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Less Medical Waste, Fewer Infections
New ways to dispose of fluids and sharps can improve your facility's bottom line.
Kent Steinriede
Publish Date: January 18, 2008   |  Tags:   Staff Safety

Disposing of used sharps has always been a sticky and costly problem. A hard plastic sharps disposal container works well until it's full. Then it's like at home. No one wants to take out the trash, so you add just one more item and leave the dirty work for someone else. In a healthcare facility, that's when a lot of needlesticks happen. Between 12 and 15 percent of needlestick injuries are related to disposal, according to EpiNet and the Centers for Disease Control and Prevention.

That was the situation in the facilities of MultiCare Health of Tacoma, Wash., until the regional health system contracted with a firm that installs its own reusable sharps containers and picks them up for reprocessing. Now, sharps containers are changed on a regular basis, regardless of how full they are.

"You never have an overfilled container, which has stopped a lot of injuries," says Marcia Patrick, RN, MSN, CIC, the director of infection prevention and control at MultiCare Health, which operates four hospitals and more than 60 clinics and outpatient surgery centers. The switch from disposable boxes for used sharps doesn't cost much more than MultiCare's old system of buying disposable sharps containers and sending them to the landfill. It has also lessoned the environmental impact from the MultiCare facilities. "In 2006, we kept 35,000 pounds of plastic out of the landfill," says Ms. Patrick.

These days, you have safer options when it comes to infectious waste disposal. You can outsource your sharps and medical waste disposal and use closed-system disposal equipment for fluid waste. In the process, you can save money and reduce the risk of infection from fluids and sharps. You can also keep track of what happens to the waste after it leaves your facility. "I'm responsible [for it]. And I want to be a good neighbor," says Ms. Patrick.

Outsourcing Waste Disposal

As the options for outsourcing your waste disposal increase, so does the need to check with whom you're doing business. Make it a point to visit the plants where your waste is disposed of or reprocessed, says Marcia Patrick, RN, MSN, CIC, the director of infection prevention and control at MultiCare Health in Tacoma, Wash. Keep in mind that a healthcare facility is responsible for what happens to its waste, from the time it's created until it's incinerated or reaches a landfill. Whenever you hire an outside firm to dispose of medical waste, make sure that you have a backup plan. "What if they suddenly go on strike? What if they suddenly go out of business?" says Ms. Patrick. Have a list of other contractors ready. Otherwise, when a crisis arrives you may become overwhelmed in waste and your throughput will grind to a halt.

— Kent Steinriede

Get the red out
Rethinking how you dispose of waste in your facility can save you cash, and fast. Red bag disposal is expensive, as much as four times the cost of standard trash. Most of what goes into red bags doesn't need to be there. Hospitals throw 50 to 70 percent of the trash they generate into the regulated medical waste system, according to Hospitals for a Healthy Environment, a collaboration among the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm and the American Nurses Association. This is a great waste of money. The CDC estimates that only 2 to 3 percent of trash really needs to be in a red bag.

The ubiquitous red bag is not going away, but many facilities are trying to use as few as possible. One way to do this is to cut down on the amount of fluid that goes into red bags. At Christiana Hospital in Newark, Del., fluid generated in the hospital's 20 ORs previously was suctioned into canisters and then solidified for disposal as red bag waste. But at 28 cents a pound for disposal, a red bag wasn't the best place for fluid waste. It's heavy. Water weighs 2.2 lbs. per liter. "It increased the cost of disposal," says Andrea C. Rodriguez, RN, CNOR, manager of Christiana Hospital's surgery center.

So administrators at the center looked into ways of keeping the solidified liquid out of the red bags. They found a solution in a wall mounted pump system that lets an OR staffer empty fluid waste canisters directly into the sewer system. When attached to specially designed canisters, the pump creates a closed system. With a closed system, there's no need to change or empty canisters during a procedure. Sending the fluid waste directly into the sewer eliminated the need for solidifying and red bagging as well as disposing of full canisters. "It's working well," says Ms. Rodriguez.

Closed systems are becoming more popular. About 79 percent of respondents to a November 2007 Outpatient Surgery Magazine survey said they use closed system suction. Some of these systems are mobile and can be moved from one OR to another. The benefit of a closed system is that the employee has less risk of contact with the fluid.

Before you use any disposal system or method that sends fluid waste down the drain and into the sewer, check with your local and state authorities because regulations differ depending on the jurisdiction, says Frederick F. Shaw, RN, director of surgical services at St. Francis Hospital in Wilmington, Del.

Triage for trash
When it comes to solid waste, it's also important to keep track of what goes into the red bags and make sure that everyone knows what goes where. "We keep the red bag trash and the clear bag trash separate," says Mr. Shaw. That means that pizza boxes, gum wrappers and Kleenex shouldn't end up in the red bags. But these are almost no-brainers.

Go deeper. If you think about every process in your center, you can find waste that shouldn't be going into the red bags. Look at the packaging of preps and other surgical supplies, says Ms. Patrick. "Much of it is not red bag material." In the ORs of MultiCare Health's facilities, the red bag trashcans are small kick buckets which, because of their size, discourage people from using them as regular trashcans.

In the emergency department, the MultiCare housekeepers use a double-bag system. The trashcan is lined first with a red bag and then, on the inside, with a clear bag. During clean up, the housekeeper first pulls out just the clear bag. If there's blood in the clear bag, then the housekeeper grabs the red bag surrounding the clear bag. The bag is then disposed of as red bag waste.

Because of environmental concerns, incinerating medical waste is becoming less common. However, incineration is still used for cultures, bedding and pathological waste such as human tissue and body parts. As a result, each year more medical waste is autoclaved and ground until unrecognizable. This is how most waste disposal companies treat medical waste. Autoclaving in-house isn't for most surgery centers because of the cost of the machinery, which begins at $110,000, says Tim Barrett, vice president of engineering at OnSite Surgical Sterilization, a manufacturer of autoclaves for medical waste based in Pottstown, Pa. It takes a 200-bed hospital to break even with an autoclave and 250 beds for it to make real economic sense, says Mr. Barrett.

One Way to Dispose of Expired Drugs

Although drugs aren't infectious waste, you still need to dispose of them properly. Unused drugs shouldn't go down the drain or toilet because trace amounts may end up in lakes and rivers, according to the FDA.

One way to dispose of expired drugs is to work with a reverse distributor. "A reverse distributor periodically takes these no longer-needed medications, sorts them by manufacturer and works with the manufacturer to obtain a credit for the original purchase," says Al Helmeczi ,RPh, MS, FASHP, vice president of pharmacy services at Christiana Care in Newark, Del. "Where something no longer qualifies for a credit, the reverse distributor handles the destruction of the material."

— Kent Steinriede

Attention pays off
These were just a few ways to reduce your infectious waste, lower your disposal costs and create a safer environment for your employees.