VOL. VII NO. 2

APR-JUN 2011

Medical Waste Management www.medicalwastemanagementnews.com

Serving Healthcare Facility Waste Management Professionals

Attention Readers !

Are you looking for Products, Equipment or Services for your business or healthcare facility? If so, please check out these leading companies advertised in this issue:

Consulting Firms Badrick Consulting – pg 13 Kessler Consulting – pg 14

Electronics Recycling SMS Memory – pg 14

Hazardous Waste Disposal & Infection Compliance Services Battery Solutions – pg 19 Clean Harbors – pg 17 The Environmental Quality Co – pg 16

Infectious & Non‑Infectious Waste Containers & Linen Carts Bomac Carts – pg 17 Busch Systems – pg 11 Rehrig Healthcare Systems – pg 6 Rotonics Manufacturing – pg 18 Solutions Inc – pg 4 TQ Industries – pg 15

Infectious Waste Sterilizing Systems Bondtech Corporation – pg 2 The Mark-Costello Co – pg 16 OnSite Sterilization – pg 15 ReGen – pg 5

Lift Systems Bayne Premium Lift Systems – pg 3

Liquid Disposal Systems Bemis Health Care – pg 18

SHREDDERS Allegheny Shredders – pg 13

In-House RMW Processing: Cure to Incineration Woes By P.J. Heller

F

(Part One)

a ced with a near extinction of incinerators to dispose of regulated medical waste (RMW), hospitals and medical facilities worldwide are discovering that in-house processing is a costeffective solution that not only is helping the environment but having a positive impact on their bottom line. In the U.S. alone, hospitals generate some 6,600 tons of waste every day, 20 percent of which is biohazardous or infectious medical waste, according to published figures. Numerous alternative treatment technologies — autoclaving utilizing steam sterilization, microwaving or other thermal treatment, electropyrolysis, and chemical mechanical systems — are among the options available to treat RMW. Autoclaving, a proven technology that has been used for decades, is the leading technology. “The steam autoclave is the most popular and cost-effective medical waste treatment

technology,” notes autoclave manufacturer Bondtech. “Unlike the incinerator, the autoclave technology does not generate any hazardous combustion air pollutant emissions, such as hydrochloric acid, carbon monoxide, dioxin/furnans, metals (particulate matter), etc. The autoclaved medical waste by-product is sanitized and safe for landfill disposal. “More than 90 percent of the newly permitted commercial medical waste facilities since 1990 employ state-of-the-art autoclave technology,” it reports. One of the newest technologies recently introduced, involves maceration via thermal friction extrusion coupled with induction heat to disinfect hospital waste, including any nonhazardous wastes such as paper. Like the other technologies, the sterilized material can then be safely placed in a municipal landfill; more importantly, however, Continued on page 3

www.bondtech.net 2

Medical Waste Management APR-JUN 2011

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PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers Tom Badrick • P. J. Heller • Norm Spitzig • Robert J. Rua Production & Layout Barb Fontanelle • Christine Pavelka Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road • Mentor, OH 44060 Ph: 440-257-6453 • Fax: 440-257-6459 Email: downassoc2@oh.rr.com Medical Waste Management (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited. Annual subscription rate U.S. is $19.95. Outside the U.S. add $10 ($29.95). Contact our main office, or mail-in the subscription form with payment. © Copyright 2011 by Downing & Associates Printed on 10% Post-Consumer Recycled Paper

In-House RMW Processing: Cure to Incineration Woes Continued from page 1

it can be used as a waste-to-energy fuel source, since the resulting residue or extrudate has a BTU value comparable to lignite coal. As hospitals transitioned over the last decades from incinerating their medical waste — the U.S. Environmental Protection Agency in 1996 found that the process was a major source of carcinogenic dioxin emissions — they were faced with a choice of outsourcing the hauling and processing of RMW or of handling the procedure in-house. The Mark-Costello Co., another major player in the autoclave medical market, says a hospital generating 50,000 pounds of RMW per month and utilizing the company’s technology — taking into account utilities, labor, supplies, maintenance and landfill disposal costs — would spend $0.043 per pound. To have that same material hauled away would cost approximately 30 cents per pound. The resulting savings amounts to $12,840 per month or more than $154,000 in the first year and more than $2 million over the life of the equipment (15 years), the company says. Hospitals, ranging in size from fewer than 200 beds to large medical complexes with thousands of beds, that have made the move to in-house RMW processing agree that the decision has proven cost-effective while providing them with “cradle-to-grave” responsibility for their medical wastes. Hospitals which have successfully installed on-site processing to handle their medical waste includes St. Joseph’s Hospitals in Florida, Mon General Hospital in West Virginia, Gaston Memorial Hospital in North Carolina and Cedars-Sinai Medical Center in California. These are their stories: Continued on page 7

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Cost Saving for Hospitals Starts With Recycling Waste, Plus Other Measures

B

ecker’s Hospital Review has published a well-researched story by Molly Gamble in its most recent issue that outlines eight costcutting measures that hospitals can take to save money without cutting services or harming outcomes. They include examples from health care systems that are actually walking the walk. They include such ideas as cutting food waste in half, as done by six Iowa Health System hospitals, These partnered with a food waste tracking company, using ValuWaste tracking systems and requiring staff to submit reasons for disposal, eventually adjusting production practces based on these data. The article notes that Iowa Methodist Medical Center and Iowa Lutheran Hospital in Des Moines have cut their food waste in half in the last 28 months since starting the tracking. Another practice also relies on waste control. Johns Hopkins has found in general that some 90 percent of material red bagged as pathologic waste does not meet criteria as such. By properly separating hazardous from nonhazardous waste, hospitals have been found to decrease waste volume by 30 percent. Another recycling practice cited is washing and reusing surgical scrubs and lab coats, which is seen to reduce medical waste by up to 20 percent, again according to Johns Hopkins researchers. Ideas can be big ones, such as standardizing and centralizing operating and supporting functions to reduce redundancies in technology and process, as suggested in the Gamble article by Joe Kuehn, KPMG LLP’s Performance and Technology Services advisory practice. Standardizing and reducing the number of supply and service vendors is also key, as is centralizing operational and clinical functions, such as nurse scheduling

and transcription. The article also cites having a smoke-free workplace to save on healthcare costs and increase productivity, as well as saving on cleaning costs. Reassessing administrative costs, says Bart Richards, of The Claro Group, a business consulting firm, can be done through more focused negotiating with financial institutions and honing banking relationships as well as better document and paper management. Pamela Morin of Reliable Technologies suggests a managed print services plan, which addresses all costs associated with printers, says the Becker article. Good money can also be saved on denied claims by categorizing them more closely and looking for patterns. Gamble cites Jay Arthur, author of Lean Six Sigma for Hospitals, as helping a hospital make changes that saved significant money per month. On the other end of the scale, Gamble also notes that Sacred Heart Hospital in Eau Claire, Wis., saved with small steps like switching from bottled soda to fountain drinks in the physicians’ lounge, going with online subscriptions to journals, and finding a new vendor for trash can liners. Finally, the article suggests rewarding employees for their ideas for savings. For over a decade, Indiana University Health Goshen has had an Uncommon Leader program, which has earned over $35 million in gain share and cost-cutting ideas, $6.3 million in the last year, from ideas such as changing the type of napkins on patient trays, switching from disposable paper gowns to cloth gains for patients in the GI department, and ordering a large quantity of a generic drug to delay the purchase of a name brand drug.

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In-House RMW Processing: Cure to Incineration Woes

Continued from page 3

St. Joseph’s Hospitals

S

t. Joseph’s Hospitals believe they are on the cutting edge when it comes to managing not only their RMW, but their entire waste stream. After nearly 20 years of operating an incinerator for a single waste stream that included trash and RMW, they are testing a new innovative destruction/disinfection technology that eventually could result not only in reducing or eliminating waste disposal costs but could help produce energy for the facility. That’s because the ReGen Vanish medical waste processing system, which uses thermal friction extrusion coupled with induction heat, produces residue in the form of either coal-like briquettes or fluff that can be used in a waste-to-energy plant. The uniqueness of the Vanish is that it offers near total destruction and guaranteed disinfection of all types of hospital waste, whether in bags, boxes or sharps containers. It does so without impacting the BTU value of the waste, which is comparable to lignite coal. The residue is ideally preconditioned for waste-to-energy, as it is dry and sized as small particles. “This country has to learn soon that waste really is fuel,” says Richard Armstrong, director of facilities and construction. “You wouldn’t throw energy into the landfill. Why would you want to do that? If you can convert it effectively and safely and environmentally soundly, why wouldn’t you just take your waste and convert it to energy.” That’s exactly what St. Joseph’s is hoping to do in the near future. The extrudate could be used to produce steam or electricity for the hospital or could be sold to other industries to help meet their energy needs. It is currently shipped to Tampa’s McKay waste-to-energy plant where it is converted to electricity. St. Joseph’s Hospitals are part of the BayCare Health System, a community-based health system in the Tampa Bay area. It is composed of a network of 10 not-for-profit hospitals, outpatient facilities and services such as imaging, lab, behavioral health and home healthcare. All of the hospitals

send their RMW to St. Joseph’s where until recently it was incinerated. Included in the hospital’s plans is the possible addition of a second ReGen unit. It could be placed at a sister hospital across Tampa Bay with the fuel then transported to a central linen facility operated by a consortium of area hospitals. In the latter case, Armstrong explains, “instead of each hospital having its own on-site energy conversion, we might just have a single energy conversion site produce steam to make electrical power and also to replace natural gas in the drying operation. We could then also take waste heat energy from the drying operation to another heat exchanger to make all the hot water. So all of a sudden, the linen processing costs for washing and drying linen is going to be greatly reduced also.” The ReGen system has been in operation at the hospital since October 2010. It has already reduced the hospital’s waste costs by approximately 50 percent, according to Armstrong. “If we do the waste-to-energy process and get the bang from BTU values that we think we can, we’re looking at virtually no cost to process RMW,” he says. Armstrong notes that the ReGen unit is geared to larger hospitals, or hospital networks, and commercial sites but that smaller hospitals could join forces to take advantage of the system as well. The ReGen system can process the hospital’s waste at nearly 2,000 pounds per hour to easily handle its 10 million pounds of waste annually. “We calculated that even at 9 million pounds per year, the energy value of that waste through ReGen has a fuel source value of 89 trillion BTUs,” Armstrong says. “That’s just the waste that we’re currently processing. “Why throw this stuff [processed RMW] in a landfill,” he asks. “Why keep filling up land that will become unusable. Why not process it in a way that it can be used and cut back on our oil consumption and natural gas to make some kind of heat energy or even electrical power. Why landfill our energy independence.”

Mon General Hospital

T

he 189-bed Mon General Hospital initially incinerated its medical according to the company. waste, then when faced with mounting environmental and permitting “We run it every day and you can walk by and not notice,” Wheeler issues, had the waste hauled off site for processing. says. “That was probably the key selling point, plus they had a very good With the amount of RMW increasing and costs to have it processed track record as far as their equipment.” off-site also going up, Mon General began looking into Mon General didn’t purchase a shredder to handle “We run it every day the feasibility of on-site processing. sharps, which it continues to send out for processing. “Our decision was based solely on economics,” says and you can walk by and That may soon end, however, as the hospital is working Dan Wheeler, director of facilities management at the with state health officials to allow sharps to be sterilized not notice ... That was Morgantown, W. Va., hospital. in the system and then disposed of. Mon General is part of the Mon Health System, an “They [state officials] are talking about allowing us probably the key selling integrated healthcare delivery system that provides a full to do that, which will mean more sterilization and less point, plus they had a range of family centered care to residents of north-central hauling, which in turn will allow us to recognize even very good track record as more savings to the hospital,” Wheeler says. West Virginia and southwestern Pennsylvania. Knowing that it wanted an autoclave system, Mon As to the viability of hospitals going to in-house far as their equipment.” General researched various companies and Wheeler processing, Wheeler says much depends on utility costs and the then-director of environmental services visited several hospitals and whether there is a location for the autoclave or if construction costs in the region. are involved. The result was the installation seven years ago of a Bondtech sterilizer “We’re in a somewhat rural area so we had space to add onto the system, which is located on a dock that is attached to a building. footprint of our building,” he says. “I don’t know that a hospital in an “Our biggest concern bringing it on-site was if it was going to create urban setting could do it as easily as we could. Our utility costs are also an odor problem, since a work space was less than 10 feet away,” Wheeler relatively cheap compared to other places.” recalls. As far as the autoclave, itself, he reports that it has operated trouble free. “We visited at least three different manufacturers and just by walking “Other than a replacement part like a gasket or a minor part, we have in the site you could tell [there was an odor],” he says. had very little issue with it,” he says. “We bring someone from Bondtech That concern proved to be unfounded with Bondtech. The sterilizer on-site annually to inspect the unit and to point out any issues. Other uses a high vacuum system that allows the amount of moisture to be than that, we’ve had very few problems, most of which have been minor controlled. Controlling the amount of moisture controls the odor, user-related issues.” Continued on page 8 APR-JUN 2011 Medical Waste Management

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medical waste management

In-House RMW Processing: Cure to Incineration Woes

Continued from page 7

Gaston Memorial Hospital

A

fter closing its on-site incinerator in the late 1980s, CaroMont In addition to fewer moving parts, designed to ensure longevity, the Health’s Gaston Memorial Hospital in Gastonia, N.C., began sterilizer uses standardized parts which are easily replaceable if necessary. contracting out its RMW to be incinerated. The hospital also purchased a shredder to post-process and further Gaston Memorial, which was established in 1946, serves Gaston compact its medical waste. That has helped limit the number of hauls to and surrounding counties. It is part of CaroMont Health in Gastonia, a the landfill. regional, independent non-for-profit healthcare system. Processing RMW on-site has provided the hospital with other benefits Like many other hospitals, Gaston Memorial began looking at ways as well. In designing the dock where the VariClave is located, for example, to reduce its costs, including the cost to treat an increasing stream of the hospital created a built-in custom washing station for carts, stretchers RMW. and other items. Water from the washing process is stored in a retaining “When we started looking at the cost of owning our own equipment pan; when the sterilizer runs its venting cycle, the water is drawn into the to treat medical waste versus paying someone else to autoclave purge system and then safely discharged into haul it off and treat it, it was amazing what we found,” “It’s expensive up front the sanitary sewer system versus the storm water sewer. reports Sam McDaniel, director of housekeeping at the “It helps keep us in compliance with more of the but it wouldn’t take 435-bed hospital. EPA regulations,” McDaniel says. After exploring both microwave treatment Processing on-site has other advantages as well, but one visit from a and steam sterilization options, the hospital in regulatory agency in here he notes. December 1998 installed its first in-house “If we have a disaster, any type of major disaster, and, boom, there goes autoclave system. The steam sterilizer paid for itself in at least I can take care of the medical waste on-site even less than two years, McDaniel reports. $200,000 to $300,000.” if I have to store it,” he says. “I can take it out to the By the fall of 2009, the hospital decided to replace parking lot and stack it up. At least it’s safe until trucks its aging sterilization system. The unit had numerous moving parts and can run again . . . I feel good being self-sufficient. I feel we’re doing our was experiencing more and more downtime, he says. part from an emergency management prospective.” “It was coming to what I considered was the end of its life,” McDaniel McDaniel admits that in-house processing requires a substantial upsays, adding that the cost to repair the unit and keeping it running for front investment, but that a sterilizer can easily be justified. another 10 years was equivalent to purchasing an entirely new system. “It’s expensive up front but it wouldn’t take but one visit from a “We felt if we could find a system with fewer moving parts that we regulatory agency in here and, boom, there goes $200,000 to $300,000,” would be better off,” he says. he says. Gaston Memorial found what it was looking for at OnSite Sterilization, “Processing on-site is definitely something I think people should a Pottstown, PA, company that manufactures the VariClave. It was installed look at,” he adds. “I am one of those advocates saying you should do it in 2010. yourself.”

Cedars-Sinai Medical Center

R

egulatory concerns in the mid-1990s over its on-site incinerator provides redundancy and can be put into service when RMW volume is prompted the highly regarded Cedars-Sinai Medical Center in Los high, Lindeman says. Angeles to install an in-house sterilizer to handle its RMW. “We have some 36 different operating rooms that generate a lot of Factoring heavily into the decision to install an in-house system were biohazard waste,” Dea says. concerns over the costs of outsourcing the waste The AS515DD systems from Mark-Costello for processing and the liability issues that such a can each process 1,125 pounds of RMW per “Because of our volume, it wasn’t cycle. plan might create. practical to outsource [RMW] ... “Because of our volume, it wasn’t practical to Cedars-Sinai compacts its RMW after outsource [RMW],” explains Douglas Lindeman, processing and then ships it to a landfill. It does It made more sense to handle it operations supervisor for plants operations at the not have a shredder to handle sharps, which are nearly 1,000-bed medical center. “It made more at the facility ... It’s a significantly processed off-site by another company. sense to handle it at the facility.” higher charge for hauling [RMW] Both Lindeman and Dea agree that in“It’s a significantly higher charge for hauling house processing of RMW makes sense for most than regular waste, somewhere [RMW] than regular waste, somewhere around hospitals. around triple the cost.” triple the cost,” notes Jerry Dea, manager of “It would all depend on the volume and the materials management. size and cost of the sterilizer,” Dea says, adding Shipping RMW off site for processing “was also another huge issue that systems range in price, size and operating costs that can meet the needs for us as far as liability,” Lindeman adds. of small to large hospitals. Cedars-Sinai officials looked only at autoclave technology for Cedars-Sinai is the largest nonprofit hospital in the western United processing its RMW, eventually opting for a system from the MarkStates. It traces its history back to 1902 with the opening of Kaspare Cohn Costello Co. Hospital, the predecessor of Cedars of Lebanon, on the east side of Los “I think Mark-Costello did it most effectively and cost-effectively,” Angeles. The merger of Cedars of Lebanon and Mount Sinai hospitals in Lindeman says. 1961 created Cedars-Sinai Medical Center. Over the last decade, as the volume of RMW has increased at CedarsToday, the hospital boasts some 2,000 physicians in every clinical Sinai — due in part to the addition of a 150-bed ICU unit as well as specialty and 10,000 employees. It is consistently ranked among the best ongoing laboratory and research work — the hospital replaced its original hospitals in the U.S. Continued on next page sterilizer with two autoclaves, both from Mark-Costello. The second unit 8

Medical Waste Management APR-JUN 2011

medical waste management Continued from previous page

The following are brief profiles of the companies that manufacture medical waste processing equipment that were discussed in the hospital profiles: Bondtech Corp.

H

aving established itself in the highly demanding, high-volume, heavy-use commercial waste market, Bondtech Corp., has used that knowledge and experience to carve out a sizable niche in providing hospitals with high vacuum/high pressure autoclaves to treat RMW. Bondtech is one of the largest medical waste treatment technology manufacturers in the world, with systems d e l ive re d t h at a re capable of processing more than 2.5 million tons of medical waste per year, according to the company. It boasts more than 1,000 autoclave technologies delivered worldwide with over 300 systems operating in the waste treatment application. Bondtech began serving the commercial medical waste market in 1986 and then began employing that same proven technology for the hospital market. “Everything we’ve done in a commercial environment we’re applying to the hospital

The Mark-Costello Co.

A

s one of the oldest active medical autoclave manufacturers in the U.S., the Mark-Costello Co., has built up a strong following for its high-pressure steam saturation autoclaves. The company’s equipment is in use nationwide and in 23 other countries. The company, founded more than 50 years ago, offers both a semi-automated system and its popular MC-EZ medical waste disposal system. It has been serving the hospital market since 1973, with more than 600 Mark-Costello units in use by hospitals today. More than half of its business comes from repeat customers and customer referrals, according to Michael Kelleher, Vice President and Co-Owner. Capacities of the sterilizers range from 200 pounds to 3,000 pounds per cycle. The sterilizers, manufactured in Carson, Calif., come completely assembled and ready for final connections. All chamber vessels are built in accordance with requirements of the ASME Pressure Vessel Code. The sterilizers are equipped with multiple safety features necessary when operating pressure vessels.

environment,” notes Angel Aguiar, Vice President. The result, he says, is “a thoroughly proven technology with superb reliability and longevity.”

“We build to the heavy industrial standards of super high demand plants,” he says. In addition to standard sterilization units for hospitals, Bondtech custom designs systems to meet a customer’s unique needs, such as the amount of space available, system location and the customer’s desired waste handling practice. The company’s most popular model for hospitals is the Bondtech Treatment Technology BTT5X9, capable of processing up to 500 pounds of waste per hour. Other units range in

The entire control panel for all of the standard sterilizers is UL listed and labeled. The company also offers a unique optional shredder

that not only is used to shred post-process medical waste but which can also be utilized to shred office documents and other papers. The company can manufacture systems to

capacity from as little as 100 pounds to as much as 6,000 pounds per cycle. An optional posttreatment shredder and compactor can reduce the volume by as much as 85 percent. The company, with corporate headquarters i n Ke n t u c ky, d e s i g n s and engineers its units in a 100,000 square foot plant in North Carolina. Support offices are located throughout the U.S. as well as in Central America and the United Arab Emirates. T h e c o m p a ny ’s proprietary design autoclave systems which has been in use since 1986 features a combination of multiple vacuums and saturated high pressure steam to facilitate what it says is “faster and more uniform penetration of steam into the medical waste to be treated” . Bondtech 1278 Highway 461 Somerset, KY 42503 Phone: (800) 414-4231 or (606) 677-2616 Web: www.bondtech.net

utilize a variety of loading procedures, including carts, shredders, conveying systems and industrial compactors. All systems employ state-ofthe-art technology in controls, information p ro c e s s i n g a n d material handling devices to provide effortless and safe processing of biohazardous waste, Kelleher notes. A network of distributors across the US sells and services the autoclaves. In addition to hospitals, the company’s autoclaves are employed by commercial waste processing facilities and for international flight waste (USDA waste). The company also designs and installs solid waste and recycling equipment systems. The Mark-Costello Co. 1145 E. Dominguez St. Carson, CA 90746 Phone: (310) 637-1851 Web: www.mark-costello.com Continued on page 10

APR-JUN 2011 Medical Waste Management

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medical waste management

In-House RMW Processing: Cure to Incineration Woes

Continued from page 9

OnSite Sterilization LLC

A

fter operating a commercial processing facility for 12 years which handled more than 200 million pounds of RMW, OnSite Sterilization set out to develop new “state of the art” autoclave steam sterilization and control technologies. The result is the VariClave, which the company describes as the only autoclave on the market that uses variable control technology. That patented process automatically adjusts the unit’s process cycle for each load by both weight and by the characterization of the material, such as operating and emergency room waste, average or general red bag waste and sharps and suction containers. “The VariClave automatically adjusts for the unit’s process cycle and guarantees complete sterilization,” says Al Koehler, Vice President of Sales and Marketing. “If you try to treat everything with the same fixed time and temperature, you’re not going to get complete sterilization. “You cannot treat heavy waste (wet wastelab, ER, OR and liquids) and light waste (dry

ReGen

T

aking a whole new approach to dealing with RMW, ReGen has developed a system that can sterilize medical waste — and can process other waste streams as well — with the resulting residue capable of being used as a fuel source. “Residue is permitted to go to a standard municipal landfill or your waste-to-energy plant since the material has a BTU value comparable to lignite coal,” the company says. The Vanish system utilizes thermal friction extrusion to preheat medical and other wastes to reduce the size of the particles. Those particles are then augered through an enclosed induction tube set at about 300 degree F for sterilization. “Vanish operates at temperatures sufficiently high to guarantee disinfection but sufficiently low that air permits are not required,” notes Bob Olexy, company President. Output from the system is either coal-like briquettes or fluff, which due to its 9,000 BTU per pound fuel value, can be

waste –patient room waste) all at the same fixed time and temperature and expect the same results,” he insists.

The control software package, described by the company as the “heart” of the system, is infinitely adjustable, allowing users to meet any new regulations. The VariClave has been on the market since 2006 and can handle from 450 pounds to 1,950 pounds per cycle. It features a processing

burned in a waste-to-energy plant. The system reduces waste volume by 85 to 90 percent, so even if the residue is shipped to a landfill, the volume is substantially reduced, Olexy says. The company stresses that Vanish is not an autoclave but rather an alternative treatment technology approved in multiple states. Re G e n r e n t s i t s w a s t e treatment system to hospitals, eliminating the need for them to make a major capital investment. A fee is charged based on the volume of waste processed a n nu a l ly ( s m a l l e r hospitals can pay a flat monthly rate). Vanish is capable of processing one ton per hour; it can handle infectious waste, confidential documents, plant trash, cafeteria waste and hospital trash in bags, boxes and sharps containers. “Quite simply, Vanish will fill the technology

10 Medical Waste Management APR-JUN 2011

chamber of stainless or carbon steel, with a 20year and 10-year life expectancy, respectively. Another key feature of the VariClave is its radiation monitor, which prevents radioactive materials from being introduced into the system. If radiation is detected, the unit will issue a visual alarm and lock out the system. Also unique to the VariClave, the company says, are “multiple vacuum pulses” that will break containerization open to expose it to direct steam treatment. “Multi-vacuum technology” ensures deep steam penetration and disruption of the waste containerization. The company also offers a postprocess shredder designed specifically for the VariClave; the shredder can handle both processed waste and confidential documents. OnSite Sterilization LLC 319 Commerce Court Suite 103 Pottstown, PA 19464-3478 Phone: (610) 495-8214 Web: www.AskOnSite.com

void brought on by the demise of hospital incineration,” the company says. “Hospital administrators will o n c e a g a i n h av e an economically viable, on-site waste p ro c e s s i n g o p t i o n capable of processing as much as 85 percent of their total waste volume and converting that volume to a useful byproduct. Hospital administrators will be able to reduce their existing disposal costs; to forecast their costs with long rent terms, and to mitigate the hazards of off-site shipment.” ReGen 10009 Discovery Terrace Bradenton, FL 34212 Phone: (800) 823-9513 Web: www.vanishwaste.com Continued on next page

medical waste management Continued from previous page

Conclusion

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hether utilizing a well-established technology such as autoclaving to treat RMW or exploring new or emerging technologies, there is little doubt that hospitals can greatly benefit by treating their biohazardous waste in-house. Sterilization systems from a variety of manufacturers are geared to large and small hospitals. Even the smallest of medical facilities can benefit by treating RMW in-house by joining forces with other small area hospitals. While only four RMW (processing technology) manufacturers were featured in this article, we hope to include more in a future edition of Medical Waste Management. We also hope to profile some alternative technologies that we have come across during the past few years. In the meantime, here is a short list of manufacturers that you may want to contact if your facility is looking to install a system for processing RMW, or other types of waste.

RMW (Processing Technology) Manufacturers AMB-Ecosteryl

Montreal, QC Canada 514-286-1458 www.ecosteryl.net

The Bell Process

West Chester, OH 513-227-2740 www.thebellprocess.com

BioMedical Technology Solutions, Inc. Englewood, CO 866-525-2687 www.bmtscorp.com

BioSAFE Engineering, LLC

Brownsburg, IN 888-858-8099 www.biosafeengineering.com

Bondtech Corporation

Somerset, KY 800-414-4231 Angel Aguiar, Vice President www.bondtech.net See ad on page 2

The Mark-Costello Co.

Carson, CA 310-637-1851 Michael Kelleher, Vice President www.mark-costello.com See ad on page 16

OnSite Sterilization LLC

Pottstown, PA Al Koehler, VP Sales & Marketing 610-495-8214 www.askonsite.com See ad on page 15

OZONATOR Industries

Regina, SK  Canada 306-791-0900 www.ozonatorindustries.com

Red Bag Solutions

Baltimore, MD 877-973-3224 www.redbag.com

ReGen

Bradenton, FL Bob Olexy, President. 800-823-9513 www.vanishwaste.com See ad on page 5

San-I-Pak

Tracy, CA 209-836-2310 www.sanipak.com

TrinovaMed

Corona, CA 951-254-9240 www.trinovamed.com

MedClean Technologies

Bethel, CT 203-798-1080 www.medcleantechnologies.com

www.buschsystems.com APR-JUN 2011 Medical Waste Management 11

medical waste management

Waste Auditing:

Get to Know Your Waste Streams

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By Tom Badrick, Badrick Consulting

etting to know your hospital’s waste streams may sound less than glamorous, but it could help you learn a lot about your organization and reduce your waste management costs. Successful waste management must start with a hard look at the various types of waste your facility generates. In other words, a waste audit. A thorough waste audit can help you see your waste streams in a new light – as potential commodities.

Beginners – Start Small

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f you have never conducted a waste audit before it’s advisable to start by examining just one or two of your waste streams. Tackling them all at once can be daunting. I recommend beginning your audit with your two most expensive waste streams, hazardous waste (including such universal wastes as fluorescent light bulbs and batteries) and medical waste. Another very good reason to begin your audit with these two particular waste streams is that they are, of course, regulated. If you want to stay compliant, you need to know what you are generating. For the purposes of this article, we will focus on regulated medical waste (RMW).

Getting Started

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he place to begin your audit is with an examination of the data that is already available to you. All waste streams “go” somewhere and they are seldom free. If you are paying for their removal, somewhere there is an invoice and that invoice holds valuable information. Most notably, the details of what you are paying for waste removal, but potentially other information as well. If you send your RMW off-site, your hauler should provide you with a manifest detailing the number, types, weights and sizes of the containers they have handled for your facility. If you are auditing a larger facility that treats its RMW on-site or employs some combination of on and off-site waste disposal, it can be more complicated. Either way, you have to get a handle on how much RMW is going out of your facility at the start of your audit process. Don’t overlook the value of reaching out to other facilities for their feedback and best practices on internal and external waste auditing, but keep in mind that every facility has its own unique waste management needs. There is no getting around it – you must do your own research for your audit to be successful.

Next Steps

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etting a handle on how much waste your facility generates is a good start, but it’s just the beginning. If you want to have any success at reducing your waste streams to benefit the environment and your bottom line, you need to take your efforts a few steps further. Start by examining where your RMW is coming from. Your facility’s patient care areas are obvious RMW generators, but exactly how much waste does each area generate? If you are not already, start tracking the total weight and/or number of containers of RMW each patient area generates to create an overview of your waste stream. Knowing the patterns of your waste stream will help you better understand and manage your labor costs. However, simply examining the volume of RMW your facility is generating is not enough. You also need to look at generation time. For example, in many hospitals surgery and post-surgery clean up will occur at fairly consistent times, making it possible to not only know how much waste your facility generates, but when it is generated. Similarly, patient discharge and the subsequent room cleaning take place at fairly consistent times. 12 Medical Waste Management APR-JUN 2011

Once you know where your RMW is coming from and when it is typically generated, you need to know specifically what kind of waste you are generating. There are several reasons for this. If you pay for your RMW by weight, then you want to make sure all your RMW is actually RMW, not RMW and beverage containers and packaging. If you pay by container, the same applies only the goal is to reduce the number of containers. Either way there is a potential to reduce the waste stream and your cost. This is the challenging part, looking into your RMW containers. The easiest and safest means of doing this is direct observation as waste is generated and supporting this with staff interviews. Doing this allows you to develop a reduction strategy that might include projects like fluid management, single-use device reprocessing or sharps recycling.

Advanced data

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ow that you have a good idea what, when and where your facility generates RMW, you can take it to the next level – comparing your waste flow to patient volume. Historically the calculation for this was based upon the daily census but a more accurate and useful tool is comparing your waste data to the Adjusted Patient Day (APD) which, unlike the daily census, includes outpatient volumes. There are several reasons to do this. The first is to establish a reliable method to measure your RMW by patient volume and thereby help you budget your labor and disposal costs more efficiently. The second reason is it that comparing your waste data to the APD will help you to set target goals based upon the full picture of daily activity in the facility, something the daily census simply cannot do. Once you’ve gathered data on your various waste streams you can benefit from analysis of your total waste generation by type. Many successful hospital waste management programs generate RMW in the 3-10 percent range when compared to other solid waste streams such as trash and recyclables. Although disposal costs can vary widely depending upon geography and other factors, RMW is more expensive than trash, so minimizing how much you generate can have a positive impact on your budget.

Conclusion

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good waste audit can be time consuming, but it will teach you things about your organization that you never would have guessed. And naturally, it’s also a great way to identify methods to reduce your environmental footprint, save your facility money on disposal costs and stay compliant. A well executed waste audit will give you the data and measurement tools you need to maximize the efficiency of your waste management system long-term. It’s worth it. Tom Badrick is President of Badrick Consulting specializing in healthcare sustainability program design and implementation. Tom is a recognized speaker in the healthcare sustainability field. He 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 website can be found at www.badricksustainability.com and Tom can be reached via email at tbadrick@aol.com.

news briefs

Frost & Sullivan Says Europe Looks to Medwaste Disposal Beyond Incineration

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ondon, UK­ – Throughout many parts of Europe the dominant method of medical waste removal continues to be incineration. Although a successful and easy way to cope with medical waste, the carbon dioxide emissions resulting from incineration are leading European countries to search for alternative methods to dispose of this dangerous and hazardous material. In a new overview of the European Medical Waste Management Market, Frost & Sullivan (www.frost.com) analyzes the market exploring what the current situation is and what the new trends are. In addition, with regional markets such as Germany and the Benelux region approaching maturity, there is a definite shift in focus towards South Europe. At the same time, key challenges of the medical waste management industry make it difficult for several hundred other smaller waste management companies to compete. “The demands of technological development and alternative treatment processes can essentially be best managed by large companies since there is a heavy requirement for financial and R&D investment which makes this viable. There is also a defined market space for specialists in the sector who can offer a technological or service provision edge,” says Suchitra Padmanabhan, Frost & Sullivan research manager. Companies need to be able to offer non-incineration methods and in doing so successfully possess the ability to manage and disinfect hazardous medical waste. The vast array of resources available to the larger companies suggests that they will inevitably continue to operate as industry leaders in waste management. Large companies can also handle the ever increasing amount of medical waste being produced. An ageing population across Europe has led to more full hospital beds and a shift in the nature of healthcare to home-based care, thereby supporting a growing medical waste management market. Consequently more medical waste will be produced than ever before and there will be a greater need to carefully dispose of it. In an attempt to combat medical waste, scientists have developed a way to pre-treat waste with disinfectants. This process doesn’t eliminate all of the germs, but it is a step in the right direction towards finding alternative methods of dealing with medical waste. Although it is unlikely incineration will discontinue throughout the rest of Europe right away due to the high demand of medical waste disposal, it is more likely that changes will be made to incineration techniques making it less harmful and more effective. Research will continue with the hope to find non-incineration methods to manage medical waste that may soon replace incineration completely.

VA and CDC Studies Show Worth of MRSA Interventions

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ashington, DC­ – Infection Control & Hospital Epidemiology offers a report by Ellingson and colleagues from the Centers for Disease Control and Prevention in collaboration with the Veteran’s Affairs Hospital in Pittsburgh to look at the sustainability of such a program of active detection and isolation, reports medscape.com. Three simple interventions were used, and MRSA colonization and infection decreased by 61%, bloodstream infections by 50%, and the proportion of Staphylococcus aureus resistant to methicillin by 30%. Hospital-wide reduction in MRSA colonization and infection was 22%. The intervention using active surveillance testing, contact isolation, hand hygiene, and environmental cleaning produces significant decreases in MRSA colonization and infection. The VA hospital system is using such interventions throughout hospitals across the country, and this study in collaboration with the CDC documents the efficacy of such an intervention.

www.alleghenyshredders.com

Need Help Setting Up Your Hospital’s Sustainability Program? — Call Tom Badrick — Tom is a recognized speaker in the healthcare sustainability field. He has also crafted and directed one of the most successful healthcare facility sustainability programs in North America, and has guided and assisted many other organizations in creating and expanding their programs.

Tom Badrick, President 1725 NE 118th Ave. Portland, OR 97220 503-539-8704 tbadrick@aol.com www.badrickconsulting.com

APR-JUN 2011 Medical Waste Management 13

news briefs Target your products, equipment & services to more than 5,000 healthcare facilities & medical waste contractors ... Advertise in MWM! Call today 440-257-6453.

CT. DPW Releases First HospitalSpecific Report on Healthcare Associated Infections

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jeffSMSmemory@gmail.com www.smsassembly.com

a r t fo r d , C T- T h e C o n n e c t i c u t Department of Public Health has released a first-ever report on central line-associated bloodstream infections acquired in the acute-care hospitals in the state to serve as a benchmark for future hospital and state prevention strategies and to assess progress toward preventing healthcare-associated diseases, reports stamfordplus.com. Connecticut’s 30 acute-care hospitals are required to report these infections using standard definitions and protocols. The report, which covers data from October 1, 2009 to September 20, 2010, allows consumers to view infection date reports as well. The number of central line-associated bloodstream infections in the state is 29% lower than expected based on US data reported to the federal Centers for Disease Control and Prevention. Healthcare-associated infections in hospitals are a significant burden in the country, associated with approximately 99,000 deaths and up to $30 billion in costs each year. To access the report and view the DPH Healthcare Associated website, go to www. ct.gov/dph/hai.

MRSA Infection Increases in Summer and Fall

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ashington, DC-Studies show a significant increase in the occurrence of methicillin-resistant Staphylococcus aureus infections in the summer and autumn months, especially in kids, reports newkerala. com. Lead author Leonard Mermel, medical director of the department of epidemiology and infection control at Rhode Island Hospital, and his colleagues conducted a retrospective 10-year study which showed that for pediatric patients there are approximately 1.85 times as many community-associated MRSA infections and 2.94 as many hospital-associated MRSA infections in the second half of the year than the first. For adults, there were 1.14 times as many CA-MRSA infections in the summer and fall, but no seasonal variation was observed in adult HA-MRSA infections. The literature showed an increased incidence of such infections during summer and autumn in many temperate regions of the world and during the warmest months of the year in tropical regions. The researchers believe that it is the sequence of the third and fourth quarters that is important, noting that maximum hydration of the skin due to high temperatures and humidity promote the environmental conditions that facilitate heavy growth of S. aureus on the skin. The study has been published online in advance of print in PloS ONE.

Private Room Intensive Care Units Associated With Lower Infection Rates

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general@kesconsult.com

www.kesconsult.com

ccording to a report in the January 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, converting hospital intensive care units (ICUs) to private rooms is associated with a reduction in the rate at which patients acquire infections. “Health care associated infections occur in about 30 percent of patients in intensive care units (ICUs) and are associated with substantial morbidity and mortality,” the authors write as background information in the article. “In ICU patients, these infections are associated with an increased length of stay of eight to nine days, and the resulting additional cost from excess stay alone is estimated to be $3.5 billion per year in the United States.” Dana Y. Teltsch, M.Sc., Ph.D. candidate, and colleagues from McGill University, Montreal, compared the rates of patient-acquired infections before and after a change from multibed rooms to single, private rooms (intervention hospital). As a control, they also used data from patients who were admitted to a similar multibed facility at a second university hospital (comparison hospital). The authors compared infection rates for a total of 19,343 ICU admissions at both hospitals between 2000 and 2005. After converting the multibed ICU to a series of private rooms, the acquisition rate of infectious organisms changed as follows: methicillin-resistant Staphylococcus aureus (MRSA) decreased by 47 percent, the rate of Clostridium difficile acquisition decreased 43 percent and yeast acquisition decreased 51 percent. Additionally, the adjusted rate of acquisition of C difficile, vancomycin-resistant Enterococcus species (VRE), and MRSA combined decreased 54 percent following the transition from multibed rooms to private rooms. The average length of stay for patients in the ICU at the comparison hospital increased steadily during the study, while the average length of stay at the intervention hospital fluctuated, but did not increase overall. Additionally, the adjusted average length of stay in the ICU fell by an estimated 10 percent after changing to private rooms.

14 Medical Waste Management APR-JUN 2011

MedicalWM_TQ_ad_8.2006_A news briefs

8/24/06

8:54 AM

Page 1

Healthcare Plastics Recycling Council Created, Will Do Studies on Helping Hospitals

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t. Paul, MN­ According to medcitynews.com, the Healthcare Plastics Recycling Council has been formed by eight companies from the healthcare, recycling and waste management industries, including Becton, Dickinson and Company, Cardinal Health, Engineered Plastics, DuPont, Hospira, Johnson & Johnson, Kimberly Clark and Waste Management. HPRC plans to add other manufacturer, waste management firm, recycler and plastic re-user members. Because data on plastics recycling is hard to quantify, the group wants to look across the complete value chain to determine what keeps hospitals from recycling items, looking at the entire life cycle. Because healthcare is highly regulated, and some plastics are contaminated, there is a lot of regulation and red tape, and in areas where recycling is unavailable, it can be expensive. But recycling can save healthcare facilities money in buy back initiatives, and the higher price of oil means opportunity for plastics recycling is improving. HPRC’s first initiative is to map the value chain, identifying challenges which prevent recycling; the second initiative is to design a document providing guidance for manufacturers of plastics packaging and products, a task hopefully to be completed by summer. The HPRC will then work to implement that guidance and analyze the economic viability. The third initiative will be a pilot study program to be held in five healthcare facilities within three years, with two of those completed this year.

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news briefs

ASHE Recognizes Health Care Facilities for Reduction in Energy Consumption

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www.EQONLINE.com

www.mark-costello.com

16 Medical Waste Management APR-JUN 2011

n observance of Earth Day, the American Society for Healthcare Engineering (ASHE) of the American Hospital Association recently recognized 13 health care facilities for their reduction of energy consumption. ASHE’s Energy Efficiency Commitment (E2C) encourages hospitals across the country to reduce their energy consumption by 10 percent or more in support of the goals of EPA’s ENERGY STAR® Challenge. ASHE recognized the following hospitals for their leadership in reducing energy consumption: • Baptist Hospital – Nashville, Tenn. • Memorial Hermann Katy Hospital – Katy, Texas • Memorial Hermann Memorial City Medical Center – Houston • Memorial Hermann Northeast Hospital – Humble, Texas • Memorial Hermann Northwest Hospital – Houston • Memorial Hermann Prevention & Recovery Center – Houston • Memorial Hermann Southeast Hospital – Houston • Memorial Hermann Southwest Heart & Vascular Institute – Houston  • Memorial Hermann Sugar Land Hospital – Sugar Land, Texas  • Memorial Hermann Texas Medical Center Heart & Vascular Institute – Houston • Memorial Hermann The Woodlands Hospital – The Woodlands, Texas • Memorial Hermann Westside Hospital –  Houston • St. Francis Eastside – Greenville, S.C. According to ASHE, the efforts of these facilities were good for the environment and saved almost $13 million in energy costs compared to their baseline year. Combined, these hospitals achieved a savings of 448,823,554 kBtus of energy—a reduction in greenhouse gas emissions equivalent to that of more than 17,800 cars. Continued on next page

news briefs Continued from previous page “Since the beginning of the E2C program in 2006, more 30 health care facilities have been recognized for their commitment to reduce energy consumption. As an organization, ASHE continues to look for ways to help its members become more energy efficient, and reduce our collective carbon footprint,” said George A. (Skip) Smith, CHFM, SASHE, 2011 ASHE president. Additional information on ASHE’s E2C initiative is available at http:// www.ashe.org/e2c/.

Registration Open for the 48th ASHE Annual Conference & Technical Exhibition

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he American Society for Healthcare Engineering (ASHE) of the American Hospital Association (AHA) recently announced that registration is now open for the 48th ASHE Annual Conference and Technical Exhibition, to be held July 17-20, 2011 in Seattle, Washington The ASHE Annual Conference provides practical, timely and realistic information to an audience of more than 2,500 health care facilities management professionals. Concurrent workshop sessions at the 2011 Annual Conference will provide information on issues in the following subject areas: administration, compliance, finance, operations, and planning design and construction. ASHE is a personal membership group of the AHA. Nearly 10,000 members count ASHE as a key source of professional development, advocacy, and representation of key issues that affect their work in physical healthcare environment. For more information about ASHE contact 312422-3800 or go to www.ashe.org.

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Medical Waste Mgt Mag 5.125h x 8.375w Color Advt:Layout 1 7/16/2010 4:26 PM Page 1

No Room For Error Do you know what the new pharmaceutical regulations are? Clean Harbors does and can help keep you in compliance. Since 1980, Clean Harbors has been providing comprehensive and customized waste management services to hospitals and healthcare institutions across North America. For more information call 888.304.7035 or email healthcareservices@cleanharbors.com www.cleanharbors.com/healthcare E X P E RT I N - H O U S E

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APR-JUN 2011 Medical Waste Management 17

news briefs

Quick-Drain™ by Bemis • Saves Money • Reduces Red Bag Waste • Increases Safety • Connects to Existing Plumbing • Requires No Electricity Call us for a cost analysis at your facility. Disposes of liquid infectious waste quickly and safely into the sanitary sewer eliminating the need for costly solidifiers. Satisfies OSHA, EPA, CDC and NIOSH guidelines for the removal of infectious waste risks.

Wisconsin Begins Drug Disposal Program to Protect Great Lakes

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shland,WI-A new Get the Meds Out program will begin this spring in 36 Wisconsin counties as a way of reducing the environmental impact of unused prescription drugs on the Great Lakes, reports ashlandcurrent.com. The University of Wisconsin-Extension received an EPA grant to teach citizens about disposing of drugs safely to keep them out of the sewer system and polluting the watershed. The program can also help reduce the amount of addictive or harmful medications in the home and prevent drug abuse. “Get the Meds Out” partners with county health departments pharmacies and senior centers so people can mail unwanted medications in for disposal in free mail-back envelopes, which are mailed to Maine for processing. People using the envelopes are also asked to complete a short survey giving their opinions and attitudes about disposal. Other educational materials are also available in participating venues. There are now one-day collection drives and permanent police station drop-boxes in several of the state’s 99 counties Maine’s “Safe Medicine Disposal for ME” program is Wisconsin’s model and is the only such program in the country with U.S. Drug Enforcement Agency approval of returning controlled substances by mail. Wisconsin hopes the initiative will serve as a model for other states.

Stericycle Ordered to Divest Sheboygan Falls, WI

Phone 800.558.7651 • Fax 920.467.8573 Email HCG@BemisMfg.com • www.BemisHealthCare.com

www.rotonics.com/medicalwaste.html

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ew York, NY-In order to get the Justice Department to approve its purchase of Healthcare Waste Solutions Inc., Stericycle Inc. must divest its transfer station in the Bronx, as otherwise competition for infectious waste treatment services in the New York City metropolitan area would be compromised, reports online.wsj.com. The original arrangement would leave only two competitors with local transfer stations, and Stericycle and HWS would control 90% of the New York City metro area’s infectious waste treatment market.

Texas Works to Resolve Radioactive Waste Storage Issues

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ustin, TX-Star-telegram.com reports that the Senate Natural Resources Committee in Texas is developing a legislative plan to better oversee and restrict the Texas Low-Level Radioactive Waste Disposal Compact Commission, which determines whether other states may send low-level radioactive waste to a Waste Control Specialists facility in Andrews Country. It has approved two bills affecting where contaminated waste including hospital and lab equipment, soil and gloves that have come in contact with radioactive material can be shipped when traveling to the facility, confronting worries about spills, contamination and liability. Waste Control Specialists, owned by Harold Simmons, applied six years ago to dispose of such waste, and the state has allowed waste from Texas, Vermont and federal sources. The two bills, by state senator Kel Seliger, R-Amarillo, would first let the site accept waste from other states, but not from other countries; limit the amount collected there and create surcharges for the waste from new states from $40 million to $60 million. The second would make the commission independent of the Texas Commission on Environmental Quality and have it report only to the state legislature. medicalwaste@rotonics.com 18 Medical Waste Management APR-JUN 2011

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www.batteryrecycling.com APR-JUN 2011 Medical Waste Management 19

Medical Waste Management Serving Healthcare Facility Waste Management Professionals

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VOL. VII NO. 2

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APR-JUN 2011

TOP STORIES In-House RMW Processing: Cure to Incineration Woes

PAGE 1

Cost Saving for Hospitals Starts With Recycling Waste, Plus Other Measures

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Waste Auditing: Get to Know Your Waste Streams

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Private Room Intensive Care Units Associated With Lower Infection Rates

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ASHE Recognizes Health Care Facilities for Reduction in Energy Consumption

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www.ahe.org