VOL. VIII NO. 1
Medical Waste Management www.medicalwastemanagementnews.com
Serving Healthcare Facility Waste Management Professionals
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Lehigh Valley Health Network Establishes Model Program for Waste Management and Recycling
BY PERRY A. TRUNICK
educing costs through effective source separation and waste minimization is a top priority for Linda Zengen, waste reduction specialist, at Lehigh Valley Health Network, headquartered in Allentown, PA. Zengen manages the waste streams for a complex of healthcare facilities and the administrative operations at Lehigh Valley Health Network (LVHN). These include infectious wastes, hazardous wastes, municipal wastes, and the organization’s recycling program. That recycling program has helped reduce costs and remove 30% of overall volume of wastes headed for disposal in 2011. That’s up from 26% the year before. Zengen started with top management support and a goal to reduce costs. Top management support is important says Bob Cougles, Cougles Recycling Inc. (www. couglesrecycling.com), a key recycling contractor working with LVHN. “The first goal is usually to save money and do the right thing by actually having things recycled,” he says. “Administration has to sign off before anything gets done,” adds Sam Blanchard, of Comprehensive Waste Stream Consulting. Blanchard also says that it will often take
a minimum of 90 days for staff members to embrace a new program and properly segregate material within their departments. At LVHN, there is a top-down commitment and a willingness to spend some time and effort in training, Cougles observes. Beyond that, you have to look at the numbers and become a cheerleader, he says. As you save money and the program is making a difference, you have to make that apparent to everyone. Compliance improves along with a willingness to pursue new initiatives. Cougles provides LVHN with monthly reports on what it has recycled, giving not only a sense of the volume improvements but also real feedback in the form of revenues generated from the recyclables. Zengen was systematic in her approach to expanding the recycling effort beyond the voluntary, single-stream program that was in place. One of the first steps is to perform a waste audit that identifies what wastes are being generated and in what volumes. The ongoing audit procedure also helps monitor compliance once a recycling program is in place and identifies new opportunities to remove costs and recycle more. Beyond auditing for recycling, Zengen checks compliance on other waste streams to Continued on page 3
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Medical Waste Management JAN - MAR 2012
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Lehigh Valley Health Network Establishes Model Program for Waste Management and Recycling PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers Perry Trunick • 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: email@example.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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Continued from page 1 ensure regulated wastes stay out of the municipal waste stream. Probably the only part of the job she doesn’t enjoy, this includes periodic trips to the landfill behind one of LVHN’s waste haulers to examine what is going into the landfill from the hospital. LVHN’s initial recycling effort relied on hospital employees, patients, and visitors to deposit recyclables in open-top recycling containers. Compliance was low and many recyclables were still being disposed of in the municipal waste stream. Zengen began by looking at container options and got approval for new containers. Then she started talking to vendors. She wanted a vendor who could handle both co-mingled recyclables and paper – someone local who could provide revenue for the recyclables, even if that was in the form of cost avoidance by removing those items from other waste disposal streams. The waste audit showed that not only were recyclables not being collected, some of the regulated waste streams where compliance was high, collected too much non-regulated waste. For example, because of privacy rules under the Health Insurance Portability Accountability Act (HIPAA), explains Zengen, documents were collected and shredded by a secure document destruction company that charged by weight for its shredding service. Many other types of paper ended up in that waste stream, adding to the disposal cost. Education can help reduce that cost by keeping common paper products out of the secure document waste stream, but Zengen took it a step further. Cougles Recycling Inc. offered the ability to maintain control of the sensitive documents and shred and recycle the high-grade paper. This not only reduced costs, it provided a revenue stream for LVHN. Cougles explains that Zengen deployed locked containers to collect the paper which his company transported to its facility. Cougles has a caged area with monitors where the secure shredding is performed. LVHN is able to audit and maintain quality control on the grade of paper and he is able to provide a rebate based on the market price he can get for the paper. “We’re destroying our documents,” says Zengen. LVHN is getting revenue for it based on a percentage of the Open Board Market price. In addition, Zengen is able to log onto the Internet and watch the document destruction as it happens at Cougles’ facility. Co-mingled recyclables are collected in green containers throughout the hospital complex and administrative offices. These include all plastics (1 through 7), says Zengen, along with bottles, cans, and glass. Cougles notes the advantage of this simple source separation. He explains that partially filled plastic bottles, even with the lid on, won’t stand up to the pressures of the compactor, and the bottle will burst and the liquids will be spilled into the paper. Likewise, glass containers
can shatter in the compactor. These types of wastes can’t be separated from the paper and it ends up going to the landfill. Not only does this add handling and transportation, it eliminates the revenue the recyclable paper would have generated for the recycler and LVHN. According to Blanchard, auditing is key to having a successful program. “You have to inspect what you expect,” he says, placing added emphasis on the first syllables of each word. The audits are a tool, he continues. Share the audits with the department heads because the performance levels create peer pressure. Most hospitals do rounds to inspect for cleanliness, look in the trash, he says. “In most hospitals, 50% of medical waste is trash,” he estimates. In one hospital, he set up a program with five pictures of the most common non-medical waste found in the medical waste stream and labeled them saying, “These items are not medical waste.” Along with Zengen and Cougles, he says, “You need something quick, easy, and understandable.” Blanchard also points to another reason why top management support is important. There’s always a cost, at least initially. In the case of LVHN, it was the containers. Zengen expanded from the blue and green containers for paper and co-mingled recyclables and added beige for trash and red for infectious waste. The simple color codes and mandatory training encouraged compliance, and Zengen reports there are now very few issues. In fact, the opposite is true. New opportunities for recycling and waste reduction keep surfacing. One of the most lucrative recycling opportunities for LVHN has been in food waste. One piece of advice Cougles offers is, “Don’t be afraid to do new things.” One of those things is food waste, which he claims is the next biggest piece of the pie to extract from the waste stream. He adds that when you build on your successes and publicize the results internally, people want to do more. Zengen agrees. “Every day we find more we can recycle or do. I don’t get ‘I don’t want to do this,’” she says. “They do it at home; they’ve embraced it.” That probably helped when LVHN began looking at food waste. Cougles works with a local farm that takes food waste and composts it for use in growing new crops. He says he has worked with not only LVHN on the food waste recycling but also another large hospital and a number of restaurants and a brewery. In addition to the internal successes, bringing examples from other hospitals or organizations helps open the discussion. LVHN takes food waste from the kitchens, but Cougles says he is working with restaurants that are also able to recover food waste from the serving area. With containers, signage, and training, the workers bussing the tables know to segregate the recyclable food waste and Cougles Continued on page 6
JAN - MAR 2012 Medical Waste Management
medical waste management
Hospital Food Waste Composting – From Kitchen to Garden By Sandy Woodthorpe
ou may have heard about healthcare facilities composting their food waste and thought it sounded like nothing more than a messy project that offered little or no benefit to the hospital. Yet as two hospital managers relate, the process of food waste composting is not all that difficult to integrate into your kitchen operation, nor is it really all that time consuming. Composting merely requires looking at your kitchen waste stream differently than you have in the past and introducing some additional steps into your food preparation and clean-up process. Once you’ve worked that out, you’re on the way to implementing this “green” practice – and discovering many benefits you might not have expected. “The hardest part was locating a vendor to haul the food scraps,” says Mark McKenna, Director of Hospitality Services at the 100-bed St. Joseph Hospital in Nashua, New Hampshire. Through networking, McKenna found a hauler who specialized in composting. He hired this vendor, who was located just across the state line in Maine. Things got underway with a regular pick up schedule, but the solution was short lived. The hauler needed more customers between his base in Maine and the Nashua area to make the run worthwhile. McKenna soon found and contacted another vendor that has worked out just fine. Although St. Joseph has been food waste composting for just a little over one year, McKenna says the operation was easy to set up, and once the kitchen staff learned which trimmings and scraps were allowable, the transition has been smooth. Says McKenna, “I don’t even have to think about it anymore!” And that, he adds, is how food waste composting should be. In Cleveland, Ohio, Steve Savanick, Sodexo Health Care’s Director Food & Nutrition Services at the 480-bed St. Vincent Charity Hospital, agrees. He started his new job just as a food composting program was being
Medical Waste Management JAN - MAR 2012
St. Vincent Charity Hospital staff shows off a morning’s worth of peelings destined for the compost heap a mile away from the hospital in Cleveland, OH. (from L-R, Chefs Craig Henefeld and Howard Lloyd, Sodexo Health Care’s Food and Nutrition Director, Steve Savanick, Chef John R. Smith). Photo courtesy of Sandy Woodthorpe. planned by The Sisters of Charity Foundation. Finding a compost hauler was a breeze for Savanick because connections had been made before he began working for the hospital. Everything else fell into place quickly. St. Vincent’s composting operation is unique in that it works in conjunction with a nearby urban gardening program funded by The Sisters of Charity Foundation. “Early in 2011, the Sisters approached me about composting,” Savanick explains. “It was a system priority. We held a meeting with a local hauler, the hospital purchasing manager, and our fresh produce supplier to work out all the details. After that, things got rolling right away.” The urban garden that receives St. Vincent’s compostable waste is run by a nonprofit called Rid-All Green Partnership. St. Vincent’s produce supplier, Srna and Sons, inspects and buys fresh vegetables from the garden and sells them to St. Vincent at market value. “In season, we buy tomatoes, cucumbers, beets, and two varieties of squash,” says Savanick. “The urban garden is a year ‘round effort. Right now they are in the planting mode.” Hospital- and community-supported agriculture can fit neatly into any food composting plan. The St. Vincent partnership with Rid-All is an ideal example of urban sustainability that benefits public and private stakeholders. Rid-All has transformed a previously long-vacant triangle of land into nearly 7000 square feet of greenhouse space, which includes aquaponics and vermiculture, where community members play a role in the continuous cycle of composting, growing and harvesting. The Rid-All Green Partnership is an official Growing Power Environmental Science Commercial Urban Agriculture Training Center, with operations throughout greater Ohio, Indiana, and Pennsylvania. These centers follow the award-winning Will Allen urban agriculture model that combines educational and hands-on training in a variety of creative ways to achieve community- and self-improvement outcomes. Nearly all hospitals have sustainability programs in place with systemwide directives that set the tone and pace for adopting new measures and carrying out programming. In St. Joseph’s case, The Leadership Committee of the Covenant Catholic Health Organization played a key role in making food waste composting a reality. “They have their own environmental council, which meets quarterly to discuss ideas for improvement,” McKenna explained. To get a food waste composting program happening in your hospital, McKenna emphasizes networking and tapping into hospital sustainability “think tanks,” such as regional hospital association sustainability councils and hospital system leadership committees. Along with experience and familiarity with the community, they have a birds eye view of sustainability and can offer all kinds of support. Additionally, there are groups such as Practice Green Health, that McKenna suggests as a repository of good information and resources. Continued on next page
MedicalWaste_1stQuarter2012.pdf medical waste management
Continued from previous page Sustainability is no longer the “fringe” notion it was as recently as ten years ago. Most regions have active policy groups that understand the local issues. The American Hospital Association (AHA) developed the Executive Primer in alignment with AHA’s Hospitals in Pursuit of Excellence, which lays out strategies to help guide hospital leadership on environmentally sustainable practices. The primer describes a broad range of “green” practices, as well as information on incentives and policy considerations. There are practical tips for leading a sustainability initiative, and even a checklist and self-assessment tool. The initial steps you take for starting a food waste composting program in your hospital are important. Both McKenna and Savanick emphasize assessing current food service operation practices. By determining and recording the amount of food waste prior to starting a composting program, you can establish a baseline. A comprehensive assessment should include everything from tracking production and consumption to reviewing food preparation and waste handling techniques. Enterprise resource software used by hospital food service managers tracks consumption trends, making it possible to tie recipe planning to scalable purchasing. Chefs can order only those perishables that they know will be used up quickly. They also can select recipes with ingredients that can be “stretched” creatively by the cooks. In this way, food service managers continually find new ways to save money and waste less. “We weren’t thinking outside the box before. Now we are,” McKenna relates. “We use a lot of tomatoes. One of our people suggested saving the sliced tomato ends for soup. Another suggested making banana bread from bananas we’d normally discard. There’s friendly competition among the cooks to get the most out of any produce we purchase.” Food waste consists of pre- and post-consumer varieties. Pre-consumer waste includes food loss from spoilage, over purchasing and overproduction, along with trim waste. Post-consumer food waste is primarily what’s leftover on the plates that come back to the kitchen. Both types of food waste can be controlled and reduced, which impacts the amount of compostable waste. In the beginning, St. Joseph’s compost hauler arrived twice a week. Now, the hauler comes once a week because of increased efficiency in meal planning, purchasing, and preparation. Training the kitchen staff how to properly separate waste is mainly a matter of educating them about composting itself. The rule of thumb, though, is that grease, meat trimmings, and dairy products cannot be composted. They don’t decompose the way pulp, peelings, coffee grounds, and egg shells do and they will spoil a load of otherwise good compostable material. “Compost facilities inspect the product that’s delivered pretty closely. It’s important to give them good product, in terms of food waste,” McKenna says. Integrating the new practice into your kitchen includes obtaining proper containers. At St. Joseph, all trimmings, peelings, pulp, and rinds go into special bins, called Slim Jims. McKenna says he compared different waste receptacles and chose the Slim Jims because they were within allowable weight limits for carrying when full and their narrow profile allowed them to fit easily in the kitchen area. Storage for pick up is the next issue. The only place St. Joseph had available to store the compost was outside the building. Kitchen staff members empty the Slim Jims into three 96-gallon, pest- and leak-proof totes that the hauler empties into the truck. “We have gone through our first year, including a really hot summer – with no problems whatsoever with vermin, insects or the heat,” McKenna says. The ideal way to store the food waste is refrigeration, which is what St. Vincent does. “Our 40-gallon rolling bins fit into a small area in the walk-in cooler,” explains Savanick. “We put out two 50-lb containers of scraps a week for pick up.” According to industry reports, food waste accounts for approximately ten percent of a hospital’s waste stream. For St. Joseph Hospital, hauling and dumping 1-2 tons of food waste per month can run several hundred dollars a week. Compare that with compost disposal fees that are less than half that cost. Both McKenna and Savanick are justifiably proud of their composting programs and each is enthusiastic about “doing the right thing” environmentally. For St. Vincent Charity Hospital and St. Joseph Hospital, doing the right thing environmentally and saving money have made food waste composting worthwhile.
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Lehigh Valley Health Network Establishes Model Program for Waste Management and Recycling Continued from page 3 says he has restaurants that are able to save $10,000 per year per facility. Once again, Zengen takes the effort a step further and is buying produce from the farm that takes the hospital’s food waste for composting. The organic fruits and vegetables are used in food preparation and in a farmers market on site. She is looking at food that comes back from patient rooms and even the cafeterias. Cougles confides that her ultimate goal is zero landfill for wastes generated by LVHN. Zengen doesn’t understate the importance of training and education. LVHN has a virtual learning center, she notes. Every year, the
clinical side of the staff receives training. It’s getting more intense, she says, because it covers pharmaceutical waste as well as proper disposal of hazardous waste and infectious waste. The non-clinical side gets less intense training in those subjects, but both sides get training in the recycling program. LVHN also has “green teams” that include management representation. The teams meet regularly and the area teams have leaders and co-leaders who come to the meetings and report progress. The green teams also look at opportunities to remove wastes and recycle. One such opportunity on the non-clinical side is the plastic lids that cover the food in the
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Medical Waste Management JAN - MAR 2012
cafeteria, says Zengen. Because there is no number stamped on them, they thought the lids weren’t recyclable. On the clinical side, the green teams look for non-infectious wastes to remove from the infectious waste stream. Just as in Blanchard’s example, they have identified items like paper towels and gloves. Though she’s a department of one, Zengen has support from some recycling team members. In one facility, it is full time because of the size of that facility. In another, it is a part-time position. Much of the support comes from vendors. Starting a program means doing a lot of homework, says Zengen. She put out requests for proposal (RFPs) and met with vendors. She visited their facilities to ensure they had the means to keep the various recyclable wastes secure and that they could handle the comingled and paper. As a result, she says, there’s a personalization, a relationship, between the hospital and Cougles. As issues come up or new facilities are added, they are able to respond. Cougles says that meetings with LVHN are mostly about what they are going to do next. For example, Cougles says they are always looking for opportunities to position a larger container and make few pick-ups in an effort to keep everyone’s costs down and improve the margin on recycling. Blanchard and Cougles point out that there are costs associated with every container (rental) and every pick-up. Cougles points out that most waste haulers don’t itemize their costs for the customer. Zengen adds that she has been able to reduce the number of pick ups in many instances by simply positioning larger containers where they are needed. Removing waste from the municipal waste stream bound for the land fill reduces demand for those services and, Cougles notes, one customer who has added a food waste program automatically reduces waste pick up by one container each time it adds a facility to the food recycling program. Another target for Zengen and LVHN is pharmaceutical waste. “We have a great program,” she says, “but it’s costly.” LVHN is paying a vendor to sort the waste. She’s looking at a process that would segregate at the point of generation (the pharmacy) and use a sticker to identify the pharmaceutical wastes separately from the unregulated wastes, similar to the efforts to remove non-infectious wastes from medical wastes. Zengen stresses the amount of “due diligence” that goes into the recycling programs. Every program is researched from every angle, she explains, from the financial to protocol to environmental. For her purposes, environmental is not only the environmental impact but also the environment in which the program must operate. That brings the discussion full circle to getting buy-in and providing good training and education to ensure compliance.
Virginia Commonwealth University Studies Role of Antimicrobial Scrubs in Preventing Hospital Acquired Infection
irginia Commonwealth University, VA–New research findings suggest that antimicrobial-impregnated scrubs, combined with strict adherence to hand hygiene practices, may help prevent the transmission of Methicillin-Resistant Staphylococcus Aureus (MRSA) in hospitals, reports news.vcu.edu. In the Virginia Commonwealth University study, “A Crossover Trial of Antimicrobial Scrubs to Reduce Methicillin-Resistant Staphylococcus Aureus Burden on Healthcare Worker Apparel,” study participants were instructed in hand hygiene techniques and supplied antimicrobial impregnated scrubs manufactured by Vestagen Technical Textiles. Cultures were taken from hands and two test sites on the scrubs – the abdominal area and pockets on the cargo pants – at unannounced intervals by the researchers. They learned that, while transmission of bacteria from garments to the participants’ hands was insignificant, the antimicrobial compound on the fabric reduced the colonization of germs on the apparel. The study conclusions reinforced the need for meticulous hand hygiene at the point of patient care. Other practices that reduced risk of a hospital-acquired infection included routinely sterilizing inanimate surfaces and apparel. An earlier study had concluded that hospital textiles may contribute to the transmission of pathogens through indirect contact via the hands of hospital staff. Where antimicrobial scrubs were worn, the “bio-burden,” or number of bacteria living on a surface before sterilization, was reduced. The role of antimicrobialimpregnated apparel in helping to limit the transmissions of pathogens calls for further investigation, the researchers say. The new study is currently available online and will appear in the March issue of the journal Infection Control and Hospital Epidemiology, the official publication of the Society for Healthcare Epidemiology of America. To view the complete study, visit http:// www.jstor.org/stable/10.1086/664045.
Bacteria Found on Paper Towels Could Pose Risk to Patients
uebec, Canada –WebMD.com reports a Canadian study published in the American Journal of Infection Control cites the risk of bacterial infection with paper towels. Researchers at Laval University in Canada tested six brands of commercial paper towels and found bacteria in all of them. Cultures from towels made from recycled fibers showed the highest bacterial counts, making this study’s findings consistent with past research that’s noted high bacterial counts on a variety of recycled paper products. The culprit is thought to be “bacterial slime,” as it is known in the paper mill business. The substance is a problem at recycled paper mills, where it corrodes machines and may damage finished paper sheets. The Laval University researchers identified two strains of Bacillus bacteria. Many Bacillus strains can produce toxins that cause food poisoning, while others have been associated with infections of the eyes, lungs, blood, and the central nervous system. Although the study did not find specific illnesses connected to paper towel use, bacteria counts on unused paper towels, especially those made from recycled paper, could be transferred to hands after washing. While healthy people are unlikely to be affected, patients in hospital isolation units and people with weakened immune function are thought to be most at risk.
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HAI Prevention as a Facility Priority Increases at Nonfederal and VA Hospitals
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nn Arbor, MI – Better hospital-acquired infection (HAI) control practices at nonfederal and Veterans Administration (VA) hospitals appear to be a sign of shifting hospital priorities, rather than a direct response to government regulations, reports medpagenews. com. After the Centers for Medicare & Medicaid Services (CMS) instituted nonreimbursement rules for HAI, a group of researchers sought to learn whether regulatory incentives for reducing HAI were effective and, if so, how. Though they say their data may have limitations due to the timing of the study – it began shortly after the CMS rules were activated – the reasons for the increased preventative practices may be more related to policy and procedural changes set by the hospitals themselves. The study findings, published in the Journal of General Internal Medicine show that both nonfederal and Veterans Administration hospitals are using antimicrobial dressings with chlorhexidine for infection control more frequently than in the past, as well as instituting other preventative practices, especially in intensive care units. The study, which was led by a group at the VA Ann Arbor Healthcare System in Michigan, focused on control methods for three types of HAIs -- central line-associated bloodstream infections, ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (UTIs). Risk for the first two infection types is higher in intensive care units, while catheter-associated UTI risk tends to exist throughout hospitals. Hospital personnel were surveyed in 2005 and then again, in 2009. The response rate was approximately 70% for both years. By 2009, 90%
Continued on next page
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news briefs Continued from previous page or more of both nonfederal and VA hospitals were using maximum barrier precautions and chlorhexidine gluconate during central venous catheter insertions. Semi-recumbent positioning and antimicrobial mouth rinsing, subglottic secretion drainage and selective digestive tract decontamination increased, as well. For catheter-associated urinary tract infections, monitoring using a portable bladder ultrasound scanner was employed in at least half the hospitals studied. Actual UTI infection control practices increased, but with less frequency than for the central line-associated infections or VAP. Most of the nonfederal hospitals reported a moderate or large increase in the prevention of all three types of infections -- 54% for VAP, 58% for central line infections, and 65% for UTIs -- as a facility priority related to the CMS rule, whereas 60% of VA hospitals reported no change in priority related to the rule. The researchers noted that VA hospitals are unaffected by the CMS rule. Hospital-acquired infections affect 5% to 10% of hospitalized patients in the U.S. and may account for nearly $45 billion in annual hospital costs, according to the researchers. Funding support for the study was provided by the Blue Cross Blue Shield of Michigan Foundation, the Department of Veterans Affairs’ Health Services Research and Development Service, the Ann Arbor VAMC/ University of Michigan Patient Safety Enhancement Program, and the National Institute of Nursing Research. www.shred-tech.com
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Biofuel Deal Promising for Cape Breton Hospital
ape Breton, Nova Scotia – Plans are underway for a large biofuel operation in Nova Scotia that will turn municipal waste into renewable energy for a Cape Breton hospital. According to greeningcanada.wordpress.com, BioGas Energy, Inc. has reached tentative twenty-year agreements with Cape Breton Regional Municipality and Northside General Hospital to turn some 7000 tons a year of sewage sludge, food waste and compost into biofuel. David Miller, BioGas’s vice-president of business development, said that an offsite anaerobic digester plant could replace all of the Northside General Hospital’s fuel oil, which it uses for heating and hot water. Northside General buys a million litres of number two fuel oil every year for heat and hot water. The switch to biofuel is projected to reduce the hospital’s power bill between $100,000 and $250,000 annually. Plans for an onsite anaerobic digester at Northside ran into a snag when waste haulers cited transportation difficulties. Under the current plan, methane gas will be collected in bottles, called, “bullets,” and transported from the Cape Breton Regional Municipality to the hospital. Construction on the anaerobic digester starts this year, according to Miller. Meanwhile, more biofuel discussions are underway with another Cape Breton hospital and additional digesters are being considered throughout Nova Scotia. BioGas already operates an anaerobic digester that converts waste food from a university and agricultural waste into resalable gas.
Clorox Buys Two Companies: Aplicare, Inc. and HealthLink
ccording to rttnews.com, The Clorox Company has bought two infection control companies, Aplicare, Inc. and HealthLink, for a combined price of between $80 million and $90 million. The acquisition strengthens the chemical company’s position in health care industries. Aplicare specializes in developing and manufacturing products that help prevent skin infection from needles or surgery. HealthLink markets AloeGuard antimicrobial hand soap and hygiene products for use by individual physicians, doctors’ offices, outpatient care centers and other health care facilities.
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10 Medical Waste Management JAN - MAR 2012
bington, PA – Abington Memorial Hospital has received two awards from Healthsystem Association of Pennsylvania in recognition of its sustainability achievements, reports montgomerynews.com. AMH’s Green Team was recently honored with the prestigious “Innovation Award,” as well as an award for “Operational Excellence.” The annual HAP award recognizes innovation, creativity and commitment to patient care and best practices. AMH was among seventeen winners selected from 168 entries in 2011. The hospital has been conducting green initiatives aimed at reducing the hospital’s carbon footprint for more than a decade. The Green Team was launched in 2006 to raise employee awareness and develop sustainability and recycling programs at the 5,600-employee hospital. Their efforts have produced cost savings in many areas of the hospital’s operations.
Kansas University Hospital Wins EPA Award for Recycling
ansas City, KS–According to an article on kansascity.com, the Environmental Protection Agency (EPA) recently recognized the University of Kansas Hospital in Kansas City, Kansas for its recycling efforts. The regional EPA office awarded the University of Kansas Hospital the 2011 WasteWise Gold Achievement Award for diverting more than 540,000 pounds of solid waste from local landfills.
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Consultant Advises More Vancomycin-Resistant Enterococci (VRE) Infection Control
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ewes, DE–While the bulk of research and media attention has focused on Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) another pathogen associated with hospital-associated infections should be getting more notice, says a Mid-Atlantic environmental health consultant quoted on environmentalexpert.com. Enterococci, a bacteria commonly found in human intestines and the female genital tract, has been found to cause certain infections, some of which are resistant to antibiotics. Vancomycin is the antibiotic frequently used to treat such infections, thus the name, Vancomycinresistant Enterococci (VRE). Infections can occur in the urinary tract, the bloodstream, or in wounds associated with catheters or other surgical procedures. Sussex Environmental Health Consultants (SEHC), a United States company that provides indoor air quality and environmental infectious disease prevention services, urges hospitals and other healthcare facilities to conduct regular sampling for Enterococci. In particular, the surfaces in the healthcare environment with which patients have direct contact, as well as surgical or other medical instruments, should be tested and routinely disinfected, says Susan White, Ph.D., CMC., President of SEHC. She also stresses the importance of hand washing because VRE also can be spread person to person by contaminated hands. “Sampling can also help identify the source of an outbreak after one has occurred to prevent additional HAIs from happening,” Dr. White says.
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UNTHA America Debuts New RS40 Shredder Configured for System Integration
Big Hanna Composter Expands into North American Market
NTHA America, Inc. has introduced a “System Integration” version of its popular RS40 series 4-shaft shredding machine, which is ideally suited for medical waste processing. Unlike the stand-alone version, this machine is designed to be used by recycling system builders and integrators where a hopper, stand, cladding, etc. are not necessary. The RS30 and 40 Series shredders were completely redesigned in 2010 and offer a variety of innovative standard features such as two-piece mechanical seals, wear plates, a central lubrication system for the front bearings and gearbox oil level monitoring. They are ideally suited for wet or dry applications such as medical waste processing, e-scrap recycling, wood and plastics UNTHA America is a wholly owned subsidiary of UNTHA shredding technology GmbH of Salzburg Austria, one of the premier designers and manufacturers of shredding equipment with over 8,000 machines in daily operation around the globe.
wedish company Susteco AB has entered the North American market with their on-site, in-vessel, aerobic composting machine Big Hanna (www.bighanna.com). This automated, all stainless steel composter has twenty years of history with installations in 16 countries. Durable and reliable, the first Big Hanna, installed in 1991, is still in use. Big Hanna can operate in both warm and cold climates, indoors as well as outdoors. Capacities for the four models available to the North American market range from 330 to 2,600 lbs. per week. Big Hanna is designed for local composting of food waste from multi-residential, institutional and commercial sectors. Big Hanna produces pathogen free, ready-touse compost from all food wastes, including fish, meat and dairy solids. The fully enclosed design provides for odorless composting. Big Hanna offers easy loading and automatic discharge. Thanks to various design features, very little maintenance is required.
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PCM Introduces New StepOn Cart for Medical Waste Containers
he sturdy extruded aluminum construction allows for the heaviest weighted contents regardless of Medical waste types; red bag, sharps, Rx, haz etc., There are 4 easy motion wheels which can also be locked into place with brakes that are included. The height of the container allows its contents to be up off the ground. The slide mechanism allows for easy access to open lab style lids in order to dispose of contents into the container. The step-on cart is a nice fit allowing it to open even if it is backed up to a wall. This allows for cramped areas where space is limited in the medical setting like lab areas. A variety of color options are available as well as slide and even lift mechanism to accommodate a variety of lid styles. Each cart is custom made and assembled by hand allowing for decades of worry free operation in the medical waste setting. For more information contact Jimmy Mack at 866-539-6277 or JimmyMack@pcmprecision.com or visit www.pcmmedicalwasterecycling.com.
12 Medical Waste Management JAN - MAR 2012
Totally Green Introduces ORCA Green™ Machine Food Digester
he ORCA Green™ Machine food digester quickly turns food waste into a nutrient-rich water effluent in as little as 24-hours. By using our proprietary Micro-Organism Solution and Bio Chips, the ORCA creates the perfect environment for extremely rapid, thorough digestion of food waste. The end result is grey water that can be sent into your sanitary sewer system or repurposed. By eliminating the need to store food waste, the ORCA also helps reduce problems with rodents and insects. The ORCA Green™ Machine is available in 3 sizes, digesting 600, 1,200 or 2,400 lbs. of food per day. The ORCA can eat almost anything a human can eat and waste can be fed into the digester continuously as long as there’s room. These heavy-duty machines are low maintenance, cost-effective to operate and are manufactured in the U.S.A. Along with the ORCA Green™ Machine, Totally Green produces Green Bottle Spring Water – natural spring water in 100% plant-based PLA-plastic bottles. Learn more about Totally Green’s products at www.TotallyGreen.com or call 918-619-9700.
Best Ways to Manage Risk with Electronic Health Records
ccording to a report on practicefusion.com, ongoing review and assessment practices, “cloud” computing, and a new type of liability insurance are effective ways to comply with HIPAA’s “Meaningful Use” requirements for safeguarding electronic health records (EHRs). As paper recordkeeping becomes nearly extinct and HIPAA-related litigation plays out in courts, risk management related to medical data becomes tied closely to computer security. Local machines with large amounts of patient health information are particularly vulnerable. Robert Rowley, MD, is an expert on HIPAA compliance and medical record risk management. He also is CEO of Practice Fusion, a company that specializes in EHR security. Dr. Rowley says that monitoring and staff training should be ongoing tasks, and he suggests appointing one person to be office security monitor. The monitor is responsible for making routine audits of all places where patient health information (PHI) is kept, overseeing access logs, conducting HIPAA privacy training for staff, and ensuring the proper destruction of records, such as unencrypted reports and image scans with PHI. These procedures, done consistently and conscientiously, are very effective, Dr. Rowley believes. The loss of unsecured PHI involves a complicated process of patient notification. If more than 500 records are lost at one time, a clinician must inform the federal government. The failure to do so carries stiff penalties. Historically, data breaches generally have been the result of theft or loss of a single computer workstation. A pending $1 billion class action lawsuit against Sutter Health is a prime example of what happens when this vulnerability is exploited. The case involves the possible breach of 3.3 million unencrypted records that were kept on single desktop workstation. Dr. Rowley advises considering a new type of liability insurance (in many cases, packaged with general malpractice insurances), that will cover the entire range of health information risk.
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Five Maryland Hospitals Noted for Environmental Excellence
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 firstname.lastname@example.org www.badrickconsulting.com
14 Medical Waste Management JAN - MAR 2012
ccording to a report on nurse.com, five Maryland hospitals have been recognized as models of leadership in advancing sustainability practices. Each year, Maryland Hospitals for a Healthy Environment considers nominees that have initiated or improved recycling, energy conservation, and other programs. The 2011 Hospitals for Environmental Excellence Trailblazer Award winners were: Anne Arundel Medical Center, Annapolis; Carroll Hospital Center, Westminster; Good Samaritan Hospital, Baltimore; Union Hospital in Cecil County, Elkton; and the University of Maryland Medical Center, Baltimore. • At Anne Arundel Medical Center, operating room surgical lights were replaced with LED lights and a surgical services recycling program was begun. • Carroll Hospital Center monitored its water, energy and natural gas consumption using sustainability tracking software. After reviewing the data, the hospital was able to take measures to reduce its natural gas use by 30%. • Good Samaritan started an employee/community vegetable and herb garden on its campus where volunteers raised crops and donated a portion of the food to a local food bank. • Union Hospital formed partnerships with local farmers to purchased meat, poultry and fresh produce for patient and cafeteria food service and also returned food waste back to the farms for composting or hog feed. The farmers were then able to increase their production to meet the hospital’s needs. • University of Maryland Medical Center was able to conserve electricity with lighting upgrades and by turning off lights when not in use or where daylight is sufficient. Denise Choiniere, RN, MS, sustainability manager for UMMC, was presented with the inaugural Nursing Leadership in Environmental Health Award for her role in leading a hazardous pharmaceutical waste management program, conducting Earth Day events and a weekly farmers market. • Hospitals for a Healthy Environment Director Barbara Sattler, RN, PhD, FAAN, received the Environmental Health Visionary Award. Sattler is founder and director of the University of Maryland School of Nursing’s Environmental Health Education Center and a professor in the school’s Community/Public Health master’s specialty.
Ottawa Hospital Cuts Paper Waste with Pilot Project
ttawa, Ontario, Canada – A successful pilot project to cut paper waste at Children’s Hospital of Eastern Ontario emergency department points to a change on the horizon that may save hospitals millions of dollars in disposable products and even save trees. CBCNews.com reports that CHEO spends approximately $1 million a year on disposable products, including some $6000 annually for paper used to cover ER examining tables. “Every patient that comes in sits on a nice sheet of clean paper,” said Dr. Curtis Lavoie, who led the project. “It’s filling our garbage bags and most of the recyclers won’t take it” because it is used in ER. Lavoie said the hospital could find no one who was actually recommending its use. During the pilot project, instead of using the paper “sleeves,” examining tables were disinfected and personnel placed a sign letting patients know the exam tables were being cleaned and sterilized between patients. Surveys conducted before and after showed the change had little impact on the patients’ comfort level with the cleanliness of the exam room, said Lavoie. Other proposed changes include using tap water instead of packaged sterile water to clean lacerations, and diverting paper towels in ER bathrooms to recycling facilities instead of garbage.
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JAN - MAR 2012 Medical Waste Management 15
Medical Waste Management Serving Healthcare Facility Waste Management Professionals
VOL. VIII NO. 1
TOP STORIES Lehigh Valley Health Network Establishes Model Program for Waste Management and Recycling
Hospital Food Waste Composting – From Kitchen to Garden
Bacteria Found on Paper Towels Could Pose Risk to Patients
Consultant Advises More Vancomycin-Resistant Enterococci (VRE) Infection Control
Best Ways to Manage Risk with Electronic Health Records
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1st Quarter 2012 issue of MWM