Bags First?

• Red Bag Waste is at least 5x more expensive than
  NRMW.
• No other waste management program will save as
  much as RMW reduction.
• Savings in RMW reduction will pave way to future
  programs.
• RMW reduction can justify more costly programs

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Red Bag Reduction Plan

• Define Pathological and Cytotoxic Drug Waste.
• Facility Survey
• Standardization
• Signage
• Education
• Monitoring
• Maintenance
• Reporting

• Calculate Potential Cost Savings
• Present to Administration
• Shared Savings Program
• Designate a Waste Manager
• Cement Administrative Support
• Define RMW through Infection Control Committee

See Laura Brannens cost savings calculation
aid attached.
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Common Obstacles

• Red bagging IV bags
• Overfilled Red Bag
• Poor Placement of Waste Containers
• Foley Bags/diapers
• Housekeeping commingling waste
• Isolation Waste

• Fear of Waste
• No Time to Segregate!
• Poor Signage

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Red Bag Waste removal is five times more
expensive than regular wasteWhat Goes in the Red
Bag Anyway?
YES RED BAG ME
NO - USE REGULAR GARBAGE

• Blood, products of blood, anything caked, soaked
  or dripping in blood.
• Suction Canisters containing any fluid.
• Cultures and stocks of infectious agents
• Pathological waste, placenta
• Items saturated with the following fluids as
  defined by OSHA vaginal fluid, semen, pleural
  fluid, cerebrospinal fluid, synovial fluid,
  pericardial fluid and amniotic fluid in addition
  to any fluid visibly contaminated with blood.
• Waste from patients isolated with highly
  communicable diseases as per CDC.

• Blood-tainted waste
• IV bags and their tubing
• Urine, vomit, feces, diapers
• Nonbloody gloves
• Items tainted (versus soaked) with the fluids
  listed.
• Nonbloody drapes, packaging, personal protective
  equipment

Questions? Call Waste Manager at 420-2442
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And Dont Forget...

• Change bag ordering to reflect usage.
• Spot check both red and clear bags!
• Walk those floors!
• Keep on Educating!
• Reward Success!
• Be patient.

• Pat yourself on the back.
• Maintain program and start planning your next
  program - recycling, bulbs, mercury phase out...

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Reusable Sharps Containers

• Eliminated incineration of 2,700 containers/month
  at one site alone
• Safer for user and staff
• Reduced cost
• Nicer looking container

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Disposable vs. Reusable Sharps Containers
Disposable
Reusable

• Nurses were responsible for changing containers
• Containers often overfilled.
• Containers often removed without being closed
  properly.
• Disposable filled containers were stored in the
  soiled utility rooms
• Too many employees handling sharps containers.
• Beth Israel incinerated approximately 2,700
  disposable sharps containers per month at one
  site alone!

• Vendor offered a full-service sharps management
  service.
• One dedicated person for handling sharps.
• Much fewer incidents of overfilled containers.
• Nicer looking container
• Reduced needle sticks associated with waste
• Elimination of 2,700 containers per month!
• Reduced liability
• Positive feedback from staff.

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Successful Programs

• Simplicity
• Economically Viable
• Communication
• Support
• Employee Incentive

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Taking our commitment to the next level

• Environmental commitment should be maintained
  like any other service line.
• Corporate and executive-wide support would
  generate a stronger community-wide commitment.
• Commitment to an environmental agenda throughout
  Continuum has to mean more than having a waste
  manager.

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Next Level

• Implement an Environmental Management System
• Environmental leadership Committee
• Environmentally Preferable Purchasing

• Energy Conservation
• Mercury phase-out
• Expanded and increased recycling
• Green cleaning
• Green building
• Surplus sharing

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Janet Brown

• Beth Israel Medical Center
• 212/420-2442
• jhbrown_at_bethisraelny.org