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New Hampshire Teaching Hospital Takes Lead in Sustainability Through Innovative Recycling Programs
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By Todd Williams
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h e Granite State’s largest hospital, Dartmouth-Hitchcock Medical Center, has made recycling a major theme in its operations and is reaping the financial benefits from this commitment. According to the teaching hospital’s Manager of Sustainability and Waste Programs, John Leigh, in 2013 Dartmouth-Hitchcock recycled and diverted over 1,001 tons of waste, with a total financial benefit of nearly $464,000. Leading to this milestone, on the road to greater sustainability, Dartmouth-Hitchcock has had a long history of recycling, beginning with a basic paper recovery program in 1991 when it moved to its new 240-acre campus near Lebanon, located along the Vermont border in western New Hampshire. Since then the medical center has forged ahead
with recycling and sustainability in nearly every facet of its operation, from cafeterias and other public spaces, to offices and operating rooms, says Leigh. This focus on recycling and energy efficiency has lead the hospital to national recognition, including kudos from Practice Greenhealth. Dartmouth-Hitchcock became the first hospital in the United States to comprehensively measure its ecological and carbon footprint. It has freely provided its calculator model to other healthcare institutions in hopes of raising the bar for sustainability measurement throughout the healthcare industry. Waste from the 2 million-square-foot, 18 building complex, employing nearly 7,000 people, goes to its 2,500-square foot waste management center. This room is the heart of the hospital’s
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medical waste management
New Hampshire Teaching Hospital Takes Lead in Sustainability
PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers Alice P. Jacobsohn Todd Williams Sandy Woodthorpe 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 For subscription information, please call 440-257-6453. M e d i c a l Wa s t e M a n a ge m e n t (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 of the U.S. add $10.00 ($29.95). Contact our main office, or mail-in the subscription form with payment. ©
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Printed on Post-Consumer Recycled Paper
Continued from page 1
recycling program, employing eight workers every day of the year. Three of the staff are electric tow motor operators who collect over 100 waste collection carts every shift, bringing them back to the center so that their contents can be sorted, processed and shipped. The carts are collected from a myriad of locations through out the facility, having been filled by employees educated in the basics of separating waste material into categories. According to Leigh, the center is fully staffed and equipped to handle all the hospital’s waste output, with shredding capabilities for paper; autoclaves for medical waste treatment; storage for recyclables; compactors; open top containers; a food waste container and a sorting station. “We have been gradually and deliberatively expanding our recycling program for many years. Starting with basic paper recycling, we’ve added many other materials and are now branching into commodities that municipal programs don’t typically collect and market, such as plastic films and textiles,” he explains. In the center, items are separated and sent to their final destinations. Infectious waste is autoclaved, added to other municipal solid waste and sent to a landfill. Paper is shredded, conveyed into compactors, and sold to a paper mill. Food waste is sent to a farm for composting. Metals are recycled by a local scrap yard. Commingled containers, including aluminum cans, bottles and rigid plastics are sorted and recycled by the hospital’s recycling partner, Casella Waste Systems. Casella also picks up blue wrap and plastic films. In fact, Casella has partnered with the medical center for over a decade in developing the recycling program that has evolved from a multi-stream, hand-separated recycling program to a modified “Zero-Sort,” where certain products are separated at Casella’s facility. The medical center is also one of 86 hospitals that have joined Practice Greenhealth’s innovative program, Greening the OR Initiative. This is a collaborative effort of members to find ways to reduce operating room waste, energy usage, and worker and patient exposure to hazardous chemicals, as well as reduce costs. Practice Greenhealth estimates that between 20-30 percent of the total waste generated by a hospital, and over half of its regulated medical waste, comes from the operating room. Dartmouth-Hitchcock’s waste audits show these percentages are a little less at its campus. Leigh says the medical center has recently implemented a new approach for operating room recycling, in which personnel place all recyclable materials, including blue wrap, rigid plastics, boxboard and paper, low density plastic films, Tyvek and aluminum foil into a bright yellow barrel, lined with a special blue bag. When blue bags arrive at the waste management center, these are set aside to be hand sorted by the staff.
According to Leigh, the highly identifiable barrel, extensive training of the operating room staff, and an improved sorting process in the waste center have resulted in an eight-fold increase in the amount of recyclable material captured from the operating rooms. Dartmouth-Hitchcock uses red bags only for the relatively small portion of infectious waste destined for off-site incineration. Leigh explains that they use the tan colored biohazard bags for the majority of their potentially infectious waste, which is autoclaved on site, co-mingled with trash, and shipped to a local landfill. There, operators can easily identify the Dartmouth treated waste (in tan bags) and continue to use red bags as a “red flag” worthy of investigation. Sharps are shipped to a treatment facility for processing, then on to a waste-to-energy municipal waste incinerator. The other items that Leigh has to deal with are Single-Use Medical Devices (SUDs). “One of the biggest challenges we face in the hospital environment is the increasing use of disposable medical devices and supplies,” Leigh explains, adding, “because of expanding infection control concerns, the use of these devices is becoming more popular.” Leigh warns that while there has been resistance to using reprocessed medical devices in some quarters of the medical community, because of fear of infection, clinicians must understand that SUD reprocessors are subject to very rigorous FDA regulations that ensure that quality standards for reprocessed items meet or exceed those of original device manufacturers. Although admitting that the medical center does not purchase nearly as many reprocessed medical devices as it could, it is a “big donator” of used devices to Stryker, a major reprocessor of SUDs. Stryker reprocesses and sells EP and cardiovascular devices, non-invasive devices, general surgery devices, orthopedic and arthroscopic equipment, as well as opened, unused and expired medical devices. “We try to promote the use of reprocessed single-use devices and support the re-use industry by maximizing our donations to Stryker,” Leigh says. He also explains that green initiatives continue to experience growth through “expanded efforts of diverting-from-disposal other product types throughout the facility, including DVTs, pulse oximeters, disposable blood pressure cuffs, ECG leads and tourniquet cuffs, as well as further education of collection protocols of single use devices.” Leigh says the biggest challenge in getting physicians to use more reprocessed devices is educating them to overcome brand loyalty and to understand the environmental impact of SUDs. According to 2013 statistics provided by Leigh, reprocessed SUDs are part of the category
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Proposed Water Regulations Could Affect Construction at Your Facility
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By Alice P. Jacobsohn
ater protection issues usually affect the medical waste management and healthcare industry in the form of drinking and washing areas, sewage systems, and stormwater management. However, water management can also impact some types of disposal units in terms of managing steam sterilization processes and washing reusable containers, and over pharmaceutical disposal with state and federal agencies’ concerns over flushing. On occasion, however, an operation can run up against water regulations when considering expanding facilities or selecting a location for building new facilities. Where land is located near protected “waters of the United States” under the Clean Water Act (CWA), a federal permit may be required and denied. Recently, proposed changes were made to CWA regulatory definitions and requirements. This article discusses the history of water permitting and outlines the proposed changes for the purpose of looking at impacts on facility expansion and new location selection. As a result of three recent lawsuits before the U.S. Supreme Court over the definition of “waters of the United States” – U.S. v. Riverside Bayview Homes, Inc., Solid Waste Agency of Northern Cook County v. U.S. Army Corps of Engineers, and Rapanos v. U.S. – the U.S. Army Corp of Engineers (COE) and Environmental Protection Agency (EPA) published a proposed rule on April 21, 2014. The comment period ends on July 21, 2014. The section 404 definition of “waters of the United States” is perhaps the most controversial provision of the CWA of 1972, as amended by the Federal Water Pollution Control Act of 1977, because the term defines the beginning point of federal jurisdiction by the COE and EPA. This is the point where water protection regulations determine whether a facility can expand, what companies must do to prevent negative impacts on waters near their operations, and how much water a company can use in protected areas. Under the CWA, any discharge of dredged or fill materials into “navigable waters” — defined as the “waters of the United States” — is forbidden unless authorized by a COE permit. The EPA also plays a role working with the COE, particularly on technical and scientific issues. In 1975, after initially determining the CWA to cover only navigable waters, the COE issued final regulations redefining “waters of the United States” to include not only actual navigable waters, but also tributaries of such waters, interstate waters and their tributaries, and non-navigable intrastate waters whose use or misuse could affect interstate commerce. The COE also claimed jurisdiction over all freshwater wetlands located adjacent to an otherwise covered water. In 1976, Riverside Bayview Homes, Inc. began adding fill to its property to build housing. The land was low-lying and marshy near the shores of Lake St. Clair in Macomb County, Michigan. The COE claimed that the property was an adjacent freshwater wetland and filed a lawsuit against the company for failure to obtain a permit. The lower court agreed with the COE and Riverside appealed. On appeal, the court found for Riverside stating that the definition of adjacent wetland only included those where the otherwise covered water was subject to “flooding” into the wetland in a manner that caused growth of aquatic vegetation. The vegetation on Riverside’s property was not caused by such flooding. On appeal to the U.S. Supreme Court by the COE, the court stated that while the definition of a wetland includes aquatic vegetation, the CWA regulations do not require a flooding 4
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situation. The language refers to surface and groundwater saturation that leads to aquatic vegetation. The facts showed that Riverside’s property was saturated by groundwater and aquatic vegetation grew. The property also was adjacent to a navigable creek – an otherwise covered water. The real question for the U.S. Supreme Court was whether the COE’s regulations were an appropriate interpretation of the CWA. Did the COE correctly determine where water ends and land begins to claim jurisdiction? The court deferred to the technical judgment of both the COE and EPA that wetlands impact water quality and wildlife habitat at adjacent lakes, rivers, and streams even if the water does not come from those waters and, thus, are included in the CWA. Therefore, the COE was not wrong in regulating all adjacent wetlands. The court issued its 1985 decision reversing the appeals court in favor of the COE requiring a permit because the wetland abutted the navigable water. In a second case, the Solid Waste Agency of Northern Cook County (SWANCC), a consortium of suburban Chicago municipalities, selected as a solid waste disposal site an abandoned sand and gravel pit with excavation trenches that had evolved into permanent and seasonal ponds. Because the operation called for filling in some of the ponds, SWANCC contacted the COE and EPA to find out if a permit was required. The COE asserted that there was federal jurisdiction because of a 1986 agency interpretation called the “migratory bird rule,” where a wetland was subject to the CWA if migratory birds made the wetland a habitat. At question in the case for the U.S. Supreme Court was whether the COE correctly interpreted the CWA and interstate commerce. The COE asserted that because Congress did not change the COE’s interpretation of the CWA in 1977, Congress agreed to it. The U.S. Supreme Court held that Congress’ authority to regulate interstate commerce was not unlimited because of Constitutional authority that gives states traditional and primary power over land and water. In addition, Congress’ failure to act does not translate to an affirmative agreement to an agency’s actions. There is no language in the CWA to indicate that Congress intended to include abandoned sand and gravel pits not adjacent to navigable waters. Therefore, in its 2001 opinion, the U.S. Supreme Court found for SWANCC. A third case came before the U.S. Supreme Court for decision in 2006. In 1989, John Rapanos and others began backfilling their Michigan properties for purposes of development. The properties included four wetlands lying near ditches or man-made drains that eventually emptied into traditional navigable waters. The sometimes saturated soil was located 11 to 20 miles away from navigable waters and the property owners were informed by regulators that they needed a permit, but three of the wetlands had been filled without a permit. One of the owners was denied a permit to deposit fill in a wetland that was separated from a drainage ditch by an impermeable berm. The U.S. Supreme Court stated that the CWA was intended “to restore and maintain the chemical, physical, and biological integrity of the Nation’s waters” and also that “it is the policy of Congress to recognize, preserve, and protect the primary responsibilities and rights of States to prevent, reduce, and eliminate pollution” and “to plan the development
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Proposed Water Regulations Could Affect Construction at Your Facility
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and use (including restoration, preservation, and enhancement) of land and water resources.” The court further stated that “waters of the United States” in ordinary terms only includes those relatively permanent, standing or continuously flowing bodies of water that form geographic features and that are described as streams, oceans, rivers, and lakes. Even though the CWA is more expansive than the ordinary definition implies, the definition does not include channels through which water flows intermittently or ephemerally, or channels that periodically provide drainage for rainfall. The COE cannot intrude on states’ rights over land use and the term “waters” is not merely a hydrologic body. The court said that
establishing coverage of the owners sites requires a finding that the adjacent channel contains a relatively permanent water of the United States, and that each wetland has a continuous surface connection to that water, making it difficult to determine where the water ends and the wetland begins. The case was sent back to the lower court to determine the facts. In the current proposed rule, the agencies are asking for comment on two approaches to the CWA definition of “waters of the United States.” The first definition concerns waters that clearly fall within the definition -- lakes, streams, rivers, territorial seas, interstate wetlands, tributaries, and other interstate waters. This category also includes adjacent wetlands where
www.bemishealthcare.com
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the wetlands are connected to downstream water bodies, i.e., the nexus alone or in combination with similarly situated water in the region, is significant based on science, the CWA, and court decisions. The agencies refer to these waters as jurisdictional by rule. In the second definition, referred to as “other waters,” the agencies plan to use a casespecific showing that alone or in combination a significant nexus to a traditional navigable water, interstate water, or territorial sea exists. These waters include prairie potholes, playa lakes, mudflats, and sandflats. At issue is how the agencies plan to determine a significant nexus. Comment is requested on the approach the agencies plan to take. Other possible approaches are listed, but will only be adopted if comments show they are predictable, consistent, and clarify the definition, while fulfilling the agencies’ responsibilities to protect water quality, public health, and the environment. The agencies also are asking whether there is a means of identifying nonjurisdictional waters by category or rule and how to address those waters where the science is inconclusive. The agencies are not changing the definition of “adjacent” and “wetlands,” but are adding new definitions for “neighboring,” “riparian area,” “floodplain,” “tributary,” and “significant nexus.” For readers that prefer agency rules that are clear and concise, the proposed rule eliminates loopholes and codifies requirements that previously were offered as guidance or where case law was inconsistent. Those that oppose the rule are concerned about land development in drought areas, further government control, and increased power by the COE and EPA over state jurisdiction. For the medical waste and healthcare industry, the impacts may be more positive. Generally, the agencies have always been more aggressive about including waters in their jurisdiction waiting for the U.S. Supreme Court to tell them otherwise; therefore, claims that the proposed rule increases federal jurisdiction may be exaggerated. In addition, rather than guessing when the agencies will assert themselves, if the proposed rule actually clarifies when the agencies will act, industry decision-making on facility expansion or selection of facility location will be easier. A clear approach to determining when water ends and land begins can reduce the total amount of time the permit process may take if only because scientists will have a better idea of what to examine. Alice Jacobsohn is an environmental attorney with expertise in government relations, regulations, guidance, and policy. She can be reached at alicej5251@comcast.net or 202-669-4001. View her LinkedIn profile at www.linkedin.com/in/ alicejacobsohn.
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New Hampshire Teaching Hospital Takes Lead in Sustainability Continued from page 3
of items that provide more than half of the financial benefit enjoyed by the hospital’s recycling program. Other items include re-used furniture, and sharps containers that are donated or recycled by the medical center. These items accounted for slightly more than 176 tons of the waste stream. The hospital avoided $17,257 in disposal costs last year, and another $312,000 in costs were avoided from not purchasing new or virgin products, for a combined benefit of $332,257. In the category of paper products, the hospital recycled over 277 tons of corrugated cardboard, with a total benefit (after transport and baling fees) of $28,212 or $101.71 per ton; over 186 tons of mixed paper with a total benefit of $9,233 or $49.51 per ton; and over 92 tons of white ledger paper, with a total benefit of $18,165 or $197.05 per ton. In the area of commingled containers, including bottles, cans and rigid plastics, over 50 tons were collected at a total cost to the hospital of $3,394. Scrap metal recycling, including items like platinum tips from catheters, showed a net income of over $1,000. A total of nearly 38 tons of food waste were sent to composting, with a net benefit of $3,666 in avoided landfill costs. And finally, Leigh says, the hospital recycled over 56 tons of plastic film, electronics, books, vinyl wall guards, blue wrap, Tyvek and toner cartridges, with a net benefit of $18,274. “Although hauling and processing costs continue to climb, especially for containers, including rigid plastics, bottles and cans, and although our paper use and corresponding recycling revenue is decreasing, income still exceeds fees in our recycling programs,” he explains. He adds that when factoring in the avoided costs, every one of the recycled materials pays for the program, totaling a net benefit to the medical center in excess of $100,000. We have been growing our program slowly and educating our employees along the way. One step at a time – that’s how this works,” Leigh notes. He explains that one of the real keys to Dartmouth-Hitchcock’s waste
management program is engineering controls. “You put the recycle containers next to the trash receptacle. You label the containers clearly. You color code the labels. You use different lids such as slots for paper and round holes for bottles and cans. Recycling has to be convenient for people, and well communicated to make it successful in an institution,” Leigh explains. Leigh says, increasingly, he spends his time educating hospital staff on how recycling is just a small piece of achieving sustainability in healthcare and that he “takes time to really engage with staff on the importance of source reduction and conserving our dwindling natural resources.” He notes that besides waste management education, he’s spending more time interacting with employees on energy usage, transportation issues, and healthier, more sustainable food choices.” “I discuss methods to reduce energy usage as well as methods to reduce the amount of chemicals used in the facility. How well we do at diverting waste from disposal is what most staff contact me about, and I use that interest to broaden the conversation to the overall environmental sustainability picture. Getting this message out is critical, especially since our medical center is a teaching facility,” he says. Leigh says the overall message he wants his colleagues to come away with is the environmental responsibility that they all have in their jobs, and as healthcare providers. “We are here to prevent human suffering and create the healthiest population possible, so it’s important that we recognize the fundamental connection between public health and the quality of the ecosystem on which we depend. Availability of resources, biodiversity, and Earth’s capacity to absorb our emissions and our waste will all have a real impact on us as a species. Reducing our environmental footprint and finding a way to live within the finite means of our one planet is the real key to our long term well-being, and thus it must become the work of the healthcare industry,” Leigh adds. Photos courtesy of Dartmouth-Hitchcock Medical Center.
www.mark-costello.com apr-jun 2014
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news briefs
Incineration of All Medical Waste Halted at Oregon Facility
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www.medwastecontainers.com
rooks, OR – Allegations published in a Canadian newspaper have had an impact on an incineration facility here, according to an article on portlandtribune.com. A report by B.C. Catholic, a Vancouver-based newspaper, alleged that fetal tissue may have been trucked from Canada along with other medical waste to the Covanta Energy facility in Oregon. Although the presence of fetuses or fetal tissue in the shipments to be incinerated is unsubstantiated – and denied by both representatives from Covanta and Stericycle Canada – the news was enough to convince Marion County Commissioners to cancel its contract with Stericycle Canada. In addition, the commissioners amended the county’s solid-waste ordinance to specifically exclude human fetal tissue from approved infectious waste. Declaring the idea of fetuses being burned for power “morally reprehensible,” the board approved an order prohibiting the acceptance and destruction of all medical waste at the facility. The order will apply to 15 to 20 companies contracted with Marion County to transport medical waste. Contracts will have to be amended to prohibit the transfer of human fetal tissue, and companies will have to provide certification that their waste stream does not contain fetal tissue. Also, inspections may be made for verification purposes. Commissioner Sam Brentano told media another reason for the contract cancellation was to restrict the origin of waste to that coming from within Oregon or the United States. The Covanta facility has been processing about 700 tons of in-county medical waste annually and about 1,200 tons from elsewhere. Out-of-town medical waste is charged a higher fee. Jolene Kelly, a spokeswoman for the board of commissioners, said that, overall, medical waste comprises only a tiny portion of the material that is consumed at the Covanta plant, or about 0.01 percent.
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news briefs
The American Hospital Association Expands UTI Prevention Program
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hicago, IL – Catheter-associated urinary tract infections are the target of a newly expanded prevention program of the American Hospital Association (AHA), reports The-Hospitalist.org. The AHA’s Comprehensive Unit-based Safety Program (CUSP), which combines infection control education and statistical tracking support to hospitals nationwide, is coordinated by the Health Research and Educational Trust (HRET). Grant funding for the project comes from the federal Agency for Healthcare Research and Quality. The grant is being administered by HRET in partnership with other organizations, including the University of Michigan Health System, the Association for Professionals in Infection Control and Epidemiology, and Society of Hospital Medicine. Catheter-associated urinary tract infections (CAUTIs) are an important target because they are the most common type of health care-associated infection in U.S. hospitals. As many as one-fourth of all hospital inpatients may have a short-term, indwelling urinary catheter placed during their hospital stay. A significant portion of these catheters are placed without appropriate indications. Complications associated with CAUTI result in increased length of stay, patient discomfort, excess health care costs, and sometimes mortality. Urinary tract infections (UTIs) account for 35 percent of all healthcare acquired infections. The estimated cost per patient for CAUTIs ranges from $750-$1,000 and the estimated total cost in the United States ranges from $340 million - $450 million annually. CAUTI-related mortality is 13,000 deaths annually. Progress by CUSP to date includes a 40% reduction in central lineassociated bloodstream infections (CLABSI) in 1,000 participating hospitals. A study published in the American Journal of Infection Control found that rates of catheter-associated urinary tract infections in adult patients given urinary catheter placements dropped nationwide to 5.3% in 2010 from 9.4% in 2001. In addition, data from the National Hospital Discharge Survey was analyzed, revealing that CAUTI-related mortality and associated length of hospital stay also declined during the same period. The goals of AHA’s national On the CUSP: Stop CAUTI project are to: • Reduce mean CAUTI rates in participating clinical units by 25 percent over eighteen months. • Improve patient safety by disseminating the Comprehensive Unit-based Safety Program (CUSP) model and tools as evidenced by improved teamwork and communication. • Promote the coordination of state-based efforts to eliminate HAIs. CUSP is a campaign of AHA’s Hospitals In Pursuit of Excellence national initiative.
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Cooley Dickinson Fined for Illegal Medical Waste Disposal
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orthhampton, MA – Cooley Dickinson Hospital in Northampton has been fined by the Massachusetts state Department of Environmental Protection improper disposal of hazardous waste, according to an article in The Republican reported on BizJournals.com. The state Department of Environmental Protection fined the hospital when inspectors determined that staff failed to properly determine the hazard level of its medical and pharmaceutical waste, and for having pharmaceutical waste hauled by a firm not licensed by the state, officials said. The inspection also found hazardous materials improperly labeled. “Certain medications that are destined for disposal are considered hazardous wastes and must be managed in accordance with the Massachusetts hazardous waste regulations,” said Michael Gorski, director of the state Department of Environmental Protection’s Western Regional Office in Springfield. Because the hospital was cooperative with investigators and took immediate steps to correct areas of noncompliance, the fine was reduced from $8,000 to $6000. The agency agreed to waive the remaining $2,000 if the hospital remained in compliance with regulations.
www.bomaccarts.com apr-jun 2014
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news briefs
New Antibacterial Fabric Promises Infection Control in Ten Minutes
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elbourne, Australia – Researchers at Royal Melbourne Institute of Technology (RMIT) have developed an antibacterial fabric they say can kill a range of infectious bacteria, such as E coli, within 10 minutes, reports Phys.org. The fabric, which uses nanoparticle technology, has potential applications for special bedding, linens and surgical aprons on which viruses and bacteria tend to grow. According to study leader, Associate Professor Vipul Bansal from RMIT University’s School of Applied Sciences, other uses for the fabric may include sporting gear and clothing. A nanoparticle is a very small particle having at least one dimension is between one and 100 nanometers (1nm is 1,000,000 times smaller than a millimeter). Led by Associate Professor Bansal, RMIT’s NanoBiotechnology Research Laboratory team studied ways in which organic materials with semi-conductor properties behave. With the long-known antibacterial effects of silver in mind, the team grew nanowires on fabric, and ran a series of tests, resulting in their development of silver TCNQ. “Silver metal, when it comes into contact with body fluids, releases silver ions and these ions are actually toxic and have anti-microbial and antibacterial properties,” Bansal explains. “The Holy Grail is to engineer the nanoparticles so they become highly active against infectious bacteria, but they do not kill human cells.” “Traditionally, silver nanoparticles are more toxic than gold nanoparticles but our research has shown that silver can be made very safe for biomedical applications by controlling the surface chemistry of nanoparticles.” Associate Professor Bansal said the surface of the nanoparticle is critically important because that is what first comes into contact with bacteria or human cells. The team is currently comparing more nanoparticles of different sizes, shapes, compositions and surface coatings to test their ability to destroy different bacteria.
New UT State Law Tightens Restrictions on Med Waste Incinerators
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alt Lake City, UT – As Stericycle upgrades its existing North Salt Lake City medical waste incineration facility, Utah Gov. Gary Herbert approved a state senate bill that prevents such facilities from being built within two miles of existing neighborhoods, reports WashtingtonTimes.com. The bill, SB 196, Medical Waste Incineration Prohibition, was introduced by state Sen. Todd Weiler. The bill was written following public outcry by residents living near the facility, as well as environmental and physician groups. The legislator also considered State studies that pointed to elevated cancer rates near the location. Air and soil tests have not resulted in any direct correlation between the illness and incineration. The new law applies to facilities built after May 13, 2014. Stericycle is moving forward with plans for a new incinerator in a more sparsely inhabited area of the state. SB 196 will apply to the company’s proposed Tooele County facility. At the new location, the closest home is 11 miles away, and the closest neighborhood is about 18 miles, company official told media. According to the Stericycle’s permit granted by the Utah Division of Air Quality (DAQ), the North Salt Lake City incinerator processes 7,000 tons of medical waste each year. “I really do believe that we have found a good location for our facility,” said Selin Hoboy, Vice President of Legislative and Regulatory Affairs for the company. As required by the DAQ’s Notice of Violations last year, the company has agreed to replace equipment to further reduce the North Salt Lake City plant’s emissions. “Look, the facility is continuously monitored. That information is given to the state and is available publicly for people to review,” Hoboy said. “We have nothing to hide, and as far as assurances, I mean, that was our single emissions violation in 25 years. I have to say it’s a pretty good track record.”
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news briefs
WHO and Columbia Nursing Study Finds Hand Sanitizer Not Easily Available
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ew York City, NY – Columbia University researchers say U.S. health facilities are missing a critical step in healthcare-associated infection prevention by not making alcohol-based hand sanitizer available at every point of care, reports Elsevier.com. Conducted by a joint team of researchers from Columbia University School of Nursing and the World Health Organization (WHO), the new study was published in the American Journal of Infection Control. The researchers surveyed 168 hospitals, ambulatory care, and long-term care facilities in 42 states and Puertro Rico for compliance with WHO hand hygiene guidelines. Findings revealed one in five medical facilities made alcohol-based hand sanitizer readily available and only about half had set aside funds in their budgets for hand hygiene training. About one in ten facilities reported that senior leaders, such as the chief executive officer, medical director, and director of nursing didn’t make a clear commitment to support hand hygiene improvement. “When hospitals don’t focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections,” says Laurie Conway, RN, study leader. “The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren’t always doing all that they can to send a clear message that preventing infections is a priority.” Hand hygiene is critical to preventing health care-associated infections, which cause about 100,000 deaths a year in the U.S. and cost about $33 billion to treat. The Centers for Disease Control and Prevention issued guidelines for hand hygiene in 2002, and the WHO followed suit in 2009. “The survey also shows that facilities participating in the WHO global hand hygiene campaign achieved a higher level of progress,” says co-author Prof. Didier Pittet, MD, MS, Director, Infection Control Program and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. “While hand hygiene compliance is the responsibility of every health care worker, U.S. health care facilities would certainly benefit from coordinated national and sub-national efforts aimed at hand hygiene improvement. They would also gather innovative ideas and trans-cultural approaches by participating in global efforts such as the WHO campaign.”
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EQ – The Environmental Quality Company and US Ecology Announce Acquisition Agreement
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S Ecology recently announced that it has entered into an agreement to acquire EQ -The Environmental Quality Company (EQ), a fullyintegrated environmental services company. The acquisition is subject to regulatory approval. EQ is owned by an affiliate of New York based private equity fund Kinderhook Industries, LLC (Kinderhook). Kinderhook acquired EQ in November of 2008. “EQ is pleased to announce this acquisition. This is a great opportunity for both our associates and the company to continue driving growth and offer best in class service to our customers,” EQ CEO Dave Lusk said. EQ is a fully-integrated environmental services and waste management organization based in Wayne, Michigan. It implements innovative technology and service solutions that minimize waste volumes, reduce costs and protect the environment. EQ owns ISO and OHSAS-certified treatment, disposal and recycling facilities and manages an extensive line of remediation, industrial cleaning, and total waste management services throughout North America. US Ecology, Inc., through its subsidiaries, provides environmental services and industrial waste management services to commercial and government entities, such as refineries and chemical production facilities, manufacturers, electric utilities, steel mills, medical and academic institutions and waste brokers. Headquartered in Boise, Idaho, the company is one of the oldest radioactive and hazardous waste services companies in North America.
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apr-jun 2014
Medical Waste Management 11
news briefs
Aurora Says “Yes” to Greening of Medical Waste Processing
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olorado Medical Waste, Inc., recently announced that Colorado has become the third state in the nation to adopt ozone technology for the processing of medical waste. According to the company, the new green technology uses ozone to process medical waste with no known environmental contaminants. Following approvals by the City of Aurora, Metro Waste Water Reclamation, and the Colorado Department of Public Health and Environment (CDPHE); final approval was granted on March 10th for operation of the Ozone Medical Waste Processor at the company’s Aurora location. According to the company, Colorado Medical Waste is the first in Colorado to adopt this technology. President Beverly Hanstrom said she has worked for over three years to obtain regulatory approvals to operate her new medical waste processor.
Recycled Pacemakers Worth their Weight in Gold
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h i l l i p s bu rg , N J – A n A m e r i c a n cardiologist, Dr. Daniel Mascarenhas has been recovering “used” pacemakers and sending them to India for cardiac patients there, according to a Newsworks.org article. Dr. Mascarenhas collects the pacemakers by contacting funeral homes to find out if any of the recently deceased have them. He then (with the permission of relatives) removes the devices and sterilizes them in Cidex solution and checks the battery life to make sure it has at least five years useful life. Pacemakers, which can continue running for about 10 years, continue to pulse after a person has died. The doctor packages the recovered devices and puts them on a plane with passengers headed to India. “The sad part is that we could reuse them in 2014 Security Shredding & this country by re-sterilizing them,” he says. “But nobody wants to do this because we are a land Medical Waste Conference where 18-20, we learn to2014 waste.” Atlanta, GA November Although there is a slim risk of transmitted Atlanta, GA November 18-20, 2014 Atlanta, GA • November 18-20, 2014 Cobb Galleria Centreinfection or device failure, the doctor contends Cobb Cobb Galleria Galleria Centre Centre that the amount of risk in reusing a $6000 pacemaker is small compared to the life it may save. 2014 Security Shredding & “In India really, there is no safety net. So if Medical Waste Conference you don’t have the money, in short, if you’re from the slum, you’re dead,” he says. Atlanta, GA • November 18-20, 2014 Nearly a quarter of a million people receive CONFERENCE Cobb Galleria Centre pacemakers in the United States annual, while the number is about 15,000 in India. “One of my patients had a pacemaker and she died,” he remembers. “They put in a pacemaker and two days later, she was dead, and they buried We’ll Show You How to Generate New We’ll Show You How to Generate New her with the pacemaker. That was an eye-opener We’ll Show You How toProfitability Generate New Revenue and Increase for me. What a waste of resources. Something Revenue and Increase Profitability costing $6,000 was buried in the ground.” Revenue and Increase Profitability Building on 2013’s successful launch, Security Shredding & Medical Waste 2014 on companies 2013’s successful launch, Shredding & “So Medical Wastewho 2014 anybody tells me that they’re going will feature equipment Building and product that supply to bothSecurity the document will feature and product companies that supply to both the document Building 2013’s successful launch,equipment Security Shredding & Medical Waste 2014 shredding medical/pharmaceutical waste industries. This event will include to Mumbai, I stop them and ask them, ‘Can We’llonand Show You How to Generate New an exceptional lineup ofand educational sessions designed to give you the insight and shredding medical/pharmaceutical waste industries. event will feature equipment productand companies that supply to both document youThis carry thiswill forinclude me?’ There’s this doctor who Revenue and Increase Profitability tools that you to generate new revenue and increase profitability. an exceptional lineup of educational sessions designedcomes to giveand youpicks the insight and They get completely shredding and need medical/pharmaceutical waste industries. This event will include them up. on 2013’s successful launch, Security Shredding & Medical Waste 2014 that you need to generate new revenue andand increase anBuilding exceptional lineup oftools educational sessions designed to give you the insight gas profitability. sterilized prior to using them. So, if I’ve will feature equipment and product companies that supply to both the document Call for Papers tools that you need to generate new revenue and increase profitability. used it in a patient who can’t afford it, and who shredding and medical/pharmaceutical waste industries. This event will include an exceptional lineup ofCall educational sessions designed to give you the insight and has still 5 years left to go on that battery, he can Papers Are you interested in speaking atfor Security Shredding & Medical Waste 2014? If tools that you need to generate new revenue and increase profitability. start planning for the future. I’ve had it all well you are for an experienced professional in the industry, this is your invitation to Call Papers you interested in speaking at for Security Shredding &thought Medical out.” Waste 2014? If participate. Submit yourAre idea online at http://goo.gl/xhL6Ke consideration. Building on 2013’s successful launch, Security Shredding & Medical Waste 2014 to Call for Papers you areatan experienced professional in the industry, this is “The your invitation Are you interested in speaking Security Shredding & Medical Waste 2014? If FDA regulations are ‘single use only,’” With questions, contact Eric Skates at: eric@semcoproductions.com or will feature equipment and product companies that the participate. Submit your idea at supply http://goo.gl/xhL6Ke fordocument consideration. you are aninterested experienced professional in the industry, this online is Waste your invitation to to both Are you in speaking at Security Shredding & Medical 2014? If he says. “[It’s] illegal if I use it in this country.” call (678) 822-9812. you are anmedical/pharmaceutical experienced industry,waste this is your invitation to participate. Submit yourprofessional idea onlineinatthe http://goo.gl/xhL6Ke for consideration. shredding and industries. This event “We willget include consent from the patient that there participate. Submit yourWith idea online at http://goo.gl/xhL6Ke for consideration. questions, contact Skates at: eric@semcoproductions.com or For information about exhibiting or attending the Eric show, email Tim Fearney is a small chance infection,” he said. “That’s an exceptional lineup ofcall educational sessions designedorto give you the insight of and (678) With questions, Eric Skates at: eric@semcoproductions.com at:With tim@semcoproductions.com or822-9812. call: (678) 822-9804. questions, contact contact Eric Skates at: eric@semcoproductions.com or not the end of it, after the device is obtained, call (678) tools that you need to generate new revenue and increase profitability. call (678)822-9812. 822-9812. theyemail need Tim to send me a letter that they got this Visit us online for conference details,about hotel exhibiting reservations, and more. the show, For information or attending Fearney For information about exhibiting the show, email Tim Fearney Registration is about opening soon!ororattending device free.” at: tim@semcoproductions.com or call: (678) 822-9804. For information exhibiting attending the show, email Tim Fearney at: tim@semcoproductions.com or call: (678) 822-9804. “It’s not only with devices, now I’ve graduated at: tim@semcoproductions.com or call: (678) 822-9804. Visit usdetails, onlinehotel for reservations, conferenceand details, andtomore. Visit us online for conference more. hotel reservations, from cardiac gastrointestinal endoscopic Registration opening soon! details, Visit us onlineis for conference hotel reservations, and more. Registration is opening soon! surgery, to laparoscopic surgery, to orthopedics, opening soon! at Security Shredding & Medical Waste Are youRegistration interestedis in speaking wherein2014? I collectIfdevices which normally would Media Sponsors Managed By have been thrown you are an experienced professional in the industry, this is your invitation to away because their shelf life has expired. But really they have not expired. participate. 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news briefs
Product Return Program Backfires – Omnicare Fined Almost $300K
CA Senate Bill Proposes PharmaPaid Med Take-Back Program
incinnati, OH – A settlement has been reached between Omnicare Inc. and the state of New Hampshire over hazardous waste violations, according to a BizJournals.com article. In a case brought by New Hampshire Department of Environmental Services (DES), Ominicare New Hampshire’s parent company, Cincinnatibased Omnicare Inc. paid $290,000 to the state’s Hazardous Waste Cleanup Fund, as well as $8,100 to the Northeast Environmental Enforcement Project. The hazardous waste violations were filed by DES when an October 2011 facilities inspection at Omnicare New Hampshire turned up improper disposal practices. The complaint filed with the state attorney general’s office alleged that Ominicare shipped pharmaceuticals to facilities that were not authorized to accept them and that the shipments were not labeled according to the law. New Hampshire’s attorney general, Joseph Foster said, “Omnicare quickly corrected the problems once identified by DES and was cooperative throughout the investigation”. “The company agreed to settle the matter in order to avoid continued litigation and to focus on its mission of helping to ensure the health of seniors and other patient populations in a cost-effective manner,” an Omnicare spokesman told the media.“The settlement is not an admission of liability, and Omnicare continues to deny that there was any wrongdoing.” Omnicare provides pharmaceutical services to long-term care institutions such as nursing homes and assisted living centers as well as individuals with long-term illnesses multiple sclerosis or rheumatoid arthritis. The New Hampshire subsidiary operates mail-order pharmacies that primarily service group living facilities, including jails.
an Jose, CA – The city of San Jose has come out in support of a proposed measure that would require pharmaceutical companies to subsidize a prescription drug disposal program, reports SanJoseInside.com. SB 1014, introduced by Hannah-Beth Jackson (D-Santa Barbara), would require the medicine-makers to establish what the bill calls a “product stewardship program.” “Serious social and environmental problems persist as pharmaceuticals are banned from solid waste disposal sites without corresponding safe and convenient disposal options made available to consumers,” San Jose Environmental Services Director Kerrie Romanow, stated in a memo. “One example of a social problem resulting from the lack of proper disposal options is the stockpiling of unused medications in the home, which can contribute to accidental poisoning among children, drug abuse and other accidental drug-related deaths.” Scientific studies in the United Kingdom and US have turned up traces of drugs in waterways and the effects on the ecosystems has been documented. Pharmaceuticals become polluting when unused medications are flushed down toilets or dumped down drains. Eventually, the substances leach into the groundwater supply and are identified as a pollutant of emerging concern by state water quality regulators. California’s current Medical Waste Management Act requires consumers to find registered hazardous materials handlers to deal with unused product. If Jackson’s bill passes, California would be the first state in the country to establish a statewide drug take-back program. Fees for the program would be paid by pharmaceutical companies, which are forbidden to pass the cost along to consumers.
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Product/Equipment Profiles DuPont Protection Technologies Announces SafeSPEC™ for Controlled Environments
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uPont Protection Te c h n o l o g i e s re c e n t ly announced the launch of SafeSPEC™ for Controlled Environments, an interactive online product selector tool. Various garment selection criteria are available for user evaluation including garment brand and design, fabric type, and processing type, making product selection a customized exercise. The tool provides search options by ISO clean room classification and also by specific clean room end use applications including pharmaceuticals; biotechnology; medical devices; lab research; electronics; semiconductors; and food and beverage uses. SafeSPEC™ for Controlled Environments enables clean room professionals to view 300 garment images accompanied by garment features and benefits, and includes access to product literature and related information. SafeSPEC™ for Controlled Environments provides product imagery, literature and “where to buy” information for clean room garments and accessories in the United States and Canada. SafeSPEC™ for Controlled Environments is available via http://www.safespeccleanroom.dupont.com.
Published Studies Validate Xenex’s Efficacy on Deadly Pathogens
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eer reviewed studies have proven that the Xenex technology is highly effective and approximately 200 hospitals and Veterans Affairs (VA) facilities in the U.S. are using the Xenex system. A study published in the American Journal of Infection Control (August 2013) reported that Cooley Dickinson Hospital (an affiliate of Massachusetts General Hospital) experienced a 53 percent decrease in the rate of hospitalacquired C.diff infections after implementing the Xenex system. A study published in Journal of Infection Prevention in 2013 reported that Cone Health experienced a 56 percent reduction in its rate of hospital acquired MRSA infections after implementing an infection prevention program that included Xenex’s room disinfection system. “Our germ-zapping robots are proven to destroy deadly superbugs in just minutes – and hospitals using our devices to disinfect their facilities are reporting fewer infections,” said Mark Stibich, Chief Scientific Officer of Xenex. For more information, contact Melinda Hart at 210‑824‑3433 or melinda.hart@xenex.com or visit xenex.com.
apr-jun 2014
Medical Waste Management 13
news briefs
HAIs Decline Yet Still Common in US Hospitals
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tlanta, GA – Healthcare-associated infections are declining, yet one Atlanta, GA – Healthcare-associated infections are declining, yet one in 25 patients becomes sick, or dies during a hospital stay, according to a report issued earlier this year by the Centers for Disease Control and Prevention, according to an OutPatientSurgery.net article. Published in the New England Journal of Medicine, the “National and State Healthcare-Associated Infections Progress Report” notes the importance of handwashing as a preventative measure against HAIs. The study reports central line-associated bloodstream infections and surgical site infections continue to approach the 5-year goals set in the National Action Plan to Prevent Health Care-Associated Infections. Hospitalonset C. difficile infections and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections have decreased, as well, but minimally. Catheter-associated urinary tract infections are up. The Progress Report states these figures signal a need for additional prevention efforts to meet the CDC’s five-year goals for reducing these infections. Patient data included the report was collected from 183 hospitals in 2011. Of the approximately 721,800 infections that occurred that year, 648,000 hospitalized patients were affected. Mortality caused by HAI was 75,000. The numbers at a glance: Infection Type Percent of Infections Surgical site (colon & abdominal hysterectomy) 22% Pneumonia 22% Gastrointestinal 17% urinary tract 13% Bloodstream 10%
Common Bacteria Causing HAIs Clostridium difficile Staphylococcus Klebsiella Escherichia coli Enterococcus Pseudomonas
Percent of HAIs 12% 11% 10% 9% 9% 7%
The CDC separately reports that progress is being made to curb infection risks, however. Central line-associated bloodstream infections decreased by 44% and SSIs associated with 10 commonly reported procedures — including hip and knee arthroplasties, colon surgery and abdominal hysterectomy — decreased by 20% between 2008 and 2012. Additionally, hospital-acquired MRSA and C. difficile infections dropped by 4% and 2%, respectively, between 2011 and 2012. “The most advanced medical care won’t work if clinicians don’t prevent infections through basic things such as regular hand hygiene,” says CDC Director Tom Frieden, MD, MPH. “Healthcare workers want the best for their patients. Following standard infection control practices every time will help ensure their patients’ safety.” CDC’s National Healthcare Safety Network (NHSN) provided data for the report. More than 12,500 hospitals and other healthcare facilities provide data to NHSN. The Report helps measure progress toward the fiveyear HAI prevention goals outlined in the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action PlanExternal Web Site Icon) set in 2009 by the U.S. Department of Health and Human Services (HHS). Progress is measured using the standardized infection ratio (SIR), a summary statistic used to track HAI prevention progress over time.
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apr-jun 2014
Recycling of Rigid Plastics Surpasses 1 Billion Pounds, Triples Since 2007
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ccording to the American Chemistry Council, the recycling of rigid plastics, excluding bottles, rose to nearly 1.02 billion pounds in 2012, an increase of 10 percent over 2011 and triple the amount recycled in 2007, when the industry first began tracking rigid plastics recycling. The “2012 National Report on Postconsumer Non-Bottle Rigid Plastic Recycling” attributes the 82 million-pound increase to rapid growth in the collection of plastics beyond bottles in municipalities across the United States. “Tripling the recycling rate for rigid plastics in just six years is an amazing accomplishment,” said Steve Alexander, executive director of the Association of Postconsumer Plastics Recyclers (APR). “In a short period of time, rigids have become the fastest growing category of plastics recycling, and we’re excited about the future.” Approximately 57 percent of the rigid plastics collected was processed in the United States and Canada with the remainder exported, primarily to China. Recycling statistics in 2012 were not affected by China’s “Green Fence” policy, which began in February 2013. Polypropylene and polyethylene plastics comprise the largest portion (72 percent) of postconsumer rigid plastics collected in the United States, with polypropylene constituting 38 percent of all rigid plastics recycled and high-density polyethylene constituting 34 percent. According to the report, polypropylene and polyethylene generally have the highest market value in both domestic and export markets because they are relatively easy to process and have a wide range of manufacturing uses. “We are thrilled to see this kind of growth in rigid plastics recycling,” said Steve Russell, vice president of plastics for the American Chemistry Council. “The increasing popularity of large bins and access to singlestream collection programs are making it easy for consumers to recycle their used plastics. We look forward to continuing to work with APR and other stakeholders in the ongoing effort to recycle and recover more plastics.”
Safer Plastics from Paper Waste
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ewark, DE – Two researchers at the University of Delaware have been able to derive a natural compound which could be used to replace a harmful chemical in plastic within five years, Phys.org
reports. UD graduate student, Kaleigh Reno, and her advisor, Richard Wool, Ph.D., discovered that lignin, a waste product from papermaking, could replace the potentially harmful chemical BPA, which is used in manufacturing many plastic products. Like BPA, lignin is an additive that provides strength and durability. Lignin is not just green, but plentiful. Papermaking and other woodpulping processes produce 70 million tons of lignin byproduct each year, 98 percent of which is incinerated to generate small amounts of energy. The scientists presented their study findings at the 247th National Meeting & Exposition of the American Chemical Society (ACS) early this year. Reno explained that BPA is banned from baby bottles due to its possible effects on the body and brain by mimicking the hormone estrogen. Approximately 3.5 million tons of BPA are produced annually worldwide in sports equipment, glues and receipt paper. Reno has developed a process that converts lignin fragments into a compound called bisguaiacol-F (BGF), which has a similar molecular shape to BPA, making it a viable component for plastics, but different in ways that make it safer. The researchers chose BGF based on their unique “Twinkling Fractal Theory,” which Wool explains can predict mechanical and thermal properties. “This approach considerably simplifies the design of new biobased materials since we can predetermine properties and screen for toxicity for a broad range of potential compounds from renewable resources such as lignin and plant oils,” he says.
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Medical Waste Management 15
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TOP STORIES New Hampshire Teaching Hospital Takes Lead in Sustainability Through Innovative Recycling Programs PAGE 1 Proposed Water Regulations Could Affect Construction at Your Facility PAGE 4 The American Hospital Association Expands UTI Prevention Program PAGE 9 New Antibacterial Fabric Promises Infection Control in Ten Minutes PAGE 10 Recycled Pacemakers Worth their Weight in Gold PAGE 12
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