environmental hygiene
By Ed Barr, CHESP
Managing Hospital Waste
O
ne of the challenges for hospitals is the expense
and expertise needed to manage multiple waste
streams. These waste streams pose a challenge, as most
are governed by multiple governmental agencies.
The average hospital will deal with the following
waste streams:
Municipal Solid Waste (MSW): MSW or trash is the
largest form of waste by volume and weight. To manage
this stream the waste is normally deposited in a compactor
and the cost is based on the tonnage generated and the
distance transported for disposal. Haulers can range from
national companies to local “mom and pop” companies.
Regulated Medical Waste (RMW): RMW is known
by several names i.e. Infectious, biohazardous, red bag
trash etc. This waste stream poses several challenges
as it is heavily regulated and consists of blood saturated
items, sharps, trace chemotherapeutic and pathological.
RMW is often mischaracterized and can cost a hospital
money if placed in the MSW waste stream. Also, since
it is normally disposed of by the pound it can be quite
costly. Special training must be provided to employees
to handle the waste and to sign manifest for shipment.
Recycling: Recycling is a waste stream that poses
a challenge for most hospitals to manage. The types
of items recycled include: Corrugated or cardboard,
office paper, aluminum cans, plastic and glass food and
beverage containers, packaging, toner cartridges are
among the items commonly recycled. Separate handling
and shipment are required and if not done properly can
lead to contamination which causes a hospital to pay
additional costs for disposal.
Hazardous Waste: Hospitals have several sources of
chemicals coming from clinical and research labs as well
as waste generated during clinical usage including bulk
chemotherapy. Other waste in this category includes
industrial grade and phone batteries.
Pharmaceutical Waste: Hospitals are now required
to collect and separately dispose of their drugs. This
requires separate collection boxes in the main and satellite
pharmacies as well as clinical areas.
Electronic Waste: This waste consists of computers,
televisions and other devises used in the institution. If
the information has patient information covered by HIPAA
you need to ensure that information is wiped out and not
accessible to any unauthorized individuals.
Bulk Waste: Any waste too large to be disposed of
in a compactor must be placed in an open top dumpster.
This includes old furniture, hospital beds and other
medical equipment
Construction Debris: Hospitals continually upgrade
their facilities and the debris from the construction must
be removed and disposed of. Some jurisdictions require
separate handling of this material.
www.healthcarehygienemagazine.com • march 2020
Radioactive Waste: Any radioactive waste used in the
treatment of patients or research must be separately stored
and disposed of.
Each of these items requires time, labor and considerable
expense to manage. Most are regulated by local, state and
the federal government.
When managing waste streams, it is important to partner
with vendors who can provide services for your institution.
Some questions you may want to ask are:
How long have they been in business?
How many hospitals are they providing service for?
What is the emergency plan for equipment failure during
nights and weekends?
Do they provide the service directly or do they subcontract
the work?
How does their program comply with local, state and
federal regulations?
How do they provide proof of destruction?
Regardless of the answers you want to make sure that
you follow the trail of the waste to endure destruction. For
example, if you have a company that removes your electronic
waste you want to make sure you can prove destruction not
just holding an invoice with the information.
For RMW, the stakes are higher if the waste is not properly
disposed of. For example, if RMW is placed in your MSW
waste stream and shows up at a landfill or transfer station
the hospital is liable for removal and proper disposal. In
addition, the waste provider will report the incident to the
state department of environmental protection which can
result in an investigation or fines for the hospital.
If you decide to treat your waste onsite there are several
things to consider:
The capital costs associated to purchase onsite treatment
frequently must compete with a limited pool capital dollar
How long has the company been in business? Is this the
company’s first install? Do they have a proven list of customers?
How complicated is the equipment? What type of skills
are needed to operate and maintain the equipment?
What support does the company offer for ongoing
preventive maintenance and repair issues?
How does the equipment disinfect or sterilize the RMW?
How do you know the waste has been treated?
Managing waste is a complicated process. However, the
good news is there help and information out there to help
you protect your institution and our planet.
Ed Barr, CHESP, is a director of environmental services for
Sodexo. He has been active in the field of waste management
and recycling for more than 30 years, having run programs
for a major academic medical center as well as serving as
program manager for hospitals in the Mid-Atlantic region.
He served as president of the Greater Philadelphia Recycling
Council and president of Greater Philadelphia AHE.
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