REGULATED MEDICAL WASTE REDUCTION

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REGULATED MEDICAL WASTE REDUCTION

• EASTERN SHORE HOSPITAL CENTER
• Elizabeth Jackson, RN, ADN
• Director of Infection Control

Environmental Excellence in Healthcare
Conference November 12, 2008
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OBJECTIVES

• The participant will be able to
• (1)   Identify 2 methods utilized by ESHC
  
• to reduce medical waste
• (2)   Identify the financial savings seen
• (3) Identify the amount of waste
• stream reduced

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EASTERN SHORE HOSPITAL CENTER
CAMBRIDGE, MARYLAND
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Description

• 80 BED Dept. of Health Mental Hygiene
• PSYCHIATRIC INPATIENT HOSPITAL
• 4 UNITS named after four rivers in our area
• NANTICOKE
• CHOPTANK
• WICOMICO
• MANOKIN
• where our medically fragile population is
  cared for and where the majority of our Regulated
  Medical Waste is generated.

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PROBLEM IDENTIFIED

• IN OCTOBER 2005 MAINTENANCE STAFF ASKED ME TO
  MEET THEM AT OUR MEDICAL WASTE STORAGE SHED

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STORAGE SHED

• WHAT I USUALLY SEE

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WHAT I SAW
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CURRENT UNIT PROCESS
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WHAT WENT WRONG?

• OUR MEDICAL WASTE CONTRACTOR HAD RECENTLY
  REPLACED OUR CARDBOARD CONTAINERS WITH SQUARE
  PLASTIC BINS

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• MAINTENANCE PROVIDED EACH UNIT WITH A CONTAINER
  AND LID ON A ROLLING BASE

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• MAINTENANCE STAFF STATED THEY HAD TOLD THE NURSE
  IN CHARGE ON EACH OF THE FOUR UNITS WHEN THEY
  DELIVERED THE NEW SYSTEM HOW IT WAS TO BE USED
• THERE ARE 109 NURSING STAFF EMPLOYED AT ESHC

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• WHAT WE HAVE HERE IS A FAILURE TO COMMUNICATE

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INITIAL CORRECTIVE ACTION

• WE POSTED INSTRUCTIONS OVER THE CONTAINERS IN
  EACH SOILED UTILITY AND TREATMENT ROOM
• EMAILED THE INSTRUCTIONS ON THE NEXT 3 SLIDES TO
  ALL NURSING STAFF AND ASKED THE UNIT SUPERVISORS
  TO INCLUDE THIS INFORMATION IN UNIT PERSONNEL
  MEETINGS FOR THE NEXT COUPLE OF MONTHS

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• Instructions for New Biohazard Containers
• Black square lightweight plastic bins with
  Biohazard labels and folding locking tops are
  provided by our contractor and stored in the
  locked Biohazard Trash Shed on the Loading Dock.
  Staff unit keys unlock the shed
• A square wheeled base and removable covered trash
  lid have been provided to each unit and are to
  remain assembled until full
• Items saturated with blood infectious body
  fluids, and Filled, Sealed SHARP CONTAINERS
  should be placed in the Red Bags Bin

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• When the Red Bag is full, tie it off
• Leave it in the square bin
• Remove the trash lid
• Fold the doors up from the sides of the bin and
  snap them closed to lock securely
• Transport the closed locked bin on the provided
  dolly to the Biohazard Trash Shed on the loading
  dock

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• Remove the full locked bin and place it in the
  right side of the Biohazard Trash Shed
• Obtain a new unlocked empty bin and Red Bag from
  the shed, placing it on the dolly return it to
  the designated place on the unit
• AT NO TIME SHOULD RED BAG TRASH BE TRANSPORTED
  THROUGH THE HOSPITAL, OR PLACED IN THE BIOHAZARD
  SHED IN ANY OTHER MANNER

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PROGRESS

• I FOLLOWED UP WITH MAINTENANCE STAFF MONTHLY
  THROUGHOUT FY 2006
• AND THEY REPORTED NO FURTHER PROBLEMS WITH
  PROPER STORAGE

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• PROBLEM SOLVED
• OR
• WAS IT?

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FY 2007 REVEALED A BIGGER ISSUE

• I REALLY LIKED THE CONTAINERS USED AT ESHC AND
  WANTED TO GET THEM FOR OUR SISTER FACILITY.
• I ASKED ESHC MAINTENANCE STAFF FOR ASSISTANCE

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• A CALL TO OUR MEDICAL WASTE CONTRACTOR REVEALED
  THAT ESHC HAD BEEN PROVIDED THESE CONTAINERS DUE
  TO THE LARGE VOLUME OF MEDICAL WASTE
  GENERATED.THEY ADDED
• ESHC GENERATED MORE MEDICAL WASTE THAN MOST OF
  THE LOCAL NURSING HOMES!!!
• A REVIEW OUR MEDICAL WASTE RECORDS FOR FY 2006
  REVEALED THE FOLLOWING INFORMATION

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INVESTIGATION IN FY 2006 ESHC GENERATED
921 CONTAINERS OF MEDICAL WASTE
AT A COST 14,653
THATS A LOT OF TRASH!
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UNIT ROUNDS LED TO THE DISCOVERY THAT MANOKIN
UNIT WAS DISPOSING ALL DIAPERS AND BLUE
PADS IN RED BAGS
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MANOKIN TUB ROOM
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REGROUPING

• THE RED BAGS ON THE MANOKIN UNIT WERE REMOVED
  FROM ALL AREAS EXCEPT THE TREATMENT ROOM
  SOILED UTILITY ROOM
• THIS CHANGE WAS COMMUNICATED TO ALL UNIT STAFF
  HOUSEKEEPING BY EMAIL AND THROUGH PERSONNEL
  MEETINGS
• MET FACE TO FACE WITH DIRECT CARE STAFF AND
  HOUSEKEEPERS

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THE REAL WORK BEGINS

• FY 2007 HOSPITAL GOAL OBJECTIVE
• RED BAG WASTE WILL BE REDUCED 20
• EMAIL EDUCATION quizzes word searches
• 36 employees returned quiz word search to
  be eligible for one of two 10 Mc Donald gift
  cards.
• Sent out correct answers key to word search
  to all staff.
• KNOW WHERE to THROW Poster, Biohazard sticker,
  Waste Disposal Table were emailed and posted on
  the units

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MONITORING EVALUATION

• THE AMOUNT OF MEDICAL WASTE PICKED UP BY OUR
  CONTRATOR WAS TRACKED MONTHLY and communicated
  to all staff
• MONTHLY UNIT ROUNDS SPORADIC SPOT CHECKS OF
  UNITS negative positive findings were
  communicated to staff
• FACE TO FACE MEETINGS WITH UNIT STAFF AND
  HOUSEKEEPERS to discuss issues or concerns

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CONTAINERS OF WASTE GENERATED BY ESHC
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RESULTS OF INITIATIVE

• FY 2007 6,642 SAVED
• FY 2008 6,212 SAVED
• 2 YEAR SAVINGS 12,854
• FINANCIAL SAVINGS 88

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• REDUCED
• MEDICAL WASTE STREAM
• 86

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MANOKIN UNIT OUR SHINING STAR
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MANOKIN TUB ROOM
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FINISHED?Choptank, Nanticoke
WicomicoTreatment Rooms
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WICOMICO UNIT
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CHOPTANK
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NANTICOKE
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• QUESTIONS?

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RESOURCES

• COMAR 10.06.06
• COMMUNICABLE DISEASE PREVENTION
• Handling, Treatment, and Disposal of Special
  Medical Waste ,
• Brenda Roup, RN, PhD- Maryland DHMH EDCP
  
• CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD
• - Posters and Signs
• HEALTHCARE WITHOUT HARM
• - Waste Minimization Segregation and
  Recycling Hospitals
• - 10 Ways to Reduce Regulated Medical Wastes
• HOSPITALS for a HEALTHY ENVIRONMENT
• - H2E Self-Assessment Guide
• -Regulated Medical Waste reduction