Conducting an organized waste sort is a comprehensive way (albeit time-consuming) to get a good look at what really is in the hospital's trash. A waste sort allows the opportunity to take a snapshot of waste procedures over the time that waste is actually collected. Depending on what the facility is trying to determine, different lengths of time for collecting the waste for sorting will be selected. For example, waste from a 12-hour shift in surgical services can be revealing, but a representative sample may not be obtained, given that procedures vary day to day. Getting a handle on waste composition from surgical services and Patient care areas may require a more extensive sampling of trash collected over a longer period of time than, for example, a sort of trash from administrative offices or the cafeteria. (A "cadillac" approach to waste sorts is covered in Chapter 7 in the section titled "MedCycle").
 
Waste sorts leave little room for questions. Before going to the trouble of conducting such an intensive program, it is necessary to determine the type of data needed to advance the program. If the hospital decides to conduct such an audit, following are guidelines to use.
 
 

Tools for a Sort

• Scale
  
• Thick plastic dropcloth sheeting (enough to cover the floor in the room in which the sort will take place and enough to cover the surfaces of tables on which to work)
  
• Duct tape (to tape the plastic to the floor)
  
• A box of unsterile gloves
  
• Tyvek protective suits
  
• Protective eye gear
  
• Tape
  
• Surgical caps
  
• Surgical booties
  
• Paper
  
• Pens/pencils
  
• Camera :
  
• Film (slide)
  
• Flash
  
• Video camera
  
• Videotape
  
• Many assorted-size corrugated boxes
  
• Large plastic trash bags
  
• Markers
  
• Trash gondolas
  
• Radio(to help pass the time)
  
• Tables
  
• Red bag waste collection containers (just in case)
  
• Sharps container (just in case)
  
• Extra boxes (for items that may be recovered from the waste, such as accidentally discarded instruments)
  

 
 

Procedure

 
A. Obtain permission.
Consult with the staff who collect the trash and gain whatever administrative approval is needed. In order not to bias the sample, it may be preferable not to inform the department that is producing the trash to be sorted.
 
B. Secure an adequate amount of space to conduct the sort.
This is determined In part try the amount of waste to be sorted. It may be preferable to sort waste from discrete areas (department by department) for a defined period of time on an "average" day to obtain baseline data. Uncarpeted conference rooms, if properly prepared with protective plastic liners, can serve as good sorting space, because these rooms tend to have good lighting, are often away from patient care areas, and are large enough to spread out. The room should have windows in case extra ventilation is needed. Check with the hospital for the most appropriate space it can offer. Good waste-sorts are time-consuming. It can get uncomfortable being suited up in protective gear, so a comfortable room to sort in is important.
 
C. Make arrangements with housekeeping or enviromnental services to help clean up the room after the sort is complete.
Careful preparation of the room prior to the sort will minimize the clean-up needed after the sort.
 
D. Select the team.
A waste sort is an eye-opening experience. Recruit staff to assist in this effort. A team of four or five people is a good number to begin with. Team assignments are a good way to maximize use of the team. Roles of team members include:

• Sorters:
  Three to four people to hand-sort the waste piece by piece. Sorters need to be aware of the potential risks associated with sorting waste. It is especially helpful to have nurses assist in this process, if waste from a patient care or medical area is being sorted because they are most familiar with many of the products and packaging in the waste stream. A physician also may be a valuable team player.
   
  
• Data Recorders:
  One to two people to be assigned to assist the waste sorters recording data, either written or photographically, or both. Recording descriptive written data includes noting comments about findings as well as weights of the various components in the sort.
  

E. A presort session on sorting techniques is important to minimize the risk of anyone getting hurt.

• All sorters must wear personal protective gear.
• Ground rules should be set about methodology. For example, all bags should be dumped on a table and sorted from there, or sorters should look before touching anything.
• Sorted wastes should be placed in labeled bags or boxes. As the bags fill they should be sealed and weighed. Data recorders should record weight and any comments about the materials. A new liner should be placed in the empty box and sorting resumed. A sorted, weighed bag of waste should be placed in a gondola for disposal. Any unusual findings or waste that should have been discarded in another place ought to be recorded on either videotape or a slide picture.

F. Setting up for the sort.
Sorting categories should be determined. As the room is prepared, cardboard boxes should be placed around the perimeter of the room and lined with large plastic bags. Large signs should be taped to each box labeling what is being collected. Some boxes should be left unlabeled so that categories can be made up as necessary. Suggested starter categories include:

• White paper-computer paper, office paper and possibly colored paper
• Glass (clear, colored)
• Cans (metal and aluminum)
• Newspaper
• Plastics (containers, stretch wrap, packaging, basins)
• Boxboard (cereal box-type packaging, often in white or grey)
• IV bags/outer wraps
• Gloves
• Magazines
• Food wastes (paper cups, napkins, foam cups, straws)
• Rigid plastic packaging

G. Ready, Set, Go!
Once you are thoroughly prepared and the waste has been collected, sorting can begin. Take time initially ask questions as sorting begins. Sorters should talk among themselves to standardize sorting practices.
 
Any unexpected findings should be recorded, especially the presence of sharps, saturated bloody wastes, instruments, unused medical/surgical supplies, or other items. It is useful to review the unusual findings of your waste sort with the person responsible for infectious waste at your facility. If you find any discarded instruments, collect and return them to the unit you obtained the waste from. Feedback of this type is not commonplace. Informing staff of wasteful habits may be enough to change behavior. During one waste sort the authors participated in, several very expensive surgical instruments were recovered. This alerted staff to the fact that they were inadvertently disposing of a reusable product. This mistake is an easy one to make given that there is an ever growing volume of disposable products.
 
H. Clean up.
Upon completion of your waste audit clean up the area by bagging all the waste you sorted and placing it into gondolas. If you are doing a large sort, you may want to involve housekeeping or environmental services to be on the alert, and retrieve the wastes as you fill the gondolas. If you discover any waste that should have been in the red bag waste system, dispose of those materials properly.
 
 

Data Collection

 
Numbers

• The number of bags of waste to sort should be recorded. The weight of each bag should be recorded prior to sorting.
   
  
• The weight of each filled bag of sorted waste should be recorded and its contents (for example, paper) documented.
   
  
• The number of bags received to sort should be totaled.
   
  
• The total weight of all bags received to sort should be totaled.
  

 
Documentation
It is helpful to videotape the sort for future reference. It is also helpful to take slides or photographs of the process of sorting and any unusual findings. Photographs may be useful as well, however, by using slides, you will be able to create slide shows to show others what you found.
 
 

Sorting Out the Sort:  What did you find and what does it mean

 
Waste sorts provide some very interesting data. By playing with the numbers, one can determine what percent of waste from a designated area is composed of what types of material. One can also discover any weak links in the hospital's current waste system by any unexpected wastes found. Some materials are more predominate in the waste stream than others. It may be useful to ask questions about why that waste is present in such abundance and what could be done to reduce it.
 
Example: A waste sort from the cafeteria reveals that most of the waste is foam or paper plates and cups. Such a sort may prompt an enquiry into the value of using reusable dishware.
 
Example: A waste sort of the shipping and receiving department reveals that most of the waste generated is either corrugated cardboard, stretch wrap, foam peanuts or white paper. This finding would be good news, because nearly the entire waste stream consists of recyclable materials.
 
Example: A waste sort of the pharmacy reveals that most of its waste stream is clear glass, corrugated cardboard, white paper, and #2 plastic bottles. A recycling program in this area will have to accommodate diverse and heavy materials.
 
Waste sorts are discovery tools to help assist the hospital in learning the composition of its particular waste stream.