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Sunday, January 11 2015
10 Steps For Regulated Waste Reduction In Maryland

10 Steps to Implementing a Regulated Medical Waste Reduction Plan

Courtesy Greenhealth Magazine

Because Regulated Medical Waste (RMW) or red bag waste can cost five to eight times more than solid waste to dispose, hospitals can save significant amounts of money by improving their waste segregation.

While the primary objective of RMW management is to minimize the risk of disease transmission, every facility has an opportunity to reduce both risk and cost through improved collection and segregation of RMW. Practice Greenhealth’s 2009 Partner for Change Award winning hospitals generated an average of 8% RMW of their total waste stream (with a median of 7%). This article will show you how to calculate and reduce your RMW waste stream. In addition to guidance from the Green Guide for Health Care ( Version 2.2 Operations Section, Practice Greenhealth recommends the following ten-step process to implement a RMW Reduction Plan.

Step 1: Develop/Review Your Facility’s Definition of Regulated Medical Waste

Keep in mind that RMW is defined by each state but hospitals also must be in compliance with federal OSHA regulations. Once you have gathered your facility and State information defining RMW in your region, work with infection control to review your facility’s policies and procedures. For further information, check out Practice Greenhealth’s RMW Resource Locator Tool at:

Step 2: Define the Problem and Develop a Cost/Benefit Analysis

There are several steps necessary to define the current state of your RMW program. Collecting the following pieces of data is critical to developing an accurate baseline needed to document improved segregation, reduction of red bag waste and associated cost savings.

Step 3: Create a Team, Set Goals, and Develop an Action Plan

With a good understanding of the amount of RMW your facility generates and the total cost of disposal, you are ready to develop your reduction program’s goals and action plan. It is critical that a multi-disciplinary team be established and staff educated thoroughly. If you already have a Green Team, this would be a good project for the team. If not, create a diverse team that includes representatives from Environmental Services, Infection Control, Nursing, Safety, Facilities, Employee Education, Employee Health, Laboratory, and clinicians— particularly those from the OR, ED and critical care areas. Highlight management commitment to the effort. (See Practice Greenhealth’s “Guide to Creating Effective Green Team’s” at: Delegate a leader and review the processes and departments that are generating the most RMW and target them first for education and reduction.

Step 4: Make Waste Segregation Simple

Provide the proper tools for employees to easily implement waste segregation. First, work with department heads and nurse managers in each area to determine the types and volumes of wastes generated. This will help you determine their container, placement and training needs. Work with Communications to develop educational information including posters, receptacle labels, newsletters and employee training.

Step 5: Determine Optimal Container Placement and Use Good Signage

Rule number one-make it easy to do it right! Proper container size, placement and signage are critical to the success of any waste segregation program. For greatest success:

  • Red bag containers should be as small as possible for a given area and covered to reduce solid waste that is casually tossed in.
  • Always place a larger, solid waste container beside the regulated waste container.
  • Signage should be clearly posted above and directly on the lid of the receptacle. Use a large font, color and bullet type format, so they are easy to read and understand at a glance. Keep the signage consistent.
  • All RMW containers should display the biohazard label.
  • Remove red bags from underneath sinks, in hallways, restrooms, non-critical care patient rooms and other areas where people are likely to dispose of their solid waste in RMW containers.
  • Size the container for the appropriate amount of waste generated. The smaller the container, the less likely clinicians will be to throw extraneous items into it. Small, eight gallon containers with step-on lids work well.
  • Ensure solid waste receptacles are emptied in a timely manner so that overfilled cans don’t result in improper use of the red bag.
  • Use multiple languages if necessary for optimal communication.
  • For high use area, consider wheeled receptacles or one waste station per several beds.

Step 6: Train, Educate, Repeat 

Training is a critical component in an RMW reduction program. Staff requires clear, consistent information to understand the reasons for proper segregation: regulations, health and safety impacts, cost implications, and environmental leadership.

  • RMW training must be part of new employee orientation.
  • Re-train current staff on the newly agreed upon definition of RMW.
  • Work with your executive team to hold department heads accountable for their RMW generation and associated disposal costs. You must include the OR, which typically generates the most RMW in the entire hospital.
  • Develop incentives or competitions to get people involved.
  • Monitor work areas regularly and consider tracking generation rates.
  • Continue with training on a regular basis, including spot checks, monitoring, reporting, and ongoing training.

Step 7: Review Your Specialty RMW Streams

Sharps Management – Sharps, including needles and scalpel blades, are singled out for special regulatory provisions by many states. Does your facility have a history of problems with needle sticks or sharps injuries due to improper waste handling? The Center for Disease Control estimates that over 800,000 accidental needle sticks occur each year among healthcare workers.

Are you using disposable sharps containers? Reusable sharps containers are normally emptied and returned by a vendor at about 2/3 full, so they can reduce needle sticks. Typically this program saves money, reduces worker exposure and handling, and can significantly improve environmental impacts.

  • Train staff on the proper use and disposal of sharps, including the imperative to dispose of sharps in the right container.
  • Safety is the priority. Assess opportunities to maximize container use by optimizing their size and placement.
  • Consider a reusable sharps container program.

Single Use Device Reprocessing – Reprocessing reduces both the purchase and disposal costs of single use devices (SUDs). Instead of treating these items as disposables, they are cleaned and reassembled for reuse. Many hospitals have started this type of service for just a few types of equipment, but quickly grow the list when they see the savings roll in. The biggest savings come from not having to purchase new equipment, and some health systems are saving millions!

Liquid Waste - Managing fluids in the OR – Liquid medical wastes such as suction canisters present another unique disposal question. Suction canisters can be responsible for up to 40 percent of infectious waste in the OR (see If you are adding solidifiers, then disposing of it in red bags, you are adding additional chemicals into the mix and could be exposing employees to splashing and spills.

There are now several technologies available to manage fluids in the OR; these systems empty liquid contents of suction canisters directly into the sanitary sewer, reducing transportation and disposal costs and removing canisters from the waste stream. Canister-free vacuum systems are also available. Work with your local POTW and state regulatory officials to determine your best disposal options.

“Trace” Chemotherapy Waste – Ensure trace chemotherapy waste is NOT disposed of in red bag waste containers, as these are often autoclaved or microwaved, potentially exposing waste management employees.

Step 8: Be Ready to Identify and Solve Problems

Even after program implementation and staff training, facilities may still encounter resistance to change and proper segregation.

  • Develop a good working relationship with anyone handling your organization’s waste."
  • Develop a written protocol for any segregation issues with waste treatment facilities and landfill operators to have a clear protocol for reporting out on any problems. A response plan is critical, in the event of a contamination or other infraction.
  • Develop a monitoring form, ongoing rounds and a mechanism to report concerns and appropriate solutions swiftly back to staff.

Step 9: Consider All Your Waste Treatment and Hauling Options

RMW must be “disinfected” before it can be disposed of, meaning that the waste must be treated to destroy or kill infectious micro organisms with a potential to cause disease. Requirements and acceptable treatment methods vary from state to state. RMW treatment technologies rely on two basic approaches to sterilization, excessive heat or chemical agents. Weigh your options and choose wisely.

Step 10: Track Your Progress, Report Successes, and Reward Staff!

A successful, sustainable program needs a strong leader, good tracking and reporting, and sustained vigilance. To realize full benefits:

  • Track the positive changes in your waste volumes and celebrate these reductions and cost-savings.
  • Reward staff for their efforts!
  • Let the community know about your successes.
  • Inform hospital administrators about any cost-savings.
  • Write a case study of the project’s results to use in your newsletter and as a performance improvement indicator for the Joint Commission.
  • Apply for an Environmental Excellence Award with Practice Greenhealth and get recognition for your hard work
Posted by: AT 10:09 am   |  Permalink   |  Email
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