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Release
Date: 2000,
February |
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| Why Have an Outside Company Handle Hospital Waste?
--- Infection Control Today |
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| By Stephen Walsh |
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Waste Management no longer means just trash hauling. There is a new breed of professionals in healthcare helping hospitals manage their waste. Names for these companies include Environmental Service Providers, Red Bag Consultants, and Waste Management Professionals. The medical waste haulers' old pitch of, "we will give you a better price per pound on your medical waste" is falling on deaf ears as many hospitals recognize the need for lower cost, not just lower price. Department heads are demanding a raft of value-added services to help them control costs and maintain compliance.
The New York Presbyterian Hospital's (NYPH) Weill Cornell Campus outsourced its waste management program in August 1999. The outside contractor that came in provided everything they needed--system planning, the necessary in-servicing, and professional support materials like posters, pens, and Post-it notes. The give-away items are effective, and since a hospital's budget usually does not allow for such items, having an outside company supply them is useful. Over the first year, the NYPH reduced 65% of their medical waste, and in December 2000 earned the EPA's Environmental Performance Track Award as recognition for their work in reduction of mercury, ozone-depleting chemicals, regulated medical waste (RMW), and solid waste.
For many hospitals, going with an outside company is difficult because there may be the impression that perhaps they could be doing this work on their own. In the end, a hospital's and waste management company's ability to focus exclusively on their core activities gets results. As a part of the offering, some outside contractors will provide specialized technology to the hospitals. For instance, Walsh Integrated Environmental Systems, Inc. developed the Waste Tracker System™ that uses handheld computers to take a picture of the red bag waste in the department and then e-mail it to that department head. There is no arguing with a photo. However, the core of the solution is old fashioned training and in-servicing. Using an outside contractor means that in-servicing will be getting done on schedule.
In 1981, The Medical Waste Tracking Act was passed, effectively creating the red bag waste industry as we know it today. Since that time, the volume of medical waste has grown and legislation has changed. Of the $1 billion spent annually on the disposal of medical waste, about 33% of that is actually necessary. "It is common knowledge in this industry that perhaps as much as 67% of all medical waste is actually general trash. We have put legislation in place to protect the environment and the general public, but many hospitals overreact," says Diane Buxbaum, Environmental Scientist, US EPA, Region 2. This overreaction is certainly unintentional, and given hospitals' desire to cut costs, it is something that is being corrected.
Given the growing complexity of legal, health, and operational issues, hospitals are increasingly relying on outside professionals to help them get and stay organized. "Since we introduced the Memorandum of Understanding with the American Hospital Association in July 1999, we have seen a significant increase in hospitals requesting assistance in developing and implementing integrated recycling and waste reduction plans," says Buxbaum. "Outside professionals are providing important services in helping hospitals meet their goals."
Hospitals with their own incinerators are also looking to outsource the management of their waste as they see increasing costs and compliance issues on the horizon. The old attitude of "throw it in the incinerator, it is easy and practically free" doesn't cut it today. With incinerator compliance upgrades in the $100,000 to $500,000 range and a Supreme Court decision to enforce the letter of the law, many hospitals are looking to reduce their red bag waste and eventually shut down their own incinerators.
As the field is increasingly complex, and the risk and cost of non-compliance increases, outsourced management contracts are becoming a more attractive option. Like many professions today, keeping abreast of the industry requires an understanding of regulations, costs, people issues, and the latest available technology. The values that Healthcare Waste Management Professionals can bring to the table are focus, expertise, and cutting-edge technology.
Focus
Many directors of Environmental Services (ES) or Housekeeping know more about hospital waste management than an outsider ever will. Unfortunately, staffing in virtually every hospital is being cut on an ongoing basis and these directors are expected to do more with less. Because the management of waste is essentially a people management issue, it is time consuming and repetitive. One's ability to succeed depends on the time and focus that can be put on the waste management issues and an outsider can provide that ability to focus.
Expertise
Optimal waste management is, at best, a moving target. A waste management partner will display a detailed knowledge of applicable regulations and guidelines, such as EPA, JCAHO, and OSHA. More than that, they must be up to date, and able to apply them in everyday use.
Usually Environmental Services (ES) or Housekeeping are responsible for spearheading the waste management initiatives. Managing waste requires the effective management of the people who produce the waste, not just those who handle it. Managing these people is centered around training and follow up. In some cases, the ES staff may not have the comfort level or expertise needed to train clinical staff, including nurses and doctors. Expertise, presentation skills, and an ability to communicate are what you would expect from an outside waste management supplier.
In-servicing must be regular and scheduled to be successful. An outsider should provide this service as a part of their program. Having a contractor deliver the in-service sessions also calms the potentially contentious relationship between the clinical staff and Environmental Services. For example, one issue that is often seen is the need for changes in the scheduling or frequency of waste pickups in certain departments. As a middle man, the outside contractor may negotiate between parties to reach a workable solution.
An agreement with an outside service should provide a hospital with guaranteed savings. An experienced company in this industry will have the ability to analyze waste costs and predict exact savings. These savings should include all additional costs and services, such as the cost of using a landfill for clean waste that will be diverted from the red bags, the costs of providing monthly in-servicing within the hospital, the cost of regular tracking of each departments performance, any reporting costs, etc.
Recycling
An outside contractor will hopefully have experience setting up and living with recycling programs as well. Recycling provides real opportunities, but must be dealt with carefully. For example, a paper recycling program may seem simple enough, but many people don't realize that most recycled paper is sorted by a person wearing work gloves who removes trash and segregates paper into various grades as it passes by on a sorting line. These people pickup and handle much of the material that comes out of the hospital and are exposed to any medical waste or sharps that might be in the recycling stream. A single instance of bloody waste or a sharps in the recycling can shut down an entire program if the recycler refuses to accept any more material from that hospital. Determining which departments should participate and which should be excluded is a critical but politically sensitive component of a recycling plan. A system that recycles five tons a week of paper for five years is much better than one that tries to do 10 tons a week, but is shut down after six months.
VHA Southwest
In the summer of 2000, Marge Montgomery of VHA Southwest was evaluating opportunities for her member hospitals who needed help with their waste management. "Our hospitals expect a lot more from us than simply reduced product costs. We partner with companies who provide products and services to solve real problems when the answer may not be so obvious. In this case, we wanted to reduce overall waste management costs, ensure compliance, and improve the safety of the programs," says Montgomery. She determined that simply negotiating a better cost per pound for medical waste destruction was not going to be enough. "We spoke to hospitals about low price, and realized that it did not equate to low cost. In other words, we saw the need to reduce the pounds of medical waste, and consequently the overall cost but we wanted these savings sustained over the long term, not for just a few months."
VHA Southwest compiled a list of required features for any given solution; detailed planning, on site in-service training, professional support materials, ongoing departmental auditing, and ideally, an integrated tracking and reporting structure. "Healthcare tends to be a report-heavy environment and we felt that efficient reporting would be a critical success factor for our clients. In addition, any solution would have to be available to all our members (in Texas and New Mexico) and ranging in size from 30 to 1000 beds. We selected a waste tracker program that met our requirements: clinical, environmental, and reporting with flexible financing."
As the management of healthcare waste becomes more complicated, and the time and resources the traditional manager can devote to it are reduced, we will to see more hospitals follow the trend toward contracted waste management services.
Where hospitals have been contracting for laundry, environmental services, engineering, or food services, they are beginning to sign waste management partnerships too. The reasons for contracted medical waste management are:
-Expertise
-Access to the proper tools and technology
-A fixed price for a specific service
-Guaranteed results
-Increased confidence that the work is being done correctly and on time
-Access to a lower net cost.
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Release
Date: 2000 |
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| Technology drives waste reduction
--- New World Health |
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| By Stephen Walsh |
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Changing attitudes to the way hospital waste is disposed of is a huge task. Tracking and reporting incidences of incorrect waste disposal will not only set this process in motion, but also lower the rate of such incidences and reduce costs.
Stephen Walsh, Walsh Integrated Environmental Systems, Inc.
Healthcare facilities routinely produce two to ten times more medical waste than is necessary. Studies have shown that improper material segregation is the leading contributor to excessive volumes, environmental compliance problems and increased safety risk.
Based upon these studies - carried out in over 300 North American hospitals - improved tracking and reporting have emerged as the most important factors in solving these problems.
Excess Cost and Non-compliance
Medical Waste typically costs four to 20 times more than regular rubbish. Therefore, producing too much medical waste significantly increases cost. These costs can be reduced dramatically by segregating the rubbish and recyclables into the appropriate streams.
Medical waste mistakenly disposed of with regular rubbish is the most common form of non-compliance. This unsafe and unhealthy practice may result in a warning, a fine, or worse. Tracking the source of non-compliance within hospitals is the first step towards correcting the problem. Walsh Integrated Environmental Systems has found that those hospitals with a strong definition of medical waste and an active tracking and reporting system commit fewer of these environmental infractions.
Safety Risk and Technology
Each year, hundreds of thousands of used needles end up in red bags or on hospital floors due to inattention or outright carelessness. These needles often injure and even kill unsuspecting housekeepers, nurses and patients. Tracking these incidents, reporting back to those departments involved and promoting safe handling practices are the way in which these problems are solved.
In 1993, the Walsh Waste Tracker system was developed to help hospitals manage their waste more effectively. This system uses a handheld computer expert system with an integrated digital camera to record comments about the waste stream. So, the camera takes a digital photograph of the waste as irrefutable proof of the safety or segregation problem. The information is then automatically formatted as an e-mail and sent to the department head.
While tracking and reporting on infractions are good practices, they are not common; they are difficult to maintain and require plenty of attention and follow-up. Automated tracking systems are effective because they leverage technology in such a way as to complete the tedious part of the task and focus the effort on in-services and ongoing communications.
Recycling management is also a key function of the Walsh Waste Tracker System. Government regulators and the general public are demanding environmental leadership from hospitals more and more. The Waste Tracker helps hospitals track recycling by department, target system improvements and report on performance automatically.
Adding Up the Advantages
Applying technology to the ongoing problem of medical waste management has delivered impressive results in a very short space of time. Reduced cost and improved health and safety are just two of the benefits of the structured approach that technology delivers. Using digital photos as e-mail reminders to non-compliant departments has proven tremendously valuable to hospital in their ongoing efforts to track and reduce waste and costs.
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Date: 2000, June |
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| Hospital
Waste Abatement and Handling Methods --- Infection Control Today |
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| By Stephen Walsh |
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| Regulated
medical waste (RMW) poses direct risks to those who produce,
handle, and dispose of it. Not
only is RMW dangerous, it is up to 20 times more expensive to
dispose of than regular waste.
Over the last 14 months, BFI Medical Waste Systems has
performed 204 waste audits using the Walsh Waste Auditor system.
The Walsh system allows the qualitative and quantitative
assessment and comparison of a hospital’s waste stream.
These audits are the first comprehensive attempt to
evaluate on a national level what hospitals are actually doing
with their waste. The
findings indicate that in some cases, up to 65% of the biomedical
waste produced is actually regular trash, such as paper, styrofoam
cups, and packaging.
In the
healthcare environment, regular trash is referred to as solid
waste—materials that have not been soiled by blood of any other
potentially infectious material.
RMW is any waste that contains an infectious substance
generated in the diagnosis, treatment, or immunization of people
or animals. In the
case of sharps and needles, mismanagement is a uniquely dangerous
issue with people being injured and even dying each year. According to the Department of Transport (DOT), it is the
waste generator’s responsibility to ensure that RMW is always
segregated from solid waste.
Herein
lies the problem: much
of the material that is being treated as RMW is actually solid
waste. Of the millions of dollars that US hospitals spend annually
on the handling and disposal of RMW, and estimated 40% is being
spent unnecessarily. Poor
segregation, along with being costly, is also potentially
dangerous.
There
is an assumption among some people that if medical waste disposal
were free then we would simply classify everything as RMW and end
up with a very safe system, no chance of red bag waste getting
into the landfill, less work all around, and reduced chance of
infecting people within or outside the hospital.
This assumption is wrong.
Research indicates that hospitals that routinely allow, or
even encourage solid waste into their RMW also have the most
problem with bloody materials ending up in their solid waste
stream. Conversely, a
hospital with a strict, legal, and enforced RMW policy that limits
the users to only true RMW would have fewer instances of bloody or
infectious material in their solid waste.
While the costs to this hospital could be much less, they,
ironically, could end up with a much safer system.
They also avoid the cost of fines for improper disposal of
RMW and the devastating press following bloody material being
found in a landfill. The
issue is people understanding the difference between RMW and solid
waste.
Infection
control personnel are one of the key players in the definition,
enforcement, and management of RMW.
Those who are too cautious, believing that “most is
safer” may be doing themselves, the hospital, and the general
public a disservice. Not
only is the definition costing their employer thousands of dollars
in unnecessary waste disposal costs, it may be exposing workers
and the public to increased risk.
Since
the late 1980s, increased attention has been focused on medical
waste and how it is handled.
Various public and environmental health regulations have
been enacted at the federal, state, and local level to govern the
proper handling and disposal of medical waste.
These regulations include the OSHA Blood borne Pathogens
Standard, the EPA Infectious Waste Guidelines, the CDC’s
Standard Precautions and Isolation Guidelines, and DOT’s
Hazardous Materials Regulations, just to name a few.
The
overriding aim of these regulations is to protect innocent people
from exposure to infectious diseases or direct injury. However,
the tendency among waste generators to take a blanket approach to
these policies has resulted in soaring RMW disposal costs.
Through a more acute understanding of what RMW really
should be on a generator-by-generator basis and adopting a common
sense approach to the interpretation of these regulations, the RMW
produced would cause fewer problems, disposal costs would fall,
and overall health and safety within the hospital would increase.
Those
handling RMW in the hospital—generally housekeepers—are bound
by all of the aforementioned regulations but are also forced to
deal with the problems caused by improper segregation or packaging
of waste at the generator level, bags that leak blood or other
fluids, and dangerous loose needles.
Since
US law prohibits employers from forcing employers from forcing
employees to work in unsafe conditions, this is a potentially
explosive situation. It
is up to infection control professionals to ensure that waste
handlers are protected adequately against such risk.
This means being aware of the day-to-day realities of how
RMW is actually being generated and disposed of within the
hospital and ensuring that practice meets policy.
In
1998, the EPA issued a Memorandum of Understanding (MOU) for the
establishment of a Mercury Waste Plan aimed at the virtual
elimination of mercury-containing waste from the healthcare
industry waste stream by the year 2005.
The MOU also calls on all parties to develop a Model Waste
Volume Reduction Plan that will assist in reducing the total
volume of all healthcare-related wastes (both regulated and
non-regulated) by 33% by 2005 and by 50% by 2010.
This MOU could force as many as 80% of hospital-operated
incinerators to shut down within the next few years unless
hospitals are prepared to invest the dollars on pollution-control
systems. This MOU is
a significant push for hospitals to reduce waste and eliminate
targeted materials.
When
disposing of RMW, there are two main objectives: first, to render
it unable to transmit disease and second, to make it
unrecognizable. Although
dozens of alternative technologies have been tried, none have
established themselves as economical alternatives to incineration
or autoclaving. However
waste is disposed and whether it is by the hospital or by an
outside contractor, waste production should be minimized.
Hospital
personnel who are involved in generating or handling waste must
deal with the medical waste stream as they would any potentially
dangerous or expensive material.
This includes infection control, nurses, doctors, and
clinical staff. For
example, paper for the photocopy machine costs two cents per pound
and follows a strict set of material management rules.
Medical waste, which costs 25 cents per pound to dispose of
and is dangerous is a material management free-for-all.
Why? Because it is garbage, and no one pays attention to the cost
and end result.
To cut
their RMW disposal and handling costs, hospitals have two options.
The first is to lower the total cost per pound of their
medical waste stream; the second is to reduce the number of pounds
of RMW. Generally,
reducing the cost per pound is done when the RMW contract is
signed. Often
alternative technologies appear to be very cost effective.
If alternative technologies are being considered, do the
homework. Talk to the hospitals that have been using the systems for
the last five years and ask pointed questions.
Really check it out because once a hospital has committed
to an expensive waste handling technology, internal political
realities suggest that there is no going back.
The
second cost cutting initiative is for hospitals to reduce the
pounds of medical waste they produce altogether.
This is done through proper segregation at the point of
generation. No matter how low you get your costs, still focus on
reducing volumes. These are not mutually exclusive strategies.
There
are several waste-reduction steps that infection control personnel
can take, hand-in-hand with their colleagues in environmental
services. First and
foremost, conduct a waste audit.
This will allow you to identify key areas that require
improvement, either because of excessive expenses or potentially
dangerous practices. Then review the RMW policy. Next, meet with hospital management and gain their agreement
on what level of improvement they envision.
Given this bottom-line goal, determine what steps must be
taken to achieve it and implement a marketing program to sensitize
those that generate and dispose of RMW.
Case
Study, New York City, 1999
In an
aim to cut costs and improve overall health and safety, one of New
York City’s most prestigious hospitals, the Weill Cornell
Medical Center of New York Presbyterian
Hospital, carried out an Infection Control Policy review
and implemented a structured program of medical waste reduction.
The 700 + bed hospital also started to track each
department’s RMW performance and provide ongoing feedback to
department heads.
Using
the Walsh Waste Auditor, the hospital personnel determined that
approximately 120,000 lbs. Of the 200,000 lbs. of RMW generated on
a monthly basis was actually solid waste.
Using the auditor’s hand-held computers with digital
cameras, housekeeping personnel noted any situations of
non-compliance. A
comprehensive e-mail message and digital photo was sent to the
appropriate manager of the non-compliant department. The waste audit determined that hospital was producing 9.6
lbs. of waste per bed per day, almost double the national average
of 4.5 lbs., and four times the EPA and AHA target levels.
As the hospital was spending close to $1 million per year
to dispose of RMW, there were significant potential savings to be
had.
Following
the audit, the hospital instituted a shared savings program using
the Walsh Waste Tracker. Within
one month of implementing this waste reduction program, RMW was
reduced by 36%. The
keys to the success of this program are people, policy, hardware,
marketing, and follow up.
The
most important factor in any waste reduction program is the people
running it. The
Director of Environmental services understood that the expenses
did not have to be so high and that a better system would reduce
the risk for his employees and the public.
He took the initiative to outsource the work on a shared
savings basis. The
outsourcing company then sent one of its waste management
professionals to the hospital to deliver ten separate three-day
training and in-service sessions.
The
director assigned his two top people to work with the company and
ensure the cooperation of housekeeping, epidemiology, nursing,
labs, etc. This team was also responsible for the day-to-day use of the
tracker computer touring the hospital, taking digital photos, and
tracking each department’s performance.
Without professional and dedicated people, long term,
meaningful change is virtually impossible.
The
policy is the next most important item.
In this case, the hospital redefined the RMW as it applies
to isolation cases. Previously,
all waste from an isolation patient was considered RMW.
Upon review, the hospital decided that this was not
necessary. Today, if
the patient is CDC class 4, then all waste is considered RMW;
otherwise, it is to be treated as it would from any other patient:
material saturated with blood or body fluid; waste from CDC
Class 4 patients; animal waste and body parts; cultures and stocks
of infectious agents; and pathological waste.
Sharps
are handled through a separate system.
While only about 10 % of the RMW is from isolation rooms,
the policy change was a terrific way to get people interested and
involved in the improvements that were wanted.
And
important reason for non-compliance is that people don’t have
the correct bins for their waste.
We took an inventory of which bins were available and where
and ensured that there were enough solid waste containers and not
too many RMW containers in each department.
From here, Walsh developed a waste reduction for the
hospital.
When
the hospital agreed to install and use the tracker system, Walsh
supplied all of the handheld computers, cameras, PCs, software,
installation, setup, and training.
Each day, e-mails were sent to every department that had
been visited, alerting them to instances of non-compliance or
congratulating them on waste reduction.
This final step is what differentiates long term solutions
from a short term fix. With
a program of structured follow up, the hospital was able to attain
objectives and maintain them.
The hospital learned that while reducing waste once is not
a problem, keeping it down is the real challenge.
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Date: 1999,
October |
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| Nothing
But 'Net' For facility managers, the Internet is a necessity-not a
novelty --- Health Facilities Management |
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| By Catherine Quayle |
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| When
the engineers at Memorial Regional Hospital, Hollywood, Fla., set
out to make sure their equipment was Y2K compliant, they faced a
daunting task. There
were hundreds of equipment types, which translated into thousands
of individual pieces at the 680-bed hospital.
“Just getting information on complaint equipment and
communicating with manufacturers it was so laborious trying to
call people and write letters,” says Dennis Grady, Memorial’s
administrative director of facilities management and
president-elect of the of the American Society for Healthcare
engineering.
Then,
about six months ago, his team began using the Internet to do this
work. The staff found
that most manufacturers had all the necessary Y2K information
posted on their Web sites. They
could find out which equipment was compliant, how to upgrade, and
when to discard. The
team has since managed to track down all but three of the
manufacturers. “The
Internet really cut our man-hours down.
Once you’ve started using it, depending on it, you wonder
how you ever got along without it,” says Grady.
Not
just a new toy
A
lot of facility managers are singing the same tune. The Internet,
once a novelty item among tried-and-true management tools, has
quickly become an essential mode of doing business in hospital
engineering and environmental services departments.
Managers are now using it for everything from
troubleshooting to committee meetings to shopping for energy.
And its uses continue to grow.
One of the most basic, of course is e-mail.
“Busy people can be very difficult to get in touch
with,” says Grady. “I
e-mail other ASHE board members and committee members since it can
be really hard to contact them by phone.
Even if you have phone mail, you get these long, drawn-out
messages, but e-mail people tend to be brief and to the point.”
And
the Internet takes person-to-person communication even further.
Sometimes a manager just needs to talk with someone without
knowing who that someone is.
Profession-specific bulletin boards and chat rooms provide
a place for managers to pose questions to their peers, seek advice
on particularly thorny problems, or simply share their successes
and frustrations with like-minded colleagues.
“If
people are concerned about medical waste or recycling, they can
say, ‘What are you doing in this area?
Are you recycling this or that?
Are you getting paid for your recycling?
How are you handling medical waste?
Are you using autoclave systems?
Do you find it cheaper to have a contractor haul it away or
handle it yourself?’” says Patricia Hosckenberger director of
environmental services at St. Clair Memorial Hospital, Pittsburgh.
As president-elect of the American Society for Healthcare
Environmental Services, Hockenberger is partial to the ASHES Web
site (www.ashes.org),
where members use bulleting boards on a variety of housekeeping
related topics. “If
you are debating laundry and linen issues—whether to go with an
in-house laundry or use contracted services, whether to have your
own linen or rent linen—there are a lot of options open to you,
and you can just get on the Internet and say, ‘Is anybody out
there running their own laundry?’
And before you know it, you’ll have a whole group of
people jumping right in,” says Hockenberger.
A
similar function exists on the ASHE site, where facility managers
find bulletin boards on topics ranging from Y2K compliance to
utility costs to fire safety.
Of course there are other ways to obtain this kind of
information: publications,
conferences, and the old-fashioned phone call.
But going online offers several advantages. It is centralized immediate, and can expose users to peers
they might not know personally or meet at conferences. “I went online and asked, ‘What kind of recognition
programs do you do?’ And
I got a lot of responses,” says Martin Shafer, operations
manager of facility operations housekeeping at the University of
Iowa Hospital and Clinics, Iowa City.
“It’s easier than sending a letter or calling
somebody.”
Regs
resource
Codes
and standards can rule a facility manager’s life, and having the
most up-to-date information is the first way to keep this rule in
check. The Internet
is now playing a big part in providing that information.
At the JCAHO site (www.jcaho.org), users find resources
relating to performance measurement and accreditation, as well as
e-mail links for answers to standards-related questions.
At the OSHA site (www.osha.gov), users can access the
actual text of codes and standards, as well as a vast library of
manuals, directives, and statistics.
Having this information centrally available online beats
searching for it in books or trying to find a human voice in the
vast offices of a regulatory organization.
“When I was giving a presentation to the state
epidemiology nurses association, I wanted to verify some
information I was going to give them from OSHA,” says Shafer.
“It was a lot easier than looking in some manual.
I just logged onto the OSHA site and found the definitions
I needed.” Facility
managers have also begun to shop online.
“You might need a new type of filter, a floor surface
covering a piece of machinery, a new recycling device, or just
anything that would be unique and new,” says Robert Loranger,
director of facilities at the New England Medical Center
Hospitals, Boston, and president of ASHE.
“And you can usually find it on the Web.”
At
St. Joseph Regional Medical Center, Lewiston, Idaho, the
facilities department frequently uses the Internet for equipment
research. Just
yesterday one of my engineers came to me trying to find some info
on a piece of equipment—a monitoring system for an underground
storage tank—that we didn’t have any service manuals on, and
we searched the Internet and found something right away,” says
Curt Hibbard, director of facilities management at St. Joseph.
The
same has proven true at Memorial Regional Hospital, where Grady
and his staff do a lot of their equipment research and purchasing
online. “It’s difficult to keep up with the advances in
technology, and the Internet can help you do that.
We go online to see what is the latest and greatest,”
says Grady. His
facilities department now does a lot of its ordering through
distributors on the Internet. “They’re online, we’re online.
It has actually made the visiting salesman obsolete, and
there’s no question that saves time.”
In
many hospitals, particularly those in a large health network, the
purchasing function is handled by a purchasing department or is
under shared-services contracts, so facilities managers are not
likely to spend a lot of time shopping themselves.
The Internet plays a role in these situations, too.
At the James H. Quillen VA Medical Center, Mountain Home,
Tenn., for example, environmental managers were preparing their
equipment lists for next year and wanted to include the most
recent equipment offered by each vendor they used.
“We were able to go to several sites and look at more
up-to-date equipment than what our old catalogs had.
It was real easy to just for to the Web for that,” says
Larry Collins, the hospital’s chief of environmental services
and president of ASHES.
At
St. Clair Memorial Hospital, shared services contracts specify
companies from which the environmental services department must
but its products. “They
may indicate that you get rebates or bonuses through purchasing 3M
products, for example, and if you’ve never used 3M, you might
get on the Internet and check with people to see if they’ve used
them and how they are working in their hospital,” Hockenberger
points out.
Watch
your waste
Online
communication has an added dimension at the University of Iowa
Hospitals and Clinics, where Shafer and his team have been using
e-mail to document and notify staff of red bag waste violations in
the 850-bed facility. Armed with a digital computer and
camera system from Walsh Waste Tracking, Montreal, the
environmental services staff roams the facility's 2.5 million
square feet examining red bags for trash that doesn't belong, such
as cups or papers.
When
they find a violation, they go to the computer, which brings up a
form allowing the user to enter the type of waste, its percentage
of contamination, the location of the violation, and any other
relevant information. It then allows the user to take a
digital photograph of the waste. All the information is
stored on the computer. At the end of the survey, Shafer
downloads this information to his PC, which is already programmed
with the names of supervisors in each area. An e-mail
documenting the violation, along with a picture of the waste, is
sent to every department where a problem has occurred.
"Our hope is that they will use this as an educational tool,
and say, "Hey, here's what housekeeping found."
Then they can correct these problems in the future, Shafer says.
The
system has been in place since January, and Shafer is certain that
it has helped to heighten awareness among the staff-no small feat
considering that the staff already had a heightened awareness
about waste; before the introduction of the waste tracking system,
the facility had reduced its red bag waste by 50 percent since
1993. "And we're still finding things. We
actually generate two to three e-mails a week," Shafer says.
"If I had people constantly doing this, I'd probably have a
lot more. If you can imagine a hospital that hasn't done
anything in the waste area, it would be invaluable. You
could pay for the system pretty quickly. At least I hope to.
A
day at the (energy) mall
Facility
managers struggling with how to take advantage of the rapidly
changing deregulating electricity industry now have an Internet
solution. A joint
project between ASHE and Healthcare Circuit News, called
the Energy Initiative Network (www.energyinitiative.com), enables
them to track their energy use, then post that data online, where
it is available to utilities that wish to bid for that energy
supply. Each morning
at 6 a.m. the network’s server dials up hospitals and downloads
information on all energy used during every 15-minute period of
the previous day, including electricity, gas, water, and steam.
Each
hospital’s load profile is then posted on the network
anonymously (revealing only the region in which the hospital is
located) and utility managers interested in taking on that load
submit a proposal into a blind inbox, from which facility managers
retrieve the proposals and select the best one.
“This is a win-win situation for both facilities and
utilities because the facilities can do their shopping online and
the utilities don’t have to have their
salespeople in the field collecting data every day,” says
Dan Chisolm, executive editor of Healthcare Circuit News,
which is published by the Motor and Generator Institute (www.mgi-hcn.com),
Winter Park, Fla.
Facilities
sign up for this service through ASHE for $150 a year while
utilities pay according to their level of participation.
ASHE membership is required to participate, but nonmembers
receive a discount on ASHE membership when they sign up for the
network. Some
hospitals buy their energy daily, some yearly, depending on their
contracts. But the
system benefits all types. “Even
if you have long-term contracts, you still need to keep a check on
what’s going on in the marketplace,” says Chisolm.
And
size is relative. “We
have all sizes signing up, from 50-bed hospitals to 50-hospital
systems. A 7 percent saving for somebody spending $30 million a year
is $2 million, and for somebody spending half a million, it’s
$35,000. It seems
like a lot either way,” Chisolm says.
Utilities, too, find value in smaller facilities.
“If a utility has most of its revenue tied up with one
customer and that customer leaves, there’s a downside to the
bigger-better deal. I’ve
had utilities tell me they’d rather have 20 $1 million customer
than five $4 million dollar customers,” says Chisolm.
What’s
up next?
Buying
energy online? It’s
just one of the amazing business practices the Internet has made
possible in a very short time.
There’s no telling what the Internet will bring next, but
if the past few whirlwind years are any indication, it is sure to
be transformational. “It
wasn’t that long ago that many of us didn’t even have Internet
access from work,” says Memorial Regional Hospital’s Grady.
“And now I can’t imagine not having it.
What was life like before?”
|
| |
| Publication |
| Release
Date: 1998,
January |
|
| Waste Tracking ---
Health Facilities Management |
|
| Reduce
liability and save money with the Waste TrackerTM
from
Walsh Integrated Environmental Systems, Montreal. The system
analyzes the state of your health facility's waste and proposes
solutions to correct potentially dangerous waste situations.
Tracking the waste from its point of origin using bar codes and
handheld computers, data is sent to a PC with the Waste TrackerTM
software.
The software highlights problems, reports on department progress,
offers solutions and provides costs by area. During waste
collection, users can record problems about extruding sharps and
other items found in the waste stream.
|
| |
| Publication |
| Release
Date: 1997,
December |
| |
| How the Waste Was
Won, Bar code enables hospitals to cut the cost and danger
of medical waste disposal. --- Hazardous Material
Tracking, ID Systems |
| |
| By
Paul
Quinn, Senior Writer
|
| |
|
Proper disposal of hospital refuse is important not only for
the obvious reason--the health and safety of all who handle
it--but also because it is expensive, and we all help pick up the
tab for it in the end, through increased health care costs.
Furthermore, the federal government is getting stricter about how
hospitals dispose of medical waste, driving up costs even more.
Consider this: it costs approximately two cents per pound
to have regular rubbish hauled off to the landfill. Medical
waste, on the other hand, is much more expensive to handle,
costing anywhere from 20 to 50 cents per pound to ship and
destroy. Which means that nearly all hospitals have policies
that direct staff members to segregate true medical waste, such as
(deep breath) discarded body parts and fluids, used dressings,
blood bags, and needles, from more mundane trash such as
newspapers, soda cans, and pizza boxes. Trouble is,
mandatory segregation of the two types of trash is difficult to
enforce, and a lot of basically harmless stuff that could simply
be buried ends up being incinerated.
Failure to separate the good from the bad and the ugly also has
another downside. All too often, really hazardous waste,
such as needles and contaminated broken glass (called
"sharps," for good reason), is not stored in the correct
containers for disposal. The result is that members of the
housekeeping staff who collect the waste daily are put at serous
risk of infection from puncture wounds and cuts, or from exposure
to contaminated material.
Such a Waste
"Anywhere from 35 to 70 percent of the medical waste
stream in North America is not actually medical waste", said
Stephen Walsh, president of Walsh Integrated Environmental
Systems, a six-year-old company based in Montreal.
"It's just junk: paper, packaging, and all this other
stuff. The reason why this is so is because hospital nursing
staffs are generally poorly informed about waste handling; there's
no feedback to users."
The Walsh firm specializes in medical waste management and has
developed a bar code-based system called Waste TrackerTM
that introduces control and accountability into environments that
traditionally have not been closely watched. The results can
be extraordinary. At one of the firm's first installations,
a Montreal hospital, bio-hazardous waste volume was reportedly cut
by 36 percent, saving $200,000 a year. In another facility
in the same city, there was a 40 percent reduction in volume of
infectious waste, and Waste TrackerTM
paid
for itself in four months.
"Our background is in recycling,
"said Mr. Walsh," and that's how we got into this business. We were
performing a waste audit for a large hospital, and we learned they
were spending about $500,000 a year for waste disposal, but they
should have been spending only about $150,000."
Together with his brother David, vice president of the firm, Mr.
Walsh began development of Waste TrackerTM,
installing the first system in 1993.
Waste Tracker's concept is simple: Establish a means of
identifying each waste collection point in the hospital, provide a
way of quickly and accurately quantifying the waste and noting any
infractions of waste disposal procedures, and create the ability
to rapidly weigh containers of waste. Once this information
has been captured, it can then be uploaded into a host PC, where
it can be evaluated and used to generate reports.
The front-line tool of this system is a handheld bar code
scanner, programmed with application software developed by Walsh.
Equipped with a small display and keyboard, the device guides the
employee through the trash pick-up process via screen prompts. For instance, when making a waste pick-up, the program asks the
user to select the type of waste being collected (such as
"Human, non-anatomical") and enter the selection.
The handheld terminal, a Symbol Technologies LDT 3805, is equipped
with a laser scanner and can store all transactions in its memory
until the end of the shift or round, when the data is uploaded
into the host PC.
Nurses and other care givers usually place medical waste in red
garbage bags. They put non-hazardous waste, such as
newspapers and disposable paper products, in green garbage bags,
and a member of the housekeeping staff later collects both types
of bags in boxes or bins that they roll around the hospital on
hand trucks. As a means of recording misbagged waste, each
bin carries a bar coded sheet of comments. This laminated
list contains about a dozen standard comments and accompanying bar
code, designating such as items as "Newspapers" or
"Leaking Blood." When the pick-up person discovers
ordinary trash in a medical waste bag, he or she simply scans in
the appropriate comment and the infraction is recorded in the bar
code scanner. This method of notation is much faster, more
accurate, and less cumbersome than trying to record infractions on
a clipboard. It also avoids the necessity of reentering the
comments later, via the computer keyboard.
A bar code label is also affixed to each rolling trash bin.
Bags from patients' rooms, operating rooms, nurses' stations, and
other pick-up points are collected and placed in the containers.
By scanning in the location point where the bag is picked up (the
label is usually placed near the light switch or other convenient
point) and then scanning the ID label of the bin into which it is
placed, it is possible to later weigh the bin's contents to
determine how much waste is generated by any given area of the
hospital.
Since effective waste disposal management relies on regulating
the weight of the refuse, the Waste Tracker system incorporates a
Weigh-Tronix electronic scale into the waste stream.
Usually, the stationary scale is located in the waste storage area
in the basement of the hospital. Containers of trash are
placed on the scale, and a telephone-type, plug-in cable is used
to connect the handheld to the scale so the terminal can
automatically collect the bin's weight. Then the handheld
scans the box's bar code, completing the transaction.
The Waste TrackerTM
systems installed to date require only one handheld per hospital,
though Mr. Walsh foresees applications in which more than one
scanner might be required. Inserting the handheld into a Symbol
docking station (which also recharges the terminals' batteries)
uploads information from the handheld to the PC. In a
typical setup, the docking station is connected directly to the
PC, though it is also possible to upload data via a built-in
modem, as is the case where one host serves multiple docking
sites.
Walsh Systems strongly recommends that a new, dedicated PC
support the system. "The reality is that when we try to
use other people's hardware, we can easily spend more money
getting it to work than we would have if a new PC had been
purchased at the outset. So it's rare that we don't demand
all new hardware with the installation," explained Mr. Walsh.
Walsh developed the software for the Waste Tracker system.
It consists of three main pieces: data acquisition
programming, which is loaded into the handheld scanner; extensive
database management software residing on the PC, which is the real
engine of the system; and the communications software, which
facilitates data exchange between the scanner and the scale.
The job of printing bar codes is carried out onsite at the
hospital with a standard Hewlett-Packard LaserJet printer.
Interfaced to the host PC, the printer generates labels using
custom software that Walsh also developed. Code 39 is the
symbology of choice. Printing the paper labels for all the
rooms is more or less a one-time proposition, with replacement
labels run off as needed thereafter. Disposable box labels
are consumed on an ongoing basis and are usually printed each
month in batched of 1000 or more, depending on the
hospital's waste volume.
Once the waste has been collected, boxed, weighed, and
recorded, it is ready for disposal. Many hospitals maintain
their own incinerators, where the hazardous waste is destroyed
on premises, while the non-hazardous can be sent to the
landfill. Conversely, a growing number of hospitals are
shipping their medical waste to outside companies for destruction,
especially in light of recently tightened air pollution
policies laid down by the EPA. Should this trend continue,
many more of the estimated 5000 hospitals in North America will be
utilizing third-party services in the years ahead.
Safety First
Waste Tracker's report function pulls all the collection data
together and turns it into meaningful information. For
instance, if a certain department within the hospital routinely
puts newspapers and trash into the medical waste bags, this fact,
backed up by times and dates, is presented to the department
supervisor and to the hospital's health and safety officer.
Or if a department is careless in its disposal of sharps, a report
to that effect is generated and passed along to the appropriate
people. In most instances, a word to the wise is all that's
needed, and the violations drop off immediately. In critical
situations, such as when leaking blood is found in a waste bag, an
audible alarm sounds in the handheld when the infraction is
scanned in, and the collection person is instructed to contact the
supervisor immediately.
Because the trash is weighed before disposal, it is a simple
matter to monitor the various categories of waste volumes at room
level. This yields reliable statistics, which in turn make
it possible to spot trends early on and to create budgets with
more precision. Furthermore, when an accreditation agency
audits the hospital's waste program, the wealth of data on file
provides the auditors with reliable, verifiable information.
One of the most important benefits of the system is that it
focuses attention on the need to properly handle bio-hazardous
refuse, decreasing the risk of infection for all individuals whose
job it is to collect sharps and infectious waste.
|
| |
| Publication |
| Release
Date: 1997, July |
| |
| Waste tracking system
--- Hospital News |
| |
|
Hamilton
Health Science Corporation has installed a state-of-the-art waste
tracker system that monitors bio-hazardous waste and recyclables in
the region's five hospitals and helps them dramatically reduce the
volume of waste they generate. The hospitals anticipate the
system will save $1 million in waste disposal costs over the next
five years.
The Waste Tracker installation in Hamilton represents a
technological advance for its creator, Walsh Integrated
Environmental Systems of Montreal. Although the system has
already helped two of Montreal's major hospitals slash their waste
disposal costs, this is the first time the systems at several
hospitals are linked together at one centralized location.
|
| |
| Publication |
| Release
Date: 1997, July |
| |
| Medical Waste Tracking
Saves Hospitals Money --- Healthcare Technology Management |
| |
|
Canadian
technology helps hospitals meet new EPA regulations that go
into effect July 31, 1997.
Hospitals
that have been sending their medical waste up in smoke for many
years will probably be considering some new options after July 31,
1997. That's when some old laws regarding hospital incinerators
are finally enforced by the Environmental Protection Agency (EPA).
These new regulations were sparked in part by information which
traced 70 percent of all the low-level dioxins emitted in the
United States back to medical waste incineration. The new
enforcement was brought about by a law suit filed by the Sierra
Club | |