Lerch Bates Inc. Building Insight

Global Leaders in Technical Consulting for the Building Industry

Cost Reductions through Proper Waste Management

Waste Management in healthcare facilites is gaining importance but is still often overlooked.    Proper waste management helps reduce operational costs, reduce a facility’s carbon foot print and increase its social responsibility to the local community.   The primary purpose of Waste Management operations within healthcare facilities is for the safe collection, segregation, staging, transportation and processing of the waste streams generated within the building.

Hospital waste is defined as the total waste stream generated from a healthcare facility.  Most hospital waste (75% – 90%) is similar to domestic waste. This includes paper, plastic packaging, cans, glass, etc….that haven’t been in contact with patients.  A smaller portion (10%-25%) is infectious waste that requires special treatment. This smaller fraction of waste is the one that poses the greatest risks to human health and environment.

The following is a breakdown of waste streams found in Hospitals and Medical Centers:

General Waste is waste that does not require any special processing. General waste commodities include:

  • Paper Products
  • Plastics
  • Cardboard
  • Food Products

Regulated Medical Waste (RMW) is generated in the diagnosis, treatment or immunization of humans.  Also referred to as Biomedical or Red Bag Waste; RMW is broken down into four (4) different subcategories.  They are:

  • Human Pathological Waste:  This waste includes tissue, organs, body fluids that are removed during surgery, autopsy or other medical procedure, specimens of body fluids and their containers, and discarded material saturated with body fluids other than urine.
  • Human Body and Blood Products:  This waste includes discarded human blood waste, discarded blood components, containers with free flowing blood or blood components, discarded saturated material containig free flowing blood or blood products.
  • Sharps:  This waste includes, but not limited to, the discrd of used sharps in human patient care, medical research, laboratories, clinical or pharmaceutical operations.  Hypodermic, intravenious, or othe rmedical needles, hypodermic or intravenous syringes to whick a needle or other sharp is still attached.
  • Cultures and Stocks:  This waste includes the culture and stock of agents infectious to humans, and associated biologicals, cultures from medical and pathological laboratories.

Hazardous Waste consists of discrded chemicals (solid, liquid or gaseous) that are generated during disinfecting procedures or cleaning processes. They may be hazardous (toxic, flammible, corrosive…) and must be used and disposed of according to the specification formulated on each container.

Recyclable Waste are those items that can be reprocessed and be reused again.  Categories of recyclable hospital waste include:

  • Paper
  • Plastic
  • Aluminum Cans
  • Glass
  • Cardboard
  • Green (Grass, landscape clippings and organic food waste)

Confidental Waste is are those items covered by the Health Insurance Portability and Accountability (HIPPA) of 1996. Items included are patient confidental information.

Radioactive Waste includes liquids, gas and solids that are contaminated with radioactive material.

Pharmacuetical Waste includes expired, unused or contaminated pharmaceutical products, drugs and vaccines.  Included in this category are discrded items used in the handling of pharmaceuticals like bottles, vials and connecting tubing.

Proper segregation will lessen the chances that waste streams have wrong waste types within them. An example is when general waste is put into the RMW waste stream.  (This occurs when all waste is removed from an operating room after a surgical proceedure and put into red bags.  Instrument and supply wrappers should be removed before the proceedure and put into a general waste  container.) RMW processing costs are higher than the processing costs for general waste.

Therefore, proper waste segregation will help a facility reduce overall waste processing costs.  Proper segregation begins with identifying the different waste types and streams within your facility.  The next step is to create a Waste Management Center that stages and/or processes your different waste types. Done in accordance with industry recognized processes and standards, a proper system will undoubtedly lead to overall reduced costs.

The Logistics Labyrinth

I love puzzles. Especially the maze type puzzles. You know the ones that have endless branches and pathways that lead you into dead ends. I seem to have a natural instinct to visualize the correct path from the start all the way to the finish line. The greater the complexity of the maze, then better the personal challenge.

I felt this way until I visited a client who had a hospital nearing the century mark in age. Like a multi-tentacle monster, the hospital had grown from a central building into a large, multiple armed (building) complex. Trying to insure good horizontal circulation, the owner had linked all buildings with tunnels, sky bridges, covered walkways, connecting corridors or a combination of all of the above.

Hospital expansions had been opportunistic over the years. Meaning; if the hospital had money, then they could find someone to build onto the existing structure. Expansions are typically dictated by the following criteria:

  • Available Funding
  • Available Property
  • Plot Size
  • Building Code Constraints
  • Profitability (operations within the proposed expansion)

Back to my story:

In most hospitals, my client, the Director of Facilities, resides in the back of the hospital on either the ground or basement floor.  I decided to park in the back of the hospital to shorten my walking distance. After entering the facility I found that I was in the wrong building. No big deal!  All I had to do is to follow the horizontal linkages going back to the main hospital. After about fifteen minutes I thought that it probably would have helped if the facility had invested into some better campus wide way finding. But I didn’t care, I love mazes.

After meandering around the campus for another twenty minutes I decided to look for the cafeteria to pick up some bread slices and water.  (I could leave bread crumbs along the way in case I got lost again. The water was to insure that I would not get dehydrated during my long arduous journey). It wasn’t quite that bad, but I did miss my scheduled appointment. I finally cried uncle and call my client asking for some friendly assistance. I gave him my coordinates and within minutes he was escorting me back to his office.

We finally got down to business and the topic was of no surprise. The opportunistic expansion of the hospital over the years had exceeded the capability of the original hospital infrastructures. (Elevator capacity, support services capacities, etc.).  Elevator wait times could be as long as five minutes.  In addition, everything that had to move (food, supplies, linen, waste, pharmaceuticals, etc.) followed long scurrilous routes through the campus. Transport labor costs were high and kept increasing.  All of this while employee and patient satisfaction kept declining.  He asked “What could be done to help alleviate this problem?” This is not an unusual issue faced by long established and successful hospitals.

The answer was simple. The hospital needed a “Master Transport and Circulation” study. This study examines everything that has to move within the hospital and the existing systems assisting in their movement. The study identifies if the needs of the hospital were being met.  In the case of this facility the answer was a resounding “No”. However, once the deficiencies are identified, then a range of solutions can be identified. The range of solutions can include:

  • System / equipment modernization
  • System / equipment additions
  • Changes in operational schedule and hours
  • Architectural alterations
  • A combination of any and all of the above

The most important advice I can give is:

An owner should understand how a proposed expansion will impact the functions of the existing facility.  These issues need to be resolved before the expansion is built and not left until someone complains.  Not everyone loves a puzzle.