You could be throwing away thousands of dollars in waste-disposal costs if you don't follow these five simple steps.

Renegotiate with your disposal company.
If you're at a new surgery center, you may have to agree to pay a higher price until you can establish facility trends, including how many cases you're doing and how many pounds of waste you're going to be disposing of each month, says Diana Procuniar, RN, BA, CNOR, director of the Winter Haven ASC in Winter Haven, Fla. "Agree to the higher rate for the first three to six months, but with the condition that after that time the data will be reviewed, and a new price will be negotiated," says Ms. Procuniar. "After renegotiating with our company, we were able to get our costs down to 29' per pound."

Another negotiating tactic: Agree to purchase your waste bags and boxes from your disposal company. "By purchasing your disposables from the company, you should be able to negotiate better pricing," says Ms. Procuniar. And don't forget to work into the contract such extra benefits as in-service training to educate your staff on red bag waste.

Take a second look at your facility's red bag waste policy.

"Our nurses were trained in the hospital to throw anything that touched the patient into red bag waste," says Deb Leib, CASC, the administrator at the Susquehanna Valley Surgery Center in Harrisburg, Pa. "We were spending around $5,400 in red bag costs a month and were disposing around 200 containers a month."

Ms. Leib checked with the Occupational Safety and Health Administration (OSHA) to find out exactly what constitutes red bag waste. You might be surprised at what she discovered:

• contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed;
• items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling;
• contaminated sharps; and
• pathological and microbiological wastes containing blood or other potentially infectious materials.

The center held an in-service to reprogram the staff on the new policy. After the in-service, nurse managers monitored what staff was throwing into the red bag containers and corrected transgressors on the spot.

"It took almost five months to get the staff completely switched over to our new policy," says Ms. Leib. "Now we're throwing away around 13 containers a month and spending only $350."

Flush fluids.
Switching from suction canisters to a liquid waste disposal system to collect, transport and dispose of fluid waste has saved Mountain Empire Surgery Center in Johnson City, Tenn., more than $100,000 a year in disposal costs alone, says administrator Ouida Klock, MSN, RN, CNOR. When Mountain Empire opened in April 2000, the center used suction canisters to collect and transport patient fluids.

"Being a new facility without much negotiating power," says Ms. Klock, "we were paying more than a dollar a pound to dispose of red bag waste." With 60 percent of the center's cases involving scopes, Ms. Klock determined that Mountain Empire was pouring nearly $100,000 a year into fluid management expenses, including labor, supplies and disposal. Even if she paid a more reasonable 50' per pound in disposal costs, she estimated the surgery center would still be paying almost $60,000 a year.

With this in mind, the center invested in a liquid waste-disposal system that would let her dispose of the fluids directly in to the sanitary sewer system. Although the initial investment is significant (many start above $20,000), these systems handle patient fluids from collection to disposal. Most units connect to your plumbing and release the collected fluids at a closed disposal station into the sewer system. Some systems also treat the fluid with either bleach or enzymatic solution, breaking down fatty components in the waste, before flushing it away (see "Liquid Waste Disposal Systems" on page 38).

Scan your waste.
Products like the MedDetect MD-2000 Instrument Detection System could help you prevent unintentional disposal of instruments, which can not only increase the cost of your red bag waste but also cost you to replace them, according to Nelson "Sig" Slavic, PhD, of Environmental Health Management Systems in Niles, Mich. "The MD-2000 is designed to detect and retrieve surgical instruments from waste and soiled linen bags," says Mr. Slavic.

Using electro-magnetic technology, the MD-2000 detects instruments by scanning bags that are either walked or waved between two parallel detection panels. When an audible and visual alarm is sounded, the targeted instrument is safely located and retrieved by using MedDetect's Magnetic Retrieval Probe. Optional features such as MedDetect's Modular Mobile Platform and EZ Glide Bag Scanner provides unlimited system mobility and hands-off scanning of waste and linen bags. The Company's MD Superfabric and VR Disposable Cover Gloves provide additional puncture and biohazard resistance during waste bag searches for lost instruments.

Remind your staff, again and again and again.
"Revisit the issue of red bag waste yearly," says Ms. Procuniar. "Post large signs on your red bag containers to deter staff from disposing of paper and plastic items after a case."

Pay less for disposal
The cost to dispose of regulated medical waste can start around 20' to 30' per pound for large hospitals and up to $1 a pound for smaller centers, with some facilities spending up to $100,000 a year on red bag disposal costs. Certainly you can think of better things to spend your money on than biohazardous waste.