necsc-waste reduction in hospitals
DESCRIPTION
In the past, many hospitals simply dumped all waste streams together, from reception-area trash to operating-room waste, and burned them in incinerators. Incineration is a leading source of dioxin, mercury, lead and other dangerous air pollutants. This session will examine how three university hospitals are addressing waste minimization and creating healthier environments for patients and caregivers, and highlight industry-specific challenges from biological waste and sterility needs to administrative hurdles.TRANSCRIPT
First Do No Harm Hospital vs.. Environment
Noe Copley-Woods, MD
Assistant Professor
Department of Obstetrics and Gynecology
University of Pittsburgh School of Medicine
Magee Women’s Hospital
• 10,000 babies born per year
• 30,000,000kWh electricity
• 166,000 decatherms of gas
• 161,500,000 ft2 space
• 494 tons of Red Bag Waste/yr
• 927 tons of Municipal Waste/yr
#7 US News Report Best
Gynecology Hospitals• NICU DEHP and PVC free
• Mercury Free Hospital
• Environmental Education Classes for expectant parents
• green roof, edible gardens used in hospital food, non-toxic cleaning products, environmentally preferred purchasing
My Job As An ObGyn
Laparoscopic Assisted Vaginal Hysterectomy
Dilation and Curettage
Magee Waste Comparison by Weight (lbs)- August
2009CDD 13700 lbs.
4.9%EWS 2280 lbs.
1.2%
RMW 46843 lbs.
16.9 %
RMW Chemo/Path
21861 lbs.
7.9%
Recycle 23800 lbs
8.6%
MSW
164500 lbs.
59.5%
Hazardous Waste
3245 lbs.
1.1%
Red Bag Waste
(Regulated Medical Waste)
• Regulated by individual states and OSHA
• Defined as medical waste capable of producing an infectious disease.
• Sharps
• Cultures/stocks
• Blood and blood products
• Isolation Waste – (from patients with a
known communicable disease)
• Dialysis unit waste
PVC (polyvinyl chloride)
1/4 of disposable medical devices are made of PVC
Dioxin released in production and incineration of PVC.
Dioxin 2,3,7,8
tetrachlorodibenzo-p-dioxin
(TCDD)• Class I Carcinogen (WHO)
• The primary toxic component of Agent Orange
• Unintentional bi-product of many industrial processes (pesticide manufacturing, pulp and paper bleaching, burn barrels, PVC)
• 2 largest sources include garbage and medical waste incinerators.
• Lipophilic and accumulates in fat.
Incinerator Emissions
• Dioxin
• Acid Gases
(hydrochloric acid)
• Particulates
• heavy metals
– Lead, cadmium,
mercury
Hazardous Wastes Commonly
Found in Hospitals• Chemotherapy
and anti-neoplastic chemicals
• Formaldehyde (Hazardous waste incinerator)
• Radio nuclides (allowed to decay and then sent to landfill)
• Solvents
• Mercury
(reclamation)
• Waste anesthetic
gases
• Cleaning and
Maintenance
chemicals
Environmental Measures at
Fletcher Allen Healthcare
Louis Dinneen
Director of Facilities Management
Fletcher Allen Healthcare
Toxicity Reduction
Benefits
• Building occupant sensitivity
• Improved indoor air quality
• Reduced packaging
• Fewer Chemicals
Green Non-Green Total
2005 0 11 11
2006 1 10 11
2007 4 3 7
2008 5 2 7
2009 5 1 6
Daily Use Chemicals
Let’s Talk Trash…
The Hierarchy of Waste Stream
Stream Impact
Infectious Waste
Trash
Recycling
Composting
Reuse
By moving the material down the hierarchy we
reduce the environmental impact.
Trash to Compost
2007Compost
2008Compost
2009Compost
Increase Recycling
Waste Stream Volume
58% 57%
29% 31%
65%
22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2008 2009
Pe
rce
nta
ge
of
To
tal
Solid Waste
Recycling
1506 T
ons
332 T
ons
14
45
To
ns
710 T
ons
1400 T
ons
746 T
ons
Energy Conservation
$ $
$$$ $
Energy Reduction Measures
Measure Electric
Consumption
(kWh)
Gas
Consumption
(MMBtu)
Carbon
Footprint
(Tons)
Capital Project
Lighting, Insulation,
HVAC, Chilled Water
(2007-8)
2,380,000 6,355 1,738
Turned off
Transformers (2009)1,200,000 N/A 492
AHU
Re-commissioning
(2009)920,000 In Progress 377
Total Reduction 4,500,000 6,355 2,607
Historical Energy Usage
Annual Electrical Consumption and Carbon Footprint
34000000
35000000
36000000
37000000
38000000
39000000
40000000
41000000
42000000
2005 2006 2007 2008 2009
Ele
ctr
ic C
on
su
mp
tio
n (
kW
h)
14000
14500
15000
15500
16000
16500
17000
Metr
ic T
on
s o
f C
02
QUESTIONS
Sustainability & Waste
Management at University Hospitals
John Leigh
Healthcare’s Footprint
• 24/7 Operations
• 3 million tons of waste per year and
growing - increase in disposables,
packaging, chemicals
• Hospitals are the second most
energy-intensive commercial
buildings in the U.S.
• Medical waste incinerators have
been a major source of dioxin
emissions
Why are hospitals more focused on
greening their operations?
• Public Health Benefits
• Cost Savings
• Reg. Compliance/Liability
• Indoor Air Quality
• Community Pressure
• Healing Environments
• Recognition of Our Large
Environmental Footprint
• Mission & Ethic
• Precautionary Principle 4
Could these trends be connected?
↑ Rise in chemical production & prevalence
of chemicals in the products we use
↑ Rise in our toxic chemical body burden
↑ Rise in the incidence of cancer, asthma,
diabetes, autism...
“Overall...the health effects of a rapidly changing
climate are likely to be overwhelmingly negative.”– World Health Organization
HEAT
SEVERE WEATHER
AIR POLLUTION
ALLERGIES
VECTOR-BORNE DISEASES
WATER-BORNE DISEASES
WATER & FOOD SUPPLY
ENVIRONMENTAL REFUGEES
MENTAL HEALTH
Heat stress, cardiovascular failure
Injuries, fatalities
Asthma, cardiovascular disease
Respiratory allergies, poison ivy
Malaria, dengue, hantavirus, encephalitis, Rift Valley fever
Cholera, cryptosporidiosis, campylobacter, leptospirosis
Anxiety, post-traumatic stress,
depression, despair
Forced migration, civil conflict
Malnutrition, diarrhea, harmful algal blooms
• Weather
extremes
• Sea level
rise
• Ecosystem
changes
• Floods
• Droughts
Ecological Overshoot:
We’re drawing down natural capital
Source: The Ecological Footprint Atlas 2008. Oakland: Global Footprint Network.
DHMC’s Ecological Footprint
More than 1,000 times our
physical footprint of 70 acres
Global
MTCO2e Acres %
TOTAL 190,288 75,096 100%
Products 85,346 29,949 40%
Energy 44,085 15,470 21%
Waste 498 175 0.2%
Transportation 46,885 24,679 33%
Food 12,095 4,329 6%
Water 332 119 0.2%
Built Land 1,047 375 0.5% -
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Acres
Total Ecological Footprint
Products
Energy
Waste
Transportation
Food
Water
Built Land
Here’s a Popular Place to Start
But excelling in
hospital waste
management
involves a lot more
than beverage
container recycling
2009 ASHES Annual
Conference
September 20-24, 2009
A Hospital’s Many Waste Streams
DHMC Waste Streams By Percentage, 2008
Ordinary
Trash,
53%
Recycling,
35%
Sharps, 1.5%
Infectious, 8.4%
Trace Chemotherapy &
Anatomical Pathology, 0.9%
Hazardous, 1%
DHMC Tons of Waste Generated, '08
Sharps
43
Trash
1531
Recycling
1020
Tan
Bag
243
Red
Bag
25
Haz.
300
500
1000
1500
2000
Hospitals Should Strive to Measure All of
Their Waste Streams Annually, By Weight
What One Can Do With Waste Data
• Track changes (generation, costs, composition)
• Generate ideas, prioritize actions
• Measure progress, see what needs attention
• Win environmental leadership awards
• Better manage your:
– Haulers
– Processors
– Equipment
– Budget
Whom I Gather Waste Data From
• Vendors (a dozen or so)
• Other departments (Pathology, Engineering, Med
School, Safety, Radiology, Inventory & Logistics)
• My staff (Excel
spreadsheets)
2009 ASHES Annual
Conference
September 20-24, 2009
Volume Reduction Programs
• Single-Use Device reprocessing
• Reusable sharps containers
• Red bag waste minimization
• Fluid management systems
• Donations of surplus supplies
• Office supply reuse center
• Online waste exchange (esp. good for
furniture & office equipment)
• Waste prevention education and
Environmentally Preferable Purchasing
Environmental Stewardship Structure
Education and Communication
Environmentally Preferable Purchasing
Waste Management and Reduction
Mercury Elimination
Energy, Water and Climate
Environmental Services
Food Services
Sustainable Sites Management
Transportation Operations
Chemical Management
ExcellentGoodFairPoor
Performance / MaturityHospital A
Environmental Stewardship Structure
Education and Communication
Environmentally Preferable Purchasing
Waste Management and Reduction
Mercury Elimination
Energy, Water and Climate
Environmental Services
Food Services
Sustainable Sites Management
Transportation Operations
Chemical Management
ExcellentGoodFairPoor
Performance / MaturityHospital B