Waste Management

at Providence St. Vincents Medical

Center

Providence Recycles

Whats in Your Garbage

Paper
Cardboard

The equivalent of 5.5

Volkswagens of trash leave
St. Vincents Campus 6 day
a week

Plastic
Sterile Wrap

Medical Waste
Food Scrap
Disposable Dishware

Composition of Hospital
Waste

Providence St. Vincent

Waste Sort

Waste Sort

Trash Collection for Waste Sort

Commingled Recycling

Material diverted from

Trash Chutes

Recyclable material waiting to be sorted

at Warehouse

Material being sorted at the

warehouse

Issue:
Contaminates in the recycling

Issue:
Hazardous items in Recycling

Warehouse improvements

2005 processed 35 Supersacks per week

2008 processed 110 Supersacks per week
2008 added 3 vocational staff
2008 purchased a new baler to process
additional recycling.
All this being done with down turn in
recycling markets.

What else can be recycled???

What else can be recycled???

Cardboard
Paper, shredded
onsite and recycled
by Iron Mountain
Glass, Tin cans,
Block Styrofoam,
Used cooking oil.
Food waste &
Compostable
Fiber

Providence Composts

Setting the Stage

Started as byproduct of a
project with Wash. County
Recycle at Work program
Waste sort revealed 23%
was food waste and
compostable fiber
Food waste compactor was
required to comply with
regulatory environment.
Grant funding was made
available by the Portland
Metro region. Funded 75%
of total project cost.

Project Costs

Composting Program
Team formed:
Nutrition, EVS, Garden
and Grounds.
Hands-on training +
signage
Currently putting 3+
tons of pre and post
consumer food waste,
compostable fiber and
yard debris per week in
our compactor.

Composting
Benefits
Increased recycling
Financial gains, savings
on disposal cost of $47
per ton @ 3 tons per
week = $564 per month.
Reduction of material
going to a landfill that
creates methane (a green
house gas).

Program Impact:

2008 Waste Stream Costs

SUMMARY
YTD lbs.

YTD Tons

Costs*

$/lb

$/Ton

Solid Waste

2,774,880

1,387.4

46.1%

$164,919

$0.06

$118.87

Recycling

2,576,831

1,288.4

42.8%

-$167,914

-$0.07

-$130.33

663,845

331.9

11.0%

$317,129

$0.48

$955.43

600

0.3

0.0%

$1,500

$2.50

$5,000.00

6,016,156

3,008.1

100%

$315,634

$0.05

$104.93

Reg Med Waste

Haz W
Total

Program Impact:
Practice GreenHealth & H2E
Environmental Awards
2005 Partner Recognition
2006 Partner for Change
2007 Partner for Change and Making Medicine
Mercury Free
2008 Environmental Leadership Award
2009 Environmental Leadership Award
Check out Practicegreenhealth.org

Lessons Learned:
Development of Administrative Support
Understanding and communicating program impact on
environmental sustainability is critical.
Found that the business case (although compelling) is often secondary
motivation for administration.

Real support for innovative and system wide sustainability

efforts came when the decision makers were brought to the
table.
Sustainability Council, created 2006
Composed of managers, administrators and green team chairs.

Lessons Learned:
Communication is Key to Success
Communicating to staff
Staff education
In-service Presentations Video
Employee Forums
Newsletter

Green Teams

Community Outreach
BBQs, Zero Waste events
Media spots, KATU news segment

Staff Training
Make staff aware of facilitys RMW
reduction goals.
Retrain current staff with agreed
upon definition of RMW.
Train new employees about waste
segregation procedures as part of
employee orientation.
Consider making compliance with
hospital waste management
policies part of every job
description.

In-services & Communication

Collections & Shipping

WASTE and BIOHAZARD DISPOSAL GUIDELINES

DISPOSAL COST = 48 cents per lb

DISPOSAL COST AFTER STEAM STERILIZATION

= 3 cents per lb

DISPOSAL COST = 3 cents per lb

TRASH
EMPTY:
IV Tubing
IV Bags WITHOUT
patient information

OTHER:
Unsaturated sponges/drapes
contaminated with blood or
body fluids

RED Tub
SATURATED = Any item with blood/body fluids
(when squeezed will drip)
JP & other small drains with fluid
Empty blood transfusion bags & tubing

BLACK Tub
Sharps containers
Glass slides & vials
Syringes

Items containing Patient Information

BULK Body Fluid filled containers

EXAMPLES:
IV bags WITH patient information
Patient ID Bands & plastic admit cards
Empty plastic medication bottles
Plastic specimen tubes & transport bags

EXAMPLES:
Suction canisters
Hemovacs
Pleurovacs

Questions? Contact Environmental Services at x62201

Problem Identification & Resolution Plan

You WILL encounter mistakes.
Conduct tours of trash areas monthly. Take a digital camera!
Develop a mechanism to report concerns or issues (e.g. photo along
with written report of issue and responsible floor/dept/unit.)
Re-educate promptly.
Hold in-service with responsible
unit to explain problem and proper
segregation technique.
Engage a nurse leader to help communicate program.

Training: Where does it go!

Training: Where does it go!

Training: Limit free flowing liquids

Signage

Lessons Learned
Setting the Stage for Success
Importance of Effective Signage
Post signage above or on RMW containers outlining types of waste are to be
disposed of as RMW
Use large font and bullet format, preferably in color
Consider MULTIPLE LA
GUAGES to ensure optimal communication.

Importance of Container Size and Placement

RMW containers should be covered to reduce solid waste.
Remove red bags from under hand-washing sinks, non-critical care patient
areas, hallways and other areas where people are likely to dispose of solid
waste.
Remove red bags from patient rooms where possible
Where there ARE red bags, locate a solid waste container directly adjacent so
staff make conscious disposal and segregation decisions.

New Trends and Technologies

Reusable Sharps Container

Programs
Benefits

Reduce waste
Improve worker safety through decreased needle-sticks
Save money
Eliminate purchase cost of new containers;
Decrease waste costs by not paying for container weight
Decrease labor costs associated with collecting and replacing
containers

More timely pick-up

Tips
Check out haulerask for
Service Includes
recommendations
Audit
Work with hauler to adjust pick-up
Container installation
timing/container replacement
On-site pick-up and replacement
See if you can include final disposal cost
Mechanical mechanism to empty
for old sharps containers in contract
Reused 500 times w/ proper disinfection
Work with hauler to determine staging area
10-30% potential reduction in needle-sticks for sharps containers

Reusable Containers
Boulder Community Hospital Case Study
Invested in hard cases - $120,000 one time
cost.
Reduced disposable blue wrap purchase
from $250,000 in 2003 to $60,000 in 2005
or $190K in savings.
This does not include reduction in waste
costs.
Manufacturers of surgical equipment are
now required to provide the durable
container as part of the equipment purchase.

Single Use Device Reprocessing

Benefits
Increasing # of disposable products in healthcare
Formulation hasnt necessarily changed, but profit margin has.
Hospitals used to sterilize onsite through CSRthen FDA cracked down.
Third party preprocessors emerged.
Nearly half (45.2 percent) of all hospitals with more than 250 beds reuse
SUDs, compared to only 12.3 percent of hospitals with fewer than 50 beds.
How Third Party Reprocessing
Sterilize used, unused but open or expired materials for reuse in patient care
settings
Strictly regulated by FDA
TPRs incur liability from faulty devices
No reported deaths from using reprocessed devicesper FDA database.
Single-use is a labeling designation determined by original equipment
manufacturers (OEMs) and not required by the FDA

Hospital Waste Management

Tracking and Measurement
Tool Demonstration of Excel Tracking Tool
Getting good data from vendors/service
providers

Why Should Hospitals

Track Waste Data?
Establishes baseline to measure success
Helps identify inefficiencies
Helps identify potential cost reductions
Helps set priorities for waste reduction
Helps identify procurement priorities
Provides justification for environmental programs

Analyze Waste Streams

List all categories and subcategories

of a specific waste stream

Determine who is responsible for

each waste stream category who
manages it and who pays the bills

Use waste bills to calculate the

amount (weight or volume) and cost
of each waste stream

Hospital Waste Management

Planning & Goal Setting
Using Green Teams, Sustainability Councils
and other employee teams to develop annual
sustainability goals
Accountable individuals and departments to
implement
On-going measurement and tracking
Reporting annually, written and presentation to
top administrators

Providence Portland Area

Sustainability Goals
2008 2010 Areas of Focus
Solid Waste Diversion
Goal: Increase recycle rate to > 50%
Strategies: Landfill avoidance through programs addressing red bag, haz waste, e-wste
(cost savings)
Supply Chain Initiatives
Goal: Increase environmental Friendly purchasing when cost and quality components
line up
Strategies: Reprocessing initiatives including surgical services, sharps containers;
Partner with PHS system supply chain initiatives and Novation (GPO)
Environmental Management Plan
Goal: Department level assessment of process, waste stream and impact
Strategies: Conduct assessment

Providence Portland Area

Sustainability Goals
2008 2010 Areas of Focus, Continued
Healthy Food Initiatives
Goal: More local and organic food sourcing
Greening the Built Environment
Goal: Incorporate best practices in green healthcare design & construction
Energy Conservation
Goal: Develop system initiatives partner and raise local awareness
Communications Plan
Goal Internal: Endorsement of statement of goals, annual report, internet site
Goal External : Reporting and media opportunities

Hospital Waste Management

Policies to Support
Environmentally Preferred Purchasing Policies
That address reduced packaging less waste to
handle
That address material composition of packaging or
devises recyclable, compostable, etc.
That address reuse and remanufacturing
That address issues of cost differential for
preferred products by including total life cycle
cost of products (including those externalized) in
analysis.

Contact Information
Mike Geller
Regional Sustainability Coordinator
Providence Health &Services
503-216-4099
Michael.geller@providence.org