Beth Israel Medical Center

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Beth Israel Medical Centers Success in
Regulated Medical Waste Reduction

• November 12, 2004
• Janet Brown
• 212/941-2486
• Janet.Brown_at_h2e-online.org
• www.h2e-online.org

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Regulated Medical Waste One part of a
Comprehensive Waste Program
Includes 2 pathological waste
Hospital Waste (Trash)
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Reduced Waste Fees
Waste Fees reduced by over 1,000,000 Per year
system-wide.
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Beth Israel Medical Center

• Petrie Campus 930 beds (1990s)
• Singer Division 230 beds
• Kings Highway Division 212 beds
• Phillips Ambulatory Care Center 200,000
  outpatient visits per year
• St. Lukes Roosevelt 400 each
• Long Island College Hospital 500 beds

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Fear of Waste ? MWTA ? Garbage Nightmare!

• April 1989 2,300 pounds RMW/Day
• 27,000/month.
• July 1989 11,000 pounds RMW/Day 130,000/month
• FTEs 15 to 26! (11 x 28K 308K)
• 808 lbs. of boxes/day! (just the weight of
  packaging alone)

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Petrie Campus 930 beds

• 1,000 doctors, 1,000 nurses
• 6,000 employees
• Operating Budget of 650,000,000 and challenged
  to cut 120,000,000 to 180,000,000. (20 25
  over three years)
• No space, no time, no money

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Successful Programs

• Simplicity
• Economically Viable
• Communication/Education
• Support
• Shared Savings
• Buy-in from Leadership
• Dedicated Staff Person
• Employee Recognition

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RMW Reduction

• Reduce volume of RMW.
• Switch to a reusable sharps container.
• Switch to reusable shipping containers for RMW.
• Address of FTEs handling RMW.

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Step by Step to RMW Reduction

• Infection Control Committee Policy Development
• Gather baseline data Project savings
• Reduce red bags BEFORE evaluating onsite
  treatment technologies
• Review waste contracts non-incineration
  treatment of RMW.
• Consider on-site versus off-site.
• Review sharps contracts.

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What goes in a red bag anyway?
YES! RED BAG
NO! Put in Clear Bag

• Blood, Products of Blood
• Anything caked, soaked or dripping in blood
• Tissues from surgery and autopsy
• Cultures and stocks of infectious agents and
  discarded vaccines.
• Suction canisters with any fluid. Hemovac and
  pleurovac drainage.
• Operating room waste saturated with body fluids
  as defined by OSHA.
• Waste from patients isolated with HIGHLY
  communicable diseases. (These are CDC Class IV
  definitions including Ebola, Lassa Fever, Marburg
  and Small Pox. NOT such conditions as AIDSlt
  Hepatitis or TB.)
• Sharps, including syringes and unused sharps.

• IV Bags, tubing, foley bags
• Non bloody gloves
• Packaging,
• Urine-soaked waste, feces, vomit
• Blood-tainted waste
• (Note distinction between blood-soaked and
  blood-tainted. A little bit of blood on an item
  can go in the regular waste stream.)

Questions? Call Waste Manager
Check your local regulations
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Waste Segregation Implementation

• Present Plan
• Survey Facility
• Develop Materials
• Purchase equipment, supplies.
• Issue Memo
• Container placement
• Properly Labeled, Signage
• Proper placement
• Training (never ends.)
• Monitoring and reporting
• Continue!

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Suction Canisters
40 of Operating Room Waste is from suction
Canisters! Potential for occupational Exposure
in transport.
http//mntap.umn.edu/health/91-Canister.htm
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Obstacles

• Fear of Waste
• Lack of training
• Old habits
• No clear can available
• Overfilled clear lined can
• Ran out of clear bags!

• Housekeeper collecting clear bags into red bag.
• Use closest can
• Change of Staff
• No time
• No can available
• Confusion of Isolation rooms
• Confusion over body fluids

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Reusable Products
Supply Chain Include waste fees when comparing
disposable versus reusable products.
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Disposable vs. Reusable Sharps Containers
Disposable
Reusable

• Nurses were responsible for changing containers
• Containers often overfilled.
• Containers often removed without being closed
  properly.
• Disposable filled containers were stored in the
  soiled utility rooms
• Too many employees handling sharps containers.
• Beth Israel incinerated approximately 2,700
  disposable sharps containers per month at one
  site alone!

• Vendor offered a full-service sharps management
  service.
• One dedicated person for handling sharps.
• Much fewer incidents of overfilled containers.
• Nicer looking container
• Reduced needle sticks associated with waste
• Elimination of 2,700 containers per month!
• Reduced liability
• Positive feedback from staff.

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10 Steps to Reducing RMW
http//www.h2e-online.org/ pubs/tensteps/Rmw10step
s.pdf
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For more information

• Janet Brown, Partner Coordinator Hospitals for a
  Healthy Environment 3 West 18th
  Street, 7th Floor
• New York, NY 10011
• Phone [phone]
• Cell 347/393-3809
• Fax [phone]
• Email Janet.brown_at_h2e-online.org

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Toll Free Hotline [phone]E-mail
h2e_at_h2e-online.orgwww.h2e-online.org
H2E Program Contacts

• Laura Brannen, DirectorLaura.Brannen_at_H2E-online.o
  rg
• 603-643-6700
• Chen Wen, DirectorChen.Wen_at_H2E-online.org
• 202-564-8849
• Janet Brown, Partner CoordinatorJanet.Brown_at_H2E-o
  nline.org
• 212-941-2486,
• cell 347-393-3809
• Sarah OBrien, Champion Coor. Sarah.obrien_at_h2e-onl
  ine.org
• [phone]
• Cecilia DeLoach, State Partnership Programs
  CoordinatorCecilia.DeLoach_at_H2E-online.org
• 800-727-4179

• Kelly Heekin, Communications Kelly.Heekin_at_H2E-onli
  ne.org
• 202-234-9656
• Emily Cronenwett, Program Assoc.Emily.Cronenwett_at_
  H2E-online.org
• 603-643-6710
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  E-online.org
• 603-643-6710
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  sst_at_H2E-online.org
• 202-234-0091 ext. 10