Inova saves by cut­ting red-bag waste

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKinney

Pizza boxes, flow­ers, wadded-up pa­per, la­tex-glove boxes—those were just some of the items reg­u­larly tossed into the red bags re­served for reg­u­lated med­i­cal waste at Inova Health Sys­tem, head­quar­tered in Falls Church, Va.

“You name it and it ended up in our red bags,” said Seema Wad­hwa, Inova’s di­rec­tor of sus­tain­abil­ity. “And it didn’t need to be there.”

In 2008, as part of a broader ef­fort to im­prove sus­tain­able prac­tices, Inova’s se­nior lead­ers no­ticed the five-hos­pi­tal sys­tem was gen­er­at­ing far more reg­u­lated med­i­cal waste than was ap­pro­pri­ate. Ex­perts say reg­u­lated med­i­cal waste should ac­count for 8% to 10% of a hos­pi­tal’s to­tal waste.

But those per­cent­ages were as high as 38% at some of Inova’s hos­pi­tals. That led Wad­hwa and other sys­tem lead­ers to con­clude that the sys­tem needed a far more ag­gres­sive waste-seg­re­ga­tion and ed­u­ca­tion strat­egy.

Though the def­i­ni­tion of reg­u­lated med­i­cal waste varies slightly from state to state, it usu­ally in­cludes items that are con­tam­i­nated with bod­ily flu­ids and have the po­ten­tial to trans­mit in­fec­tion, such as blood-soaked gowns, tub­ing and drains, gauze and suc­tion can­is­ters.

Be­cause reg­u­lated med­i­cal waste has to be spe­cially treated be­fore it can go to a land­fill—of­ten by au­to­clav­ing—dis­posal costs are at least five to 10 times as much as for reg­u­lar garbage, and the en­ergy bur­den is far greater, Wad­hwa said.

“Hos­pi­tals may not re­al­ize just how many dol­lars go right into the waste stream,” said Janet Howard, di­rec­tor of fa­cil­ity en­gage­ment for Prac­tice Green­health, a Re­ston, Va.-based not­for-profit mem­ber­ship group that pro­motes sus­tain­abil­ity in health­care.

On av­er­age, hos­pi­tals gen­er­ate 32 pounds of waste per bed per day, Howard said. “If you are putting di­a­pers, con­tain­ers and other things into those red bags, you are pay­ing at least five times more and that re­ally adds up over time.”

Be­fore they launched a pro­gram to curb reg­u­lated med­i­cal waste, Wad­hwa and her team con­ducted a sys­temwide au­dit, walk­ing the halls to as­sess whether waste con­tain­ers were in the right places, por­ing over bills and pa­per­work from Inova’s waste haul­ing ven­dors, and ex­am­in­ing the con­tents of waste bags.

Un­der­stand­ing how much of your hos­pi­tal sys­tem’s waste stream is reg­u­lar garbage, how much is hazardous waste, such as mer­cury and formalde­hyde, how much is re­cy­clables and how much is reg­u­lated med­i­cal waste is a cru­cial first step, Howard said. “Talk to your haulers and ask for those num­bers,” she said.

Wad­hwa’s first tar­gets were the op­er­at­ing rooms at 926-bed Inova Fair­fax Hos­pi­tal, Falls Church, which pro­duced nearly 900 pounds of reg­u­lated med­i­cal waste each day. Her strat­egy in­cluded a staff ed­u­ca­tion cam­paign tout­ing the ben­e­fits of proper waste­dis­posal prac­tices, lots of reg­u­lar mea­sure­ment and feed­back, and much smaller waste con­tain­ers to cut down on in­ap­pro­pri­ate use.

Those ef­forts, which later were im­ple­mented across the whole Inova sys­tem, have re­sulted in a re­duc­tion of sev­eral mil­lion pounds of reg­u­lated med­i­cal waste and sav­ings of more than $300,000 to date.

The pro­gram wasn’t with­out its chal­lenges, she said. Staffers were ac­cus­tomed to dis­pos­ing of waste in cer­tain ways and some were wary of changes. For ex­am­ple, staff in the in­ten­sive-care unit ex­pressed con­cern that the new, far smaller reg­u­lated med­i­cal waste con­tain­ers wouldn’t be large enough for their needs. “We had to over­come those bar­ri­ers of per­ceived in­con­ve­nience,” Wad­hwa said.

Now, Inova’s reg­u­lated med­i­cal waste ranges from be­tween 8% and 16% of its to­tal waste.

Howard at­tributes much of the sys­tem’s suc­cess to Inova CEO Knox Sin­gle­ton, who has cham­pi­oned en­vi­ron­men­tally con­scious prac­tices and even co-au­thored a book with Wad­hwa for health­care man­agers on sus­tain­abil­ity.

“Sus­tain­abil­ity has pro­vided an op­por­tu­nity for us to support our mis­sion to im­prove the health of our com­mu­nity,” Sin­gle­ton said. He also said the sys­tem’s ef­forts have helped to en­gage em­ploy­ees and cut costs.

“Any hos­pi­tal can re­al­ize the ben­e­fit of tak­ing a closer look at their waste stream,” Howard said. “What’s spe­cial about Inova is that Knox sees sus­tain­abil­ity as a pri­or­ity and in­vests in it.”

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