Tools for Identifying Materials Management Problems
Evaluating the Current Status of Your Healthcare Facility
Prior to implementing change, you will need to become better informed and raise awareness of the issues by conducting an
evaluation of the current situation. To conduct this evaluation, you will need to be familiar with definitions of hospital waste.
Our glossary can help you become familiar with this terminology. Please be aware, however, that definitions of some of these
wastes can differ from state to state. For example, not all states define Regulated Medical Waste exactly the same way.
Generally, there are two major aspects to examine in auditing a hospital facility: Procurement Practices, and Waste Management Practices.
Proper procurement practices can help to reduce the amount of packaging, find alternative non-toxic products (latex, mercury, PVC), and reduce the use of disposable items.
- Waste Management:
Waste segregation can drastically reduce the volume and toxicity of the waste stream. It is a necessary component
of recycling, and requires some training and education. Waste segregation will reduce the amount of materials
incinerated, since only Pathological Wastes must be disposed of by incineration, according to the Centers for Disease
Control guidelines. Medical products which are made of PVC plastic (#3) should especially be segregated and NOT
incinerated because they can produce dioxin-like substances, which are endocrine disruptors and carcinogens.
The first step may be to form a Hazardous Waste Management Committee to conduct a survey of hospital practices. Discuss how
employees will be informed about the activities of the committee, whether advanced notice of inspection will be given, how you can
gain support and cooperation for your efforts from staff, and to whom the results of the survey will be reported.
Check with your state Department of Environmental Protection, or similar agency, for regulations concerning disposal of medical
wastes. You may need to check with state and Federal OSHA representatives as well, who deal with regulations around worker
safety issues. In addition, your local waste water treatment facility (Publicly Owned Treatment Works, POTW) will have regulations regarding hazardous wastes in the wastewater system.
Evaluate the awareness and knowledge of the hospital staff regarding the hazards of handling various types of waste,
handling of toxic substances, accident and spill training,etc. Find out what the current institutional policies are and the existing regulations regarding waste disposal and handling of hazardous chemicals.
An audit can be as simple as following the flow of trash within various areas of the hospital, looking into trash
containers, finding out where red bag waste is disposed of, and visiting the landfill where the trash hauler takes
non-incineration waste. This is the "quick and dirty" method. Always be aware of your own safety if you decide to
examine waste and trash receptacles. Wear protective equipment. Or, a consultant can be called in for a
formal, more comprehensive assessment. If you do not have the support or resources to conduct a complete facility
audit, you may wish to focus on particularly problematic substances first. For example, you could begin with a mercury audit.
Below are some resources to assist you in this process. In addition, talk
to other facilities that have conducted similar audits or implemented waste management plans, to avoid pitfalls they may have encountered.
- Hospitals for a Healthy Environment (H2E)
- H2E Self-Assessment Guide
This checklist facilitates the collection of baseline data on annual weight and cost of every waste stream leaving the facility, allowing a facility to prioritize actions and document successes.
- Waste Reduction Guide: Cutting Costs & Minimizing Waste From Your Facility
This resource helps waste managers develop an action plan for a facility. Guidance includes: getting started, forming a team; performing a waste assessment; educating and training staff; and communicating policies and procedures for effective program implementation, monitoring, and reporting.
- Kansas State Pollution Prevention Institute
- Minnesota Technical Assistance Program (MnTAP)
- Sample Letter to Hospital Group Purchasing Organization Requesting Less Toxic Products
This focuses on preventing pollution at the procurement stage by asking GPOs to identify mercury- or PVC-containing products sold to the hospital. For each of these products, the GPO is asked whether it offers more environmentally preferable alternatives and seeks the GPO's commitment to foster the use of less toxic products and materials.
- Techniques from An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities, Chapter 4; by
Glenn McRae, Hollie Shaner, and Connie Leach-Bisson; American Society for Healthcare Environmental Services of the American Hospital Association (ASHES)
This tool outlines a multi-step approach for conducting a waste assessment in a strategic and cooperative manner, including educating and enlisting support of participating departments.
- Conducting a Waste Sort
A waste sort is a specialized and comprehensive way to assess what really is in the hospital's trash. Waste sorts show the exact composition of waste from a designated area and can flag weak links in the waste system by revealing unexpected wastes. If a hospital decides to conduct this specialized type of audit, this resource provides guidelines to use.