NECSC-Waste Reduction in Hospitals

First Do No Harm Hospital vs.. Environment Noe Copley-Woods, MD Assistant Professor Department of Obstetrics and Gynecology University of Pittsburgh School of Medicine

Magee Women’s Hospital • • • • • •

10,000 babies born per year 30,000,000kWh electricity 166,000 decatherms of gas 161,500,000 ft2 space 494 tons of Red Bag Waste/yr 927 tons of Municipal Waste/yr

#7 US News Report Best Gynecology Hospitals • NICU DEHP and PVC free • Mercury Free Hospital • Environmental Education Classes for expectant parents • green roof, edible gardens used in hospital food, non-toxic cleaning products, environmentally preferred purchasing

My Job As An ObGyn

Laparoscopic Assisted Vaginal Hysterectomy

Dilation and Curettage

Magee Waste Comparison by Weight (lbs)- August 2009 EWS 2280 lbs.

1.2%

CDD 13700 lbs.

4.9%

Hazardous Waste 3245 lbs.

1.1%

RMW 46843 lbs.

16.9 %

RMW Chemo/Path 21861 lbs.

7.9% MSW 164500 lbs.

59.5% Recycle 23800 lbs 8.6%

Red Bag Waste (Regulated Medical Waste) • Regulated by individual states and OSHA • Defined as medical waste capable of producing an infectious disease.

• Sharps • Cultures/stocks • Blood and blood products • Isolation Waste – (from patients with a known communicable disease)

• Dialysis unit waste

PVC (polyvinyl chloride) 1/4 of disposable medical devices are made of PVC Dioxin released in production and incineration of PVC.

Dioxin 2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) Class I Carcinogen (WHO)

• • The primary toxic component of Agent Orange • Unintentional bi-product of many industrial processes (pesticide manufacturing, pulp and paper bleaching, burn barrels, PVC) • 2 largest sources include garbage and medical waste incinerators.

• Lipophilic and accumulates in fat.

Incinerator Emissions • Dioxin • Acid Gases (hydrochloric acid) • Particulates • heavy metals – Lead, cadmium, mercury

Hazardous Wastes Commonly Found in Hospitals

• Chemotherapy and antineoplastic chemicals • Formaldehyde (Hazardous waste incinerator) • Radio nuclides (allowed to decay and then sent to landfill)

• Solvents • Mercury (reclamation) • Waste anesthetic gases • Cleaning and Maintenance chemicals

Environmental Measures at Fletcher Allen Healthcare

Louis Dinneen Director of Facilities Management Fletcher Allen Healthcare

Toxicity Reduction Daily Use Chemicals Green

Non-Green

Total

2005

0

11

11

2006

1

10

11

2007

4

3

7

2008

5

2

7

2009

5

1

6

Benefits • • • •

Building occupant sensitivity Improved indoor air quality Reduced packaging Fewer Chemicals

Let’s Talk Trash…

The Hierarchy of Waste Stream Stream

Impact

Infectious Waste Trash

Recycling Composting

Reuse By moving the material down the hierarchy we reduce the environmental impact.

Trash to Compost 2007

Compost

2008

Compost

2009

Compost

Increase Recycling Waste Stream Volume 100% 90%

Percentage of Total

80% 70%

65%

58%

60%

57% Solid Waste

50%

Recycling

40%

31%

29% 30%

746 Tons

2008

1400 Tons

2007

710 Tons

0%

1445 Tons

332 Tons

10%

1506 Tons

20%

22%

2009

Energy Conservation $ $

$

$ $

$

Energy Reduction Measures Measure

Electric Consumption (kWh)

Gas Consumption (MMBtu)

Carbon Footprint (Tons)

Capital Project Lighting, Insulation, HVAC, Chilled Water (2007-8)

2,380,000

6,355

1,738

Turned off Transformers (2009)

1,200,000

N/A

492

AHU Re-commissioning (2009)

920,000

In Progress

377

Total Reduction

4,500,000

6,355

2,607

Historical Energy Usage Annual Electrical Consumption and Carbon Footprint

42000000

17000 16500

40000000 16000

39000000 38000000

15500

37000000

15000

36000000 14500

35000000 34000000

14000 2005

2006

2007

2008

2009

Metric Tons of C02

Electric Consumption (kWh)

41000000

QUESTIONS

Sustainability & Waste Management at University Hospitals

John Leigh

Healthcare’s Footprint • 24/7 Operations • 3 million tons of waste per year and growing - increase in disposables, packaging, chemicals • Hospitals are the second most energy-intensive commercial buildings in the U.S. • Medical waste incinerators have been a major source of dioxin emissions

Why are hospitals more focused on greening their operations?

• • • • • • •

Public Health Benefits Cost Savings Reg. Compliance/Liability Indoor Air Quality Community Pressure Healing Environments Recognition of Our Large Environmental Footprint • Mission & Ethic • Precautionary Principle

4

Could these trends be connected? ↑ Rise in chemical production & prevalence of chemicals in the products we use ↑ Rise in our toxic chemical body burden ↑ Rise in the incidence of cancer, asthma, diabetes, autism...

“Overall...the health effects of a rapidly changing climate are likely to be overwhelmingly negative.”

– World Health Organization

• Weather extremes • Sea level rise • Ecosystem changes • Floods • Droughts

HEAT SEVERE WEATHER AIR POLLUTION ALLERGIES VECTOR-BORNE DISEASES WATER-BORNE DISEASES WATER & FOOD SUPPLY ENVIRONMENTAL REFUGEES MENTAL HEALTH

    

Heat stress, cardiovascular failure Injuries, fatalities Asthma, cardiovascular disease Respiratory allergies, poison ivy Malaria, dengue, hantavirus, encephalitis, Rift Valley fever  Cholera, cryptosporidiosis, campylobacter, leptospirosis  Malnutrition, diarrhea, harmful

algal blooms  Forced migration, civil conflict  Anxiety, post-traumatic stress,

depression, despair

Ecological Overshoot: We’re drawing down natural capital

Source: The Ecological Footprint Atlas 2008. Oakland: Global Footprint Network.

DHMC’s Ecological Footprint Total Ecological Footprint

MTCO2e

TOTAL Products Energy Waste Transportation Food Water Built Land

190,288 85,346 44,085 498 46,885 12,095 332 1,047

Global Acres 75,096 29,949 15,470 175 24,679 4,329 119 375

% 100% 40% 21% 0.2% 33% 6% 0.2% 0.5%

Acres

80,000 70,000

Products

60,000

Energy

50,000

Waste

40,000

Transportation

30,000

Food

20,000

Water

10,000

Built Land

-

More than 1,000 times our physical footprint of 70 acres

Here’s a Popular Place to Start But excelling in hospital waste management involves a lot more than beverage container recycling

A Hospital’s Many Waste Streams

2009 ASHES Annual Conference

DHMC Waste Streams By Percentage, 2008 Hazardous, 1% Sharps, 1.5% Infectious, 8.4%

Recycling, 35%

Trace Chemotherapy & Anatomical Pathology, 0.9%

Ordinary Trash, 53%

Hospitals Should Strive to Measure All of Their Waste Streams Annually, By Weight DHMC Tons of Waste Generated, '08

2000 1500 1000 500 0

Trash 1531 Recycling 1020 Tan Bag 243

Sharps 43

Haz. 30

Red Bag 25

What One Can Do With Waste Data • • • • •

Track changes (generation, costs, composition) Generate ideas, prioritize actions Measure progress, see what needs attention Win environmental leadership awards Better manage your: – Haulers – Processors – Equipment – Budget

Whom I Gather Waste Data From • Vendors (a dozen or so) • Other departments (Pathology, Engineering, Med School, Safety, Radiology, Inventory & Logistics) • My staff (Excel spreadsheets)

2009 ASHES Annual Conference

Volume Reduction Programs • Single-Use Device reprocessing • Reusable sharps containers

• Red bag waste minimization • Fluid management systems • Donations of surplus supplies • Office supply reuse center • Online waste exchange (esp. good for furniture & office equipment) • Waste prevention education and Environmentally Preferable Purchasing

Hospital A Environmental Stewardship Structure Education and Communication Environmentally Preferable Purchasing Waste Management and Reduction Mercury Elimination Energy, Water and Climate Environmental Services Food Services Sustainable Sites Management Transportation Operations Chemical Management

Poor

Performance / Maturity Fair Good Excellent

Hospital B Environmental Stewardship Structure Education and Communication Environmentally Preferable Purchasing Waste Management and Reduction Mercury Elimination Energy, Water and Climate Environmental Services Food Services Sustainable Sites Management Transportation Operations Chemical Management

Poor

Performance / Maturity Fair Good Excellent