Continued on page 3

VOL. 6 NO. 4 Oct-dec 2010

Serving The Healthcare And Medical Waste Industries

Attention Readers !

Are you looking for Products, Equipment or Services for your business or healthcare facility?

If so, please check out these leading companies advertised in this issue:

Infectious & Non-Infectious Waste Containers & Linen Carts

Busch Systems - pg 5Rehrig Healthcare Systems - pg 7Rotonics Manufacturing - pg 12

Infectious Waste Sterilizing Systems

OnSite Sterilization - pg 16Ozonator Industries - pg 15

ReGen - pg 10TrinovaMed

Medical Waste Solutions - pg 9

Liquid Disposal Systems

Bemis Health Care - pg 10

Shredding Equipment

Vecoplan LLC - pg 8

Waste Management & Infection Compliance Services

Waste Management - pg 2

X-Ray Film & Material Recovery

Gemark Corporation - pg 11

t Palomar Pomerado Health, going green is also saving the medical system a lot of green. Not only is Palomar Pomerado

Health’s on-site shredding truck enabling the facility to handle its own document shredding, but it is also expected to save the medical system more than $840,000 over five years.

“We’re really trying to continue to make that connection between human health and the environment,” explains sustainability manager Barbara Hamilton. “If our mission is to promote health in the communities that we serve, then it’s also important that we follow the precautionary principle of ‘first do no harm.’ We have the opportunity to minimize our impact.

“Hospitals are typically the biggest waste producers in a community,” she notes. “So if we can find ways to reduce our waste, then we’re going to be able to reduce the health impact of all that transportation, fuel, and emissions to transport the material, as well as all of the environmental impacts of extracting natural resources. These things have a direct impact on

human health.”A similar scenario is playing out more than

2,000 miles away at the Medical University of South Carolina, where a comparable switch from an outside document shredding company to an on-site operation saved $100,000 in the first year alone — including the purchase of a shredding truck.

“It cost us less to buy the truck than we were spending on the contractor,” recalls sustainability manager Christine von Kolnitz Cooley.

Now, after running the on-site document shredding program since 2006, von Kolnitz Cooley is convinced more than ever that the switch was justified.

“I would say there is no contractor that could do what we do for the amount of money we do it for,” she says. “They could not match our price.”

The Medical University of South Carolina in Charleston includes a 750-bed medical center (teaching hospital) and six colleges that train

Hospitals Save Big With On-Site Shred Trucks

By P.J. Heller

A

Vecoplan shred truck operating at the Medical University of South Carolina.

Medical Waste ManageMent oct-dec 20102

77777710.05.10 09:52

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Info Request #134

www.healthcare.wm.comor contact a Healthcare Solutions specialist today at 1-877-383-8539.

Medical Waste ManageMent oct-dec 2010 3

Continued from page 1

Publisher / EditorRick Downing

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healthcare professionals. It is the oldest medical school in the South, having been founded in 1824.

The Palomar Pomerado Health District is the largest hospital district in California, covering some 850-square miles in the northern San Diego County area. It includes the 319-bed Palomar Medical Center in Escondido, the 107-bed Pomerado Hospital in Poway and the planned 450-bed Palomar Medical Center West in Escondido, which is under construction and slated to open in 2012.

What both medical complexes share in common, other than the patient care for which they are known, is a move from outsourcing document shredding to handling the job on-site.

After shredding documents, both medical complexes sell the material to paper dealers. Medical University of South Carolina has taken in as much as $50,000 a year in paper sales; Palomar Pomerado Health is on track to take in some $20,000 this year for paper alone.

“The real key . . . to the success of the program is the avoided costs of outsourcing,” Hamilton says. “That’s where the real savings come in. If we were just making money on selling the paper, we wouldn’t be able to fund the program.”

Medical University of South Carolina (MUSC)

Recycling is nothing new at MUSC, which has had a program in place since the early 1990s. Since then, its recycling

rate has grown from 1.4 percent to 27 percent, slightly below the state’s goal of 30 percent.

While items such as glass, plastics, aluminum and steel cans, electronic waste, batteries, mobile phones, medical products (excluding medical waste), toner cartridges and yard waste are all part of the recycling mix, it is paper which is far

and away the largest generated item, according to von Kolnitz Cooley.

She estimates the medical facility — both on-campus and satellite medical clinics — generates some 20,000 pounds of paper each week.

Initially, an outside vendor would collect paper that had been placed in enclosed 45-, 65- or 95-gallon locked bins. Most of those papers were medical-related documents that MUSC wanted destroyed to comply with the federal Health Insurance Portability and Accountability Act (HIPAA).

The HIPAA Privacy Rule established national standards to protect individuals’ medical records and other personal health information. Among other things, the government requires “appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization.”

“HIPAA was a major driver for shredding with a contractor,” von Kolnitz Cooley says.

But, she adds, “The medical center was spending so much on the outside contractor that it made economic sense just to buy our own truck.”

Af ter contac t ing companies that manufactured and sold shredding vehicles — as well as getting sample bags of shredded paper to see the shred size — MUSC purchased a Vecoplan VST 32i shred truck. The truck was paid off in 18 months.

“We actually weren’t surprised,” von Kolnitz Cooley says of the $100,000 in savings in the first year of the on-site program. “It was clear that you could save that kind of money.”

“A contractor may charge us anywhere from $40 to $60 to shred a bin depending on size,” she

Hospitals Save Big With On-Site Shred Trucks

Continued on page 8

Alpine Shredders shred truck operating at Palomar Pomerado Health.

Printed on 10% Post‑Consumer Recycled Paper

Medical Waste ManageMent oct-dec 20104

By Kevin T. Bain

The following article is the second part of a comprehensive two‑part series exploring the public health and environmental impact of household pharmaceutical waste in the US.

Environmental and health concerns are not the only public health implications of household pharmaceutical waste; costs are also an important factor. Whether it is consumers or other entities, someone has to pay for wasted pharmaceuticals. Any unconsumed or unused

pharmaceutical is a wasted healthcare resource, and wasted healthcare resources add to the total costs of our healthcare system. Nearly a decade ago, experts estimated that more than $1 billion worth of pharmaceuticals were wasted each year in the US. Pharmaceutical purchases in this country have increased markedly in recent years; waste has increased concurrent with this trend.

For example, researchers recently studied the cost of household pharmaceuticals wasted during hospice care. In a single hospice program, they found that the average cost of wasted drugs was between $100 and $200 per patient. If these data were extrapolated to the number of patients receiving services from all US hospice programs per year, it would mean that up to $290 million (in 2005 dollars) of drugs are being discarded by hospice programs alone. Considering that hospice programs get paid approximately $135 per patient per day for routine home care, which must cover payment for all of the patient’s hospice-related drugs, and that this estimate includes a relatively small segment of the US population, these figures are quite staggering.

Recommendations for Reducing Environmental Exposure to Household Pharmaceutical Waste

There are opportunities to reduce environmental exposure to household pharmaceutical waste in every phase of the life cycle of pharmaceuticals: design; approval and regulation; production;

use; and discharge and disposal. The top priority should be to reduce the amount of pharmaceutical waste generated, rather than dealing with the pharmaceutical waste once it has been generated. Reducing the amount of pharmaceutical waste generated starts at the beginning of the life cycle, where pharmaceuticals are designed. One potential solution to this problem is the use of “green chemistry,” also known as sustainable chemistry. Green chemistry is the design and application of chemical products and processes that reduce or eliminate the use or generation of hazardous substances. Green chemistry offers great potential to help reduce the amount of pharmaceutical waste related to the design and production of pharmaceuticals. It also has the potential to enhance or improve the absorption, bioavailability or delivery of pharmaceuticals, which makes it possible to design pharmaceuticals with the same therapeutic effect that use less Active Pharmaceutical Ingredients (API). As a result of using less APIs in the design of pharmaceuticals, the amount of pharmaceutical waste generated both by production and by human excretion is decreased. Green chemistry can facilitate more rapid removal of pharmaceuticals upon release to the environment, which ultimately would decrease environmental persistence of pharmaceutical waste.

The pharmaceutical industry should incorporate green chemistry principles into its design and production processes. Providing incentives, possibly through the pharmaceutical approval process, to support the use of green chemistry should be examined by the federal government. I recommend an Environmental Assessment (EA) for all pharmaceuticals. Currently, the FDA is the federal agency responsible for regulating the approval of pharmaceuticals. While the FDA is required to conduct an EA for pharmaceuticals seeking approval, there are a number of exclusions to this requirement. The federal government should reevaluate and consider removing these exclusions, thereby requiring an EA for all pharmaceuticals before the FDA will approve them to be marketed.

We know that the environmental impact of pharmaceuticals can be lessened simply by reducing the amount of unconsumed or unused pharmaceuticals. In the US, most drugs are prescribed and dispensed in 30 or 90-day supplies, in part due to insurance requirements. If prescribers and pharmacies, respectively, could prescribe and dispense in shorter supplies, a great deal of pharmaceutical waste could be avoided. The federal government should fund research and pilot programs to identify new payment systems to encourage prescribing and dispensing in shorter supplies and to explore the use of new technologies, such as automated dispensing systems, that facilitate dispensing in shorter supplies.

Unfortunately, there is currently very little coordination between federal government agencies – the FDA, the EPA and the DEA – when it comes to handling pharmaceutical waste. The FDA recommends that consumers take advantage of community pharmaceutical take-back programs. Meanwhile, the EPA and the DEA have their own individual efforts underway to address the disposal of pharmaceuticals. The EPA addresses pharmaceutical waste disposal, while the DEA addresses the disposal of controlled substance waste. This patchwork approach has made some progress in handling pharmaceutical waste, but these agencies need to work together to establish more cohesive national guidelines that are environmentally friendly, practical and safe for the public and healthcare providers.

The establishment of more community pharmaceutical take-back programs would lead to significant reductions in the impact of pharmaceutical waste on the environment. Community pharmaceutical take-back programs are periodic or ongoing events that allow people to bring unconsumed or unused pharmaceuticals to an organized collection site, such as a local pharmacy or police station, for proper management and disposal. Currently, there are relatively few take-back programs in the US, primarily because very little funding is available for such programs. They are frequently short-lived, pilot programs funded by federal government grants. To begin to establish more community pharmaceutical take-back programs and to enable them to become permanent programs, the federal government should identify other funding sources for them, including requiring pharmaceutical companies to pay for these programs and levying other waste disposal taxes and fees. Additionally, the federal government must ensure that these programs are convenient to access and free for people who want to participate in them.

In the long term, perhaps the most important effort that can be made to reduce levels of pharmaceutical waste in the environment is educating

Understanding the Public Health Implications of Household

Pharmaceutical Waste in the US – Part Two

Continued on next page

Medical Waste ManageMent oct-dec 2010 5

Info Request #113

the public and healthcare providers about disposal options. Currently, there is no national database or federal coordination to collect and disseminate information to the public or h e a l t h c a re p rov i d e r s ab o u t s a f e pharmaceutical disposal practices and about community pharmaceutical take-back programs that are available for them to utilize. As a result, the public and healthcare providers may be unaware that these programs exist in their area. To begin to solve this problem, the federal government should establish a national clearinghouse to collect information about safe pharmaceutical disposal practices and community pharmaceutical take-back programs and they should provide technical assistance to state governments to disseminate this information to the public and healthcare providers.

In the short term, we must establish more environmentally friendly methods for handling pharmaceutical waste. Incineration has the potential to permanently destroy pharmaceutical waste while simultaneously preventing harm to the environment. It is necessary, however, for the incineration to be done with an incinerator that has been designed and approved for this purpose. Currently, few of these incinerators are available in the US, and those available can be costly. Providing incentives, possibly through the tax code, to begin to establish more of these incinerators and to expand their use is something that should be explored by the federal government. Although wastewater treatment plants remove some pharmaceuticals, most conventional plants do not effectively remove most pharmaceuticals from wastewater effluents and removal rates are highly variable. Advanced wastewater treatment techniques such as activated carbon, membrane bioreactors and filtration, and oxidation by chlorination or ozonation can increase pharmaceutical removal rates. Expanding the use of these techniques to more wastewater treatment plants in the US is something that should be explored by the federal government and the EPA.

Conclusion

It is clear that trace concentrations of household pharmaceuticals, such as antibiotics, hormones and controlled

substances, are finding their way into our nation’s environment. In many cases, household pharmaceuticals enter the water when people excrete them or wash them away in the shower. In other cases, unconsumed or unused household pharmaceuticals are being flushed down the toilet or the drain and disposed of in the trash. Researchers suspect that the quantity of household pharmaceuticals entering our nation’s water supply is increasing, particularly because per capita drug use in the US is on the rise. This has public health and environmental officials in a quandary.

On the one hand, there is no evidence that trace concentrations of household pharmaceuticals harm humans. On the other hand, researchers have found pharmaceuticals almost everywhere they have looked for them, and

there is evidence that trace concentrations of household pharmaceuticals are

harmful to aquatic life. This begs the question: should public health

and environmental officials wait until scientists can make a still stronger case for a link between household pharmaceutical waste and harmful effects in humans? It would seem cavalier

to dismiss the possibility of harm because of a paucity of evidence.

Our nation’s experience with the most egregious of chemicals (such as

asbestos, lead and tobacco) demonstrates that it can be costly, in terms of human lives, health and dollars, to defer action until evidence of harm is overwhelming.

Although swift action is needed to mitigate the public health threat of household pharmaceutical waste, implementing the strategies recommended in this article will require major changes in attitudes, behavior and regulations. These changes will take time and some will likely be met with opposition. For example, the use of green chemistry would require a major change in the way pharmaceuticals are designed and brought to market through the regulatory approval process. Today, without the widespread use of green chemistry, it takes more than a decade (on average) to bring a new pharmaceutical to market in the US, costing the pharmaceutical company millions or billions of dollars.

The issue of who will pay for the use of green chemistry certainly needs to be addressed. Reducing the amount of unconsumed or unused household pharmaceuticals would require a major change in attitude and among prescribers, payers, pharmacies, and consumers. Consumers would need to access their prescribers and their pharmacies more frequently. In exchange, prescribers and pharmacies would need higher or more frequent reimbursement and dispensing fees, respectively, to support their more labor-intensive services. Payers would need to pass on these fees to consumers, resulting in increased premiums, co-payments, or both. Whether or not such a change is possible, even on a small scale, needs to be explored. In summary, no single strategy will fix the problem of household pharmaceutical waste overnight, yet taking no action is unacceptable.

Kevin T. Bain is a board certified pharmacotherapy specialist certified geriatric pharmacist and a certified public health professional. He is currently the Vice President of Clinical Support for excelleRx, an Omnicare company (www.excellerx.com). His concentrated fields are medication therapy management and hospice and end‑of‑life care. You can contact Kevin at kbain@excellerx.com.

Continued from previous page

“Although swift action is

needed to mitigate the public health threat of household pharmaceutical waste, implementing the

strategies recommended in this article will require major

changes in attitudes, behavior and regulations.”

www.buschsystems.com

Medical Waste ManageMent oct-dec 20106

Green Your Workplace: Build a Green Team

Greening the workplace was once a fringe activity but in recent years it has become mainstream. Yet despite its popularity, green terminology can still cause a fair amount of confusion for some people. Terms like “sustainability,” for example, can

elicit blank stares for those not already in the know. And because green is so closely associated with “saving the planet” (a daunting task that’s monumental in scale) many people feel overwhelmed. That feeling of being overwhelmed keeps many people from taking a more active role in greening their workplace. Green teams are a great way to engage co-workers and make your workplace more eco-friendly. How? By bringing down the scale of “saving the planet” to a manageable level that anyone can feel comfortable with. The benefits of green teams are many: improved employee satisfaction, better communication of green goals throughout your workplace and greater ease at accomplishing green goals by sharing the workload.

So, what is a green team? Well, as you might have guessed, a green team is like any other team or committee except for its focus is making the workplace eco-friendly. To be a part of a green team there is one requirement members must have; a strong passion for environmental stewardship. Making the workplace greener is not like other projects; passion for going green can carry over to a person’s home life as well. If you do it right, and your green team can inspire your co-workers with a level of enthusiasm not to be underestimated.

Getting Started

The first step to building a green team is to gain the approval of management. This step should not be difficult if you prepare yourself to make a strong case for why your workplace needs a green team.

Before you meet with management, prepare a proposal that outlines the team’s purpose and the potential scope of the work you plan to do. You should also have some idea of who and how many of your co-workers would become members of the team. But be flexible; leave the door open for additional members to join further along in the process. In a healthcare setting, a typical team might include representatives from nursing, supply chain, engineering and environmental services. Also be sure to come to your meeting prepared with a proposed budget to facilitate the green activities you’d like to undertake. Remind management that a green team provides a tremendous avenue for your organization to identify potential future leaders.

Once you have management approval, it’s time to form the team. This can be accomplished in a variety of different ways. You could ask the heads of key departments to appoint a representative or publicize your green team and its goals throughout your workplace to attract volunteers. However you decide to get the word out about your new green team, make sure you have a selection process in place. Why? Because it’s likely you will have more volunteers than you need and you may want to include those who don’t make the cut in projects or recruit them as members at a later time. Your selection criteria should take into account diversity, a person’s physical work location, their level within the organization and their level of interest.

In the world of healthcare, people are often appointed to green teams, but it really is better in the long run to identify and recruit volunteers who have a real passion for going green. It’s the passionate volunteers that will cross pollinate their ideas between departments and keep interest in your activities from waning. Green teams also offer opportunities for co-workers to participate in team projects.

Once your team is set, the first thing you need to do is to make sure all of the members understand their role as well as your team charter.

Next, make sure the team members have all the tools they need to succeed and reach your green goals. Educate them about what it means to be green – for their own benefit and the benefit of your organization – and they will become ambassadors of your greening program. Develop goals with deadlines for completion to keep the team members on task. This step is an important one. Not only will it enhance the team experience, it will go a long way toward satisfying the objectives of your organization’s management.

Communicate

An often overlooked component of successful green teams is communication. To succeed as a team your team members need to know you, as the leader/organizer, exist. They’ll be excited to be “in

the loop” and receive regular communications about the overall team’s activities. Share with everyone a roster of team members, the team’s overall projects and goals, and how the team is progressing on them. Good communications will have the side effect of attracting the interest of new team members as well. This is important to note. Why? Because green teams are like all other teams and attrition will happen for many reasons. Making sure to have a short list of potential new members is a good idea, both to keep on task with your goals and to keep fresh energy and ideas coming.

Have Fun and Be Flexible

Green teams are as much about passion as accomplishing goals. People are very passionate about being green. Greening is not just another “work project”. It’s more like a philosophy or lifestyle, something

people carry back and forth with them between work and home. Remember this when setting team goals. Hold regular team meetings and make sure to provide some fun activities. Lastly, as the organizer, be flexible so the team can adapt to changes and embrace new ideas.

Summary

Starting a green team at your organization can be a wonderful activity that accomplishes far more than meeting a few green goals. Interest in being green is something we all can embrace regardless of job title.

People from every walk of life are interested, whether a nurse, doctors or the person handling the soiled linen. This is an opportunity to facilitate communication across the organization and beyond to your customers and your community. When building a team, start by developing a plan and getting management approval, then let them team work within that structure to develop goals and timelines. Don’t be shy, share the information, let people know the exciting work you are doing and let them be a part of it. And last but not least, have fun with it. Being green shouldn’t be drudgery; it should be fun and satisfying

Project ExamplesHere are just a few brief examples of green team activities you should consider:

Help start a farmer’s market or produce stand on your campus.•Start a recycling program or enhance an existing one.•Coordinate community activities such as tree plantings or other •beautification efforts.Here’s an easy, but impactful idea, start an initiative to eliminate •disposable cups from your facility. Improve your energy efficiency by conducting small scale energy audits. •

Continued on page 10

By Tom BadricK

Medical Waste ManageMent oct-dec 2010 7

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explains. “Because of the way we do things and the volume that we shred, and the fact that we’re just working for ourselves, we charge less than $5 to shred a bin.”

With the shredding program on-site, no longer are shredded documents limited to confidential patient records.

“We just shred everything,” von Kolnitz Cooley says. “There was concern in the institution that everything is confidential: research, medical paperwork, employee information. So we shred it all.”

Secure recycling containers are placed throughout the campus, which are emptied by a dedicated recycling staff of three full-time and three part-time employees. A seventh employee, the operations manager, maintains the shredding vehicle and oversees the three full-time employees who can drive the truck.

“I don’t think there’s a single program that we run that really costs that much money,” she says of the sustainability program. “It doesn’t cost that much to recycle if you do it right.”

Palomar Pomerado Health (PPH)

When plans were being formulated for its new “green” hospital of the future, one of the areas that was explored was how to reduce costs from the various waste streams, including

shredding of paper documents. The result was to change in 2007 from outsourcing document

destruction to handling the shredding of documents on-site. In addition to paper, the medical system also recycles cardboard, shrink

wrap, batteries, light bulbs, ink and toner cartridges and bottles and cans. A 10 percent increase per year in document shredding is projected, and is

expected to increase substantially when Palomar Pomerado West hospital opens in 2012. That new facility will include a “green roof” covered in

vegetation, designed not only to provide energy efficiency for the hospital but to help patients recover faster by providing access to nature, a trend in modern medicine.

Overall, PPH’s goal is to be recycling 40 percent of all its waste streams, which includes recyclables, hazardous waste, solid waste and regulated medical waste. The state’s goal is to divert 50 percent of

non-regulated medical wastes from landfills. The majority of the material being recycled is paper, according to

Hamilton. At the end of November 2010, PPH reported shredding more

than 252,000 pounds of paper and confidential documents, recycling 330,900 pounds of cardboard and more than 2,600 pounds of shrink wrap. Revenues from all three waste streams totaled more than $26,000, Hamilton reported.

The on-site shredding program operates similar to the way it operated when document destruction was outsourced. Locked confidential document consoles are strategically located throughout the facility for paper collection, which are serviced five days a week by two shredding technicians from the sustainability department.

Both confidential and non-confidential patient and employee documents, as well as any outdated forms and other papers, are destroyed in a mobile shredding system, which PPH leases from Alpine Shredders Ltd. in Kitchener, Ont., Canada. The shredded paper is then sold to Allan Co., of San Diego.

Continued from page 3

Hospitals Save Big With On-Site Shred Trucks

Continued on next page

“I don’t think there’s a single program that we run that really costs that much money. It doesn’t cost that

much to recycle if you do it right.”[ [

www.vecoplanllc.com

Medical Waste ManageMent oct-dec 2010 9

Info Request #111

Continued from previous page“We’re actually beginning an analysis

about adding more staff and possibly adding another truck,” Hamilton says. “We have a lot of physicians all around our various campuses who do business with PPH and who would like us to extend service to them.”

She agrees that HIPAA was a factor not only in the original document destruction scheme, but in bringing it in-house. Running the program on-site eliminated transportation issues and the chance for something to happen to the documents before they were shredded.

“All of our bins are locked,” she says, adding that only security officers and the shredding technicians have keys for access.

PPH also conducts a highly popular free monthly shredding event for the community.

Hamilton, who came to PPH in the fall of 2010 from her sustainability consulting firm, says the staff has embraced recycling. Both MUSC and PPH have green teams which advocate for sustainability.

“The staff is really into recycling,” Hamilton says. “It’s very tangible. An organization can be doing a lot of work behind the scenes trying to save energy and save water, but having those recycling bins out there really makes a big difference for the staff and people who visit the facility.”

Cover photo courtesy of the Medical University of South Carolina. Page 3 photo courtesy of Palomar Pomerado Health.

www.ahe.org

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Continued from page 4

Try testing at co-worker’s desks so they can see the impact. •Host green contests. For example, hold a recycling contest between •departments.Host a green event. For example, celebrate Earth Day by giving staff •and guests opportunities to learn more about how to be green. This can also be a great forum to celebrate your green team successes.Start a green newsletter or write a regular green column in an existing •newsletter or e-news.Form a car-pool program, or help sponsor activities that support use of •alternative transportation.Help reduce unnecessary office supply purchases by setting up a “free •area”. This can be a physical space and/or an online exchange site.

Tom Badrick is President of Badrick Consulting specializing in healthcare sustainability program design and implementation. Tom is a recognized speaker in the healthcare sustainability field. He successfully crafted and directed the nationally recognized and award winning sustainability program for a large health system and has guided and assisted many other organizations to create or expand successful programs. Tom has a background in Environmental, Health and Safety management in biotech/chemical manufacturing and the electronics industry. Badrick Consulting offers a wide range of services from program creation/development to partnering in management of specific components of a sustainability program ranging from waste management to climate change initiatives. The Badrick Consulting website can be found at www.badricksustainability.com and Tom can be reached via email at tbadrick@aol.com.

Green Your Workplace: Build a Green Team

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Researchers Say Higher Temperatures are the Key to Killing Wastewater Bacteria

Civil engineering researchers with the University of Minnesota’s College of Science and Engineering have released

a new study that reveals treating municipal wastewater solids at higher temperatures – 130 degrees Fahrenheit (55 degrees Celsius) – may help kill the antibiotic-resistant bacteria often referred to as “superbugs”, reports sciencedaily.com. The research team says higher temperatures effectively destroy the genes within bacteria that confer resistance to antibiotics.

In recent years, growing concern about the gradually decreasing effectiveness of antibiotics in stopping bacterial infections has led researchers to explore new methods for fighting superbugs. U of M civil engineering professor Timothy LaPara says, “The current scientific paradigm is that antibiotic resistance is primarily caused by antibiotic use, which has led to initiatives to restrict antibiotic prescriptions and curtail antibiotic use in agriculture. Our research is one of the first studies that considers a different approach to thwarting the spread of antibiotic resistance by looking at the treatment of municipal wastewater solids.”

When patients take antibiotics, LaPara adds, antibiotic resistant bacteria can develop in their gastrointestinal tract. These bacteria are shed when the patient defecates and make their way into the sewer system where they eventually pass through municipal water treatment facilities. Most treatment plants transfer wastewater sludge to digesters that decompose the organic material at temperatures of 95 to 98 degrees Fahrenheit (35 to 37 degrees Celsius) – roughly the temperature of the human body. These temperatures, says LaPara, are perfect for resistant bacteria to survive and grow.

On the other hand, treating the sludge at higher temperatures destroys up to 99.9 percent of the genes that confer resistance in bacteria. LaPara believes that taking this approach to sewage treatment coupled with other steps, such as limiting the use of antibiotics, could extend the lifespan of antibiotics. As an added bonus, raising the temperature of wastewater treatment digesters is not cost-prohibitive because the digesting bacteria produce methane gas that can be used to heat the reactor.

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Penton Media Announces New Name for the Annual Medical Waste Conference

Penton Media’s Medical Waste Conference announced recently that it changed its name to the Healthcare Waste

Conference to reflect changes in the industry. The Healthcare Waste Conference will take place May 11-12, 2011 in Dallas, Texas, in conjunction with WasteExpo, the largest event in North America serving the solid waste and recycling industry.

Rita Ugianskis-Fishman, Managing Director of Penton Media’s Waste Industry Group stated: “The new name and format will allow the conference to expand and stay in tune with the healthcare waste industry, while allowing attendees to gain a greater understanding of the changing industry. The Healthcare Waste Conference remains the only annual conference in the United States strictly devoted to healthcare waste, and we’re pleased that we’re able to adapt the conference to fit the ever-changing needs of the healthcare waste industry.”

Therefore, the annual conference that serves medical waste management interests, healthcare facilities, manufacturers and distributors, as well as government educators and regulators, must change. The new name of the annual Medical Waste Conference is Healthcare Waste Conference, which will allow for discussion and networking on a much broader scope than regulated medical waste and infectious substances. The name change also coincides with the Medical Waste Institute’s name change to the Healthcare Waste Institute.

In addition, the format of the conference has changed to increase networking and to take advantage of attendees’ knowledge. Instead of presenters speaking to the audience and then allowing for questions and answers, the conference will be audience interactive. Healthcare waste subjects will be selected and attendees will be divided into groups to discuss those topics and develop solutions to problems or a plan of action to pursue future goals. Attendee groups will be kept on course through discussion leaders.

Fo r m o re i n fo r m at i o n , v i s i t t h e Healthcare Waste Conference website at www.healthcarewasteconf.com

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Info Request #114

Could TV Waste Prevent Infection?

Here is a story that’s sure to make the list of “who’d a thunk it?” scientific discoveries. Researchers with the University of York’s Department of Chemistry say they’ve discovered a

method for transforming e-waste into a new tool for battling hospital infections. Sciencedaily.com reports that the university’s research team has discovered a way to transform the chemical compound polyvinyl-alcohol (PVA), found in liquid crystal display (LCD) televisions, into an anti-microbial substance that destroys such hardy bacteria as E. coli and some strains of Staphylococcus aureus.

Using a complex process, the researchers heat and then cool the PVA before dehydrating it using ethanol to produce a high surface area mesoporous material that is compatible with the human body. This material, they say, can be used to create regenerative tissue scaffolds as well as pills and dressings designed to deliver drugs to particular parts of the body. By adding silver nanoparticles researchers say they can enhance the material’s anti-microbial properties enabling it destroy to most bacteria.

This discovery has the potential not only to make a significant impact in the fight against infection, but the European Union’s (EU) growing e-waste problem as well. In the EU, an estimated 2.5 billion LCDs are approaching the end of their life cycle. The research team says the next step will be to compare the substance with commercial compounds to determine its relative effectiveness, and to obtain approval from regulatory agencies regarding the suitability of silver nanoparticles for human health applications.

MRSA Infection Rates are on the Decline

According to a new study of nine US metropolitan areas, cases of methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital patients decreased from 2005 to 2008, reports

sciencedaily.com. An estimated 99,000 MRSA-related deaths occur annually in US hospitals (of the roughly 1.7 million cases of MRSA infection are reported by US hospitals annually). Public health agencies and policy makers have taken aggressive action to combat MRSA, and their efforts seem to be paying off.

The study examined 21,503 cases of invasive MRSA infections. More than 17,500 of the cases were either hospital-onset or health care-associated community-onset. Researchers found that cases of hospital-onset invasive MRSA infections decreased about 9.4 percent per year from 2005 through 2008; while there was a significant 5.7 percent decrease per year in the modeled incidence of health care-associated community-onset infections. Overall, hospital-onset invasive MRSA infections decreased 28 percent and invasive health care-associated community-onset infections decreased 17 percent over the study period.

Researchers found that 88 percent of health care-associated infections involved a positive blood culture. These infections were classified as bloodstream infections (BSI). BSI-related infections decreased 34 percent overall for hospital-onset MRSA and 20 percent overall for health care-associated community-onset MRSA over the study period. Though the specific reasons for these decreases are not known, researchers say they are the result of the increase of various prevention practices.

http://www.rotonics.com/medicalwaste.html

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Medical Waste ManageMent oct-dec 2010 13

New Law Allows for Safe Disposal of Prescription Drugs

The recent passage of the bipartisan Safe and Secure Drug Disposal Act will allow individuals and long-term care facilities

the opportunity to safely dispose of potentially harmful prescription drugs through the proper authorities, reports cawrecycles.org. The bill also encourages the development and expansion of pharmaceutical take-back programs. Roughly 4 billion prescriptions are written in the US annually. Experts estimate that as much as 40 percent of these drugs go unused, resulting in about 200 million pounds of pharmaceutical waste per year – waste that poses serious public and environmental health hazards. To complicate matters, unused drugs are often accidentally or illegally consumed. The new law seeks to curb prescription drug abuse, reduce the cost of drug take-back programs and help keep unused drugs out of the environment.

A New Superbug is on the Rise

According to a recent study by the Duke Infection Control Outreach Network (DICON), a deadly new

antibiotic-resistant bacterium, or “superbug”, known as Clostridium difficile is on its way to surpassing incidents of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. While MRSA infections have been on the decline since 2005, C. difficile infections have increased since 2007. C. difficile is a multi-drug resistant bacterium that causes diarrhea and in some cases life-threatening inflammation of the colon. Though this superbug can be treated with one of two antibiotics, relapses are commonplace. Roughly 25 percent of infected patients experience a relapse.

DICON researchers say a small percentage of patients infected with C. difficile die, despite treatment. In addition, the drug is able to survive the application of alcohol-based hand cleansers that kill MRSA. The study consisted of data from 28 US hospitals over a two year period. There were 847 cases of C. difficile infections reported over that span – a rate of infection 25 percent higher than that of MRSA in the participating hospitals.

DICON says the fight against C. difficile must become a priority for hospitals, and advises that any prevention methods developed to combat the bacteria must not comprise the progress made in the fight against MRSA.

The Clorox Company Launches Clorox® Bleach Cream Cleanser

The Clorox Company recently announced the launch of Clorox® Bleach Cream Cleanser, its newest product specially designed for Environmental Services who face the challenge of keeping hospital settings visibly clean.

According to Clorox officials, Clorox® Bleach Cream Cleanser, made with 1.3 percent sodium hypochlorite, contains a bleach formula that has been proven to work on tough stains found in hospital settings, including food and beverages, bodily fluids, soap scum and mildew stains.

Clorox officials also stated that Clorox® Bleach Cream Cleanser has been tested for compatibility with most hospital surfaces – such as sinks and tubs, toilets and countertops. It can also be used in other settings – like break rooms, kitchens and bathrooms – where it can be applied on kitchen countertops and appliance surfaces to remove even the toughest stains – like coffee, grease, or blood.

Clorox® Bleach Cream Cleanser is the latest addition to the company’s portfolio of products designed for Environmental Services, which includes Clorox® Germicidal Bleach Terminal Wipes, Dispatch® Bleach Spray and Clorox® Germicidal Bleach.

Formerly the Medical Waste Conference

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Penton Media’s WasteExpo Announces 2011 Conference Program

Penton Media’s WasteExpo, the largest event in North America serving the solid waste and recycling industry, has announced its 2011 Conference Program. WasteExpo will be held May 9-12,

2011, in Dallas. Organized by the Environmental Industry Associations (EIA),

WasteExpo’s Conference Program offers over 40 sessions and workshops designed to provide waste and recycling professionals with the critical information they need to perform their jobs more effectively and efficiently.

“The WasteExpo 2011 educational program has been completely revamped to provide new topics from the attendees’ perspective,” stated Alice Jacobsohn, director, education, EIA. “Many sessions offer a how to approach to topics that attendees can take back to their facilities and implement. Other sessions allow for attendee participation to ensure current issues are considered and discussed.”

Conference Tracks for the 2011 event include: Recycling, Small Hauler Interests, Cost-Effective Solutions, Alternative Energy Systems, Workplace Health, Recycling Markets, Financial Growth, Collection Technology, Media Relations, Safety, Composting and Recycling, Business Communication, Compliance for Haulers, Municipal Collection, Fuel Management, Security, Statistics for Business, and Truck Technology.

In addition, WasteExpo will offer two in-depth, day-long workshops. Current Developments in Landfills will focus on headline issues, Clean Air Act compliance, and construction innovations. Fleet Management will look at practical and logical solutions to the problems of fleet maintenance for the public and private sectors.

The always popular Boxed Lunch Discussions are now known as the Lunch-n-Learn Discussions and will feature the following topics: From Company Beginnings to Success: Adventures in the Waste Industry; Extended Producer Responsibility: A Panel of Possibilities; and The Gulf Coast Oil Clean-Up, A Waste and Recycling Industry Perspective.

Enhancing the educational component of WasteExpo are the co-locating conferences that provide the specific, critical information the waste industry needs. The Healthcare Waste Conference (formerly the Medical Waste Conference) is an industry-recognized educational event that focuses on the largest regulatory, legislative and technical issues that affect the healthcare waste business. The Waste Training Institute is an industry-specific business training initiative designed to help employees in small-, medium- and large-sized waste companies run their businesses more effectively. The Fluid Power Conference & Expo offers a variety of topics, from fluid power fundamentals to compressed air preparation, motion control basics to hydraulic systems filtration, and much more.

For more information, visit the WasteExpo website at www.wasteexpo.com.

Hospitals Join Greening the Operating Room Initiative

Businesswire.com reports that an increasing number of hospitals are joining the Greening the Operating Room (OR) Initiative, a coalition created by the organization Practice Greenhealth (PG) to green US

operating rooms. Greening the OR also seeks to raise awareness of the vast amount of waste ORs contribute to a hospital’s overall waste stream. According to PG, an OR can account for up to 30 percent of a hospital’s total waste. Forward-thinking hospitals, manufacturers and related stakeholders have joined the initiative to identify best practices, help reduce the environmental impact of the nation’s operating rooms and help hospitals reduce costs and improve worker and patient safety.

Hospitals participating in the Greening the OR Initiative include: The Cleveland Clinic in Cleveland, Ohio; Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire; St. John Hospital and Medical Center in Detroit, Michigan; and the University of Maryland Medical Center in Baltimore, Maryland, among others.

ORs are the most resource-intensive and waste-generating areas of most hospitals. A recent study estimated supply costs for ORs can be as high as 56 percent of a hospital’s total operating room budget. Most of the waste generated in ORs is classified as regulated medical waste, which costs between ten and fifteen times more in disposal fees than regular waste. Much of this waste could be disposed outside of the regulated medical waste stream. In addition, most OR supplies are thrown out after only one use.

Mercy Medical Center to Host Environmental Programs in Lieu of Fine

Canton, Ohio’s Mercy Medical Center (MMC) recently agreed to host five environmental programs as part of a deal with the EPA, reports cantonrep.com. By hosting the programs, MMC will not have to

pay a nearly $20,000 fine issued by EPA in October as a penalty for storing crushed fluorescent light bulbs on premises without the proper permits. Ohio EPA spokesman Mike Settles said the agreement works out well for both sides because the agency prefers not to levy fines against non-profit hospitals, such as Mercy.

As part of the agreement, MMC has agreed to join the Medicine Cabinet program to collect unused medications. MMC also coordinated the Drug Enforcement Administration’s Take Back initiative and plans to launch a pharmaceutical waste disposal program, host a hazardous waste symposium in 2011 and offer a pharmaceutical collection day next year.

Medical Waste Found in Alaskan Landfill

F iercehealthcare.com reports that contaminated medical waste was found recently during a random load inspection at the Anchorage Regional Landfill. The waste – which included bags of infected human

blood, used IV tubing, needles and other waste – originated from Providence Alaska Medical Center (PAMC). PAMC has been temporarily banned from using the landfill forcing officials to send the center’s medical and non-medical waste to a third-party processor at the cost of tens of thousands of dollars.

The waste, which should have been incinerated or sterilized, was reportedly mistakenly placed in general black trash bags rather than the standard red bags. PAMC has responded to the incident by changing its disposal polices to avoid a repeat incident. The center now uses clear plastic garbage bags and all bags must undergo two visual inspections before they leave the facility.

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Medical Waste ManageMent oct-dec 2010 15

Info Request #115

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TOP STORIES

Hospitals Save Big With On-Site Shred TrucksPAGE 1

Understanding the Public Health Implications of Household Pharmaceutical Waste in the US

PAGE 4Green Your Workplace: Build a Green Team

PAGE 6MRSA Infection Rates are on the Decline

PAGE 12A New Superbug is on the Rise

PAGE 13Hospitals Join Greening the Operating Room Initiative

PAGE 14