Choosing a healthcare facility can be a complicated process involving a number of factors such as medical expertise quality of care cost geography ease of access and insurance coverage. A secondary factor to consider is the ecological footprint of the facility. This may not seem obvious at first but the choice can impact your health and the cost of care.
Measuring the ecological footprint of a facility is complicated and involves factors such as energy and water use transportation issues types of food and where its grown and the building impact. Another important factor and one that can be easily measured is waste management. The American Hospital Association and EPA report that American hospitals produce approximately 6600 tons of waste per day.
Most of this waste is no more hazardous than typical household waste. However there can and should be a significant amount of public concern about some of the waste streams healthcare generate such as infectious waste including needles.
Surprisingly the amount and types of waste vary widely depending upon type of service size and location. Waste characteristics vary widely between rural and urban facilities and also between countries and even regions within countries.
Why is Managing Waste Important?
Incorrect disposal of healthcare waste creates other health risks. Although the risk is low contaminated waste potentially causing viral outbreaks can occur with devastating results.Contaminated injection equipment such as needles may be scavenged. According to a World Health Organization (WHO) report it was estimated that in 2000 injections from contaminated syringes caused:
- 21 million Hepatitis B virus (HBV) infections (32% of all new infections)
- Two million Hepatitis C virus (HCV) infections (40% of all new infections) and
- At least 260000 HIV infections (5% of all new infections).
In 2002 the results of a WHO assessment conducted in 22 developing countries showed that the proportion of healthcare facilities that do not use proper waste disposal methods ranges from 18% to 64%. Compliance in more developed countries still poses a problem although less than those numbers.
Proper disposal of waste can be expensive and is often managed as a necessary evil a cost of doing business rather than as it should be viewed a commodity. Poorly managed waste can lead to significantly higher operational costs which increases the cost of providing healthcare. The end result is higher cost to operate and higher cost to the patient.
What to do about it ~ Management Approach
Before deciding how to manage a particular waste stream the single most important thing to do is to take a wider view and ask yourself the question How do we prevent the waste?Simply managing waste after its created is the proverbial finger in the dike holding back a reservoir. As a planet we are well beyond our ability to continue wasting resources at the rate we currently are.
This requires a very different mind-set where one looks at waste as a commodity not waste and terms such as zero waste should become expected not a far in the future dream. The second step is to review all regulatory requirements and perform an audit to verify compliance. Hospital waste is regulated by any number of agencies and governing bodies making this a complex task.
Often a third party reviewer is helpful to ensure all perspectives are reviewed.The third step is to review waste generation not just in total cost but in terms of cost as a relationship to doing business. One tool to consider is looking at waste cost in relation to the adjusted patient day volume as it accurately reflects waste generated by all parts of the business of healthcare.
Looking at the fiscal component also allows you to prioritize where to make changes first.Another unexpected benefit of managing waste holistically is employee engagement. Rather than imposing a top down approach many aspects of waste management benefit substantially from employee ideas and active involvement. The side benefit to this for everyone is that involved and engaged employees are generally happier and will be more productive something both administration and patients can find appealing.
Types of Waste
To a patient or administrator it may seem like waste disposal is fairly simple but managing waste well requires being aware of the different types of waste and management practices. Managing it well ensures compliance public safety and can save a significant amount of money.
Solid Waste (Trash)
Technically most of what we consider waste is considered solid waste by many regulatory standards at least in the United States. But in practical terms solid waste is a common name for common trash or rubbish as well. This can vary widely but often includes soiled paper such as paper towels exam table paper from restrooms or exam rooms and disposable products packaging and a significant amount of potentially recyclable material like office paper cardboard and food and beverage containers.
Of the regulated wastes this is the most prevalent and generates the most attention from the general public when handled poorly. The image of bloody waste and needles washing up on beaches has been burned into the minds of many. Medical waste incinerators used to be common at many hospitals.
Now modern treatment methods have significantly reduced the pollution generated from treating the waste but we still need further effort at preventing the waste and where thats not possible managing it in a way that produces a product instead of a special and dangerous waste. Medical waste generally is defined as materials saturated with bodily fluids and sharps such as needles and scalpels and other instruments but additional materials include lab specimens and tissue.
Hospitals generate more hazardous waste than many people realize. Although it is a very small proportion of the waste volume it carries significant risk and carries a high disposal cost and regulatory burden. Some of the more common materials include:
- Fluorescent light tubes
- Formaldehyde and Formalin
- Computers and equipment
No longer quite the risk it once was technology has rendered this less of a problem. Yet it is still a problem needing management. The challenge has been greatly reduced by improved delivery mechanisms and the need for lower and more focused doses but as risk has been reduced in many ways it has now grown as patients are capable of leaving hospitals while still hot and from a public health perspective the controlled public exposure is now not as controlled. Although a small risk in the big picture nevertheless it is one deserving of attention.
As we have advanced our ability to treat various types of cancer with less reliance on use of radiation we have expanded our use of chemicals in treatment known as chemotherapy. Although dosage is quite small so is toxicity. It is imperative to remember that the chemicals used in chemotherapy can be highly toxic.
Their sole function is to kill cancer cells and it is not possible at this time to create a chemical that can do both that and leave non-cancerous cells untouched. Its very important that all stages of this chemical be closely managed from creation to use with proper protocols to disposal.
One class of waste drawing increased attention is Pharmaceutical waste. This is a complex type of waste to manage. There are two major sources of generation the actual healthcare setting such as hospitals and patient personal generation. Some studies have suggested that nearly 70% of all pharmaceutical waste is generated by the patient outside of the healthcare setting. Given the huge impact we are now seeing in our waters and lands this is a daunting task.
There are fresh efforts to create green pharmaceuticals that provide for the medical need while having less of a negative impact on the environment. Another management approach is to control generation. Current practice is to hand out samples freely as a way to market the product. One new trend is to give the patient an Rx to turn in thus limiting the number of pills wasted by freely handing them out.
This issue is further complicated by the sheer volume of non-medical products that are producing similar results on the environment. A common belief is that flushing the medicines down the drain is the right solution but our wastewater treatment technology is nowhere near sophisticated enough to treat the countless varieties of pharmaceutical products nor can we afford to make it so.
Recycling and Re-use
Many products in healthcare can be reused or recycled with proper care. This is a much more challenging issue than one might imagine because it requires a solid understanding of waste as a commodity. And like any commodity recycling requires a demand for the materials and a cost effective way to collect and process the materials. One product best typifies the challenge.
Healthcare is a consistent user of Styrofoam in various forms and Styrofoam is definitely recyclable. It is also very light and this creates a much higher cost of transportation (collection) and because of this its not widely recycled creating a challenge with the other component a demand for it as a commodity. Some examples include:
- Surgical instruments and tools
- Basins and containers
- Linens such as bedding scrubs gowns and more
- Paper and cardboard
- Metals and glass
- Sharps containers (if properly treated first)
Hospitals with food service can generate a significant volume of waste. Much of this waste can either be recycled converted into a useful material through composting or feeding to farm animals. If those options are not available the weight and volume of the food waste can be reduced though extraction of the liquid. Typically this portion of the waste stream has simply been land filled but its now gaining significant attention as the markets adjust to collecting new and different materials.
Where do we go from here?
Over the last decade a significant shift in thinking about healthcare has occurred where before it was simply about direct patient care to one of understanding healing environments. This is more apparent in green building standards being employed for healthcare facilities but additional focus would help us better prevent and manage waste as well.
The three key steps towards the future are:Change our mind set from one of waste generation to waste prevention and zero wasteChange our view of materials as waste disposal into one of managing commoditiesReview all sources of waste generation as a means to prevent and properly manage those materials for the good of public safety compliance and to reduce costs
Healthcare Waste Management is an often underappreciated subject and as part of a greater societal issue would benefit from further attention. In the past waste was seen as a cost of doing business and there was a begrudging acceptance of regulatory burden. In the future we must change this paradigm to one of waste prevention and commodity management. This will make for a safer and healthier planet for us as well as reducing the cost of providing healthcare.
About the Author
Tom Badrick is President of Badrick Consulting specializing in healthcare sustainability program design and implementation. Tom is a thought leader and recognized speaker in the healthcare sustainability field. Tom successfully crafted and directed the nationally recognized and award winning sustainability program for a large health system and has guided and assisted many other organizations to create or expand successful programs as well as partnering with suppliers.
Tom has a background in Environmental Health and Safety management in biotech/chemical manufacturing and the electronics industry. Badrick Consulting offers a wide range of services from program creation/development to partnering in management of specific components of a sustainability program ranging from waste management to climate change initiatives. The Badrick Consulting web page is www.badricksustainability.com and Tom can be reached via email at firstname.lastname@example.org.