Release Date: 2000, February

Release Date: 2000

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.

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?”

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 Tracker^TM 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 Tracker^TM 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 Tracker^TM, 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 Tracker^TM 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.

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.

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 and the Natural Resource Defense Council.

With more than 3,000 hospital-based incinerators operating in the United States, a number of hospitals will be faced with tough decisions. Some may choose to contract with a medical waste management company to haul the garbage away. But that's not cheap either. The cost of disposing of medical waste can be twenty to forty times more than the cost of disposing of general waste. For example, general waste disposal may run one or two cents a pound while medical waste runs 40 to 50 cents per pound.

Some may decide to retrofit their old incinerator or purchase non-burn medical waste processing equipment to meet the new stringent requirements, but this probably entails more money than most hospitals can afford to spend.

Waste Tracker^TM uses a handheld barcode reader and a computer to track waste throughout the hospital. Sorting problems can be easily pinpointed.

All the available options have the potential of increasing the budgeted costs of medical waste management. Having been a medical waste manager for a number of years. I know there are only two ways to decrease the medial waste cost in a hospital. One is to find a less expensive waste-processing technology or service. Unfortunately, it's not likely that hospital-based medical-waste incinerator facilities will find either of those. If either of those were readily available the facility would have made the switch years ago.

A second option is to reduce the volume of medical waste by improving the sorting of that waste. Medical waste managers know that segregation or sorting in most hospitals is done haphazardly. Part of the reason for this lies in the relationship between clinicians and the housekeeping or engineering departments. It's difficult for a department such as housekeeping, which traditionally lacks political clout, to tell the powerful doctors and nurses who generate the waste what to do.

But under managed care, everyone is doing, more with less, Housekeeping and engineering are no exception. Hospitals across the country have reduced budgets and staff in both these departments over the last five years. On the other hand, many of those same hospitals have acquired doctors' offices or clinics without a corresponding increase in the environmental services and engineering staff. The directors of these departments and their staffs are spending more time per month at their job than ever before. Department directors are faced with prioritizing an increasing number of demands at a time when all the "fat" has already been squeezed out of the budget. Any additional decreases in budget and staff would directly impact the quality of work in maintaining the facility.

EPA incineration regulation impacts hospitals

Given the political, regulatory, and economic hurdles, medical waste managers face an unusually daunting year ahead. Optimistic healthcare managers like to portray challenges as undiscovered opportunities. At this juncture in the managed care journey, many of the challenges that department directors face are merely that — challenges. Until recently, I would have said the same about the hospitals' medical waste dilemma for 1997.

At the University of Wisconsin Hospitals and Clinics, where I served as hazard control officer from 1982 to 1990, I was continually frustrated by clinicians' inattention to medical waste sorting. Newspapers, pizza boxes and other non-medical waste were common sites in red-bag, medical-waste containers. In my book, Medical Waste Management — A Practical Guide, I detailed the system we developed which was awkward at best and not as effective as we had hoped. Despite the drawbacks of this somewhat clumsy system, we were able to reduce the amount of medical waste. The system involved manually tabulating which departments had inappropriately segregated medical waste and then manually generating reports pointing out the problems.

Computerized Waste Tracking - A Potent Tool

Recently I had the pleasure of reviewing a simple and effective Canadian technology that solves the waste-generation tracking problem quite well. The Waste Tracker^TM, developed by Walsh Integrated Environmental Systems Inc., uses a handheld barcode reader and a computer to track waste throughout the hospital. Areas where sorting is a problem can be pinpointed easily.

A barcode-numbered plaque is placed in each room where medical waste is produced and thrown away. Each housekeeper carries a barcode scanner and a master list of 10 likely waste violations, sharps, paper, soda can, each with an accompanying barcode. The housekeeper looks in the trash bag before closing it to see if someone has accidentally thrown away a Coke can or unprotected needle. For example, someone in the department might have inappropriately thrown newspapers in the infectious waste bag. After scanning in the violation, the housekeeper takes the handheld barcode reader back to the central office where the information is downloaded to a computer. From there a notice can automatically be issued to the department where the infraction occurred.

The system insures that departments generating medical waste are held accountable for properly segregating that waste. The major benefit of the system for the housekeeping or engineering department is that it is so easy to track and respond to the violations. The system can be set up so that at the end of the month or quarter, reports are sent to the safety and/or infection control committees. Trends indicating repeat offender departments or personnel can be seen easily.

The Waste Tracker^TM provides a high-tech solution to the low tech but expensive problem of waste segregation. Clinicians who previously threw out their Coke cans and pizza boxes without much thought, are thinking twice now that they know they are being monitored. It makes a huge difference in how they segregate waste in the future.

Medical Waste Volume Reduced by 40 to 50 percent

The Montreal General Hospital in Montreal, Canada saw its medical waste expense drop from $140,000 to $85,000 after one year of using Waste Tracker^TM. "One of our sister hospitals actually installed the system first," said Guy Sabourin, director of housekeeping. "I was very impressed with the results. The system was easy to install and use. This was important because we didn't want to spend a lot of time training our staff."

"We guarantee when we install a system that if it doesn't pay for itself in the first three years, we will write the hospital a check for the difference." said David Walsh of Walsh Integrated Environmental Systems. The average waste reduction over one year is 35 percent, according to Walsh. The average pay back time is nine months, the longest being one year and the shortest being six weeks. Currently, there are seven systems installed in hospitals in North America. One Waste Tracker^TM costs $60,000 and that includes installation and all support and upgrades for three years.

Montreal General has had the Waste Tracker^TM for a little over a year and experienced a 40 percent reduction in its volume of infectious waste. Its sister hospital, Royal Victoria Hospital, experienced a 50 percent reduction in its volume of medical waste generated. Royal Victoria decreased its waste charges for one year from $550,000 to $180.000. "Individuals are very impressed with the fact that we can so carefully monitor what's going into the infectious waste bags. We know if any inappropriate waste such as newspaper or soda cans, which should go in general waste cans, is getting disposed of in the infectious waste bags," said Sabourin.

At the Royal Victoria Hospital they also use Waste Tracker^TM to produce monthly invoices for every department. The invoices include the correct weight of waste, its destruction cost, cost of boxes and bags and sharp containers. There's even an allocation for overhead and the cost of the Waste Tracker^TM itself.

The report capability of Waste Tracker^TM is an important feature for hospitals seeking JCAHO accreditation and general quality improvement," said Sabourin. "We have tailored the reporting mechanism to meet our needs. We wanted to know what percentage of our infectious waste was animal anatomical, human anatomical and non-anatomical waste. We are able to generate monthly reports on these categories of infectious waste. Administration really appreciates the financial reports generated. We experienced a pay back in six months for our investment in Waste Tracker^TM."

Chedoke-McMaster Hospitals installed the Waste Tracker^TM at two hospitals in its system and plans to add three more because Paul Porteous, director of sanitation engineering at the five-hospital system in Hamilton, Ontario, had heard that other hospitals had experienced significant savings using it. "We've had the system in place only a short time, but we're expecting a 30 percent reduction in waste volume at one hospital and 50 percent at another:" Porteous said.

Service departments like the tool because it helps them have more control over their budget. It gives them the documentation, and thus the authority, to inform waste generators that segregation has not been properly conducted. The benefits they are looking for with this regional system include saving $80,000 in the first five years and having one person manage the waste in the five institutions.

Waste Tracker^TM can help hospitals whether they use a waste management firm or their own on-site processing equipment. The savings comes from reducing the volume of medical waste generated since the cost of sending regular waste to a landfill is much lower than the cost of processing medical waste.

With computers infiltrating every other hospital department, it's not surprising that they've made their way into garbage collection. "Nobody gets up in the morning and says. 'How can I screw up my hospital's waste disposal system today," said Walsh. "The reality is that everyone has a lot of work to do, and it's easy to not focus on where you throw your trash. In a perfect world, our system would not be needed. But we don't live in a perfect world."

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 to dramatically reduce the volume of waste they generate. The hospitals anticipate that the system will save them $1 million in waste disposal costs over the next five years.

The Waste Tracker^TM installation in Hamilton represents an exciting 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 that systems at several hospitals are linked together at one centralized location.

"The consolidation of Hamilton's hospitals into one regional facility has prompted a variety of moves aimed at streamlining and standardizing hospital procedures; and the introduction of the Waste Tracker system is one such initiative," explains Denise Arseneault, Vice President, Support Services at Hamilton Health Science Corp. and chairperson of the Hamilton Hospitals Regional Value Improvement Program. "The Waste Tracker^TM is an efficient and easy-to-use tool that has improved our information gathering procedures and helped us to effectively manage bio-hazardous waste at all five hospitals."

"With Hamilton's multi-hospital installation, it is now possible for each hospital to establish an environmental benchmark for comparing how well it manages medical waste disposal costs and safety factors in relation to the other four facilities," explains Stephen Walsh, president of Walsh Integrated Environmental Systems and inventor of the Waste Tracker^TM. The system consists of a handheld device that uses a bar code system for weighing and recording exactly how much waste each department within a hospital produces. This information is downloaded and incorporated into weekly reports that show how much bio-hazardous waste was produced, and those areas where corrective action is needed.

The Waste Tracker^TM has achieved impressive cost savings, both at Montreal's Royal Victoria Hospital, where bio-hazardous waste volume was reduced by 36 percent and disposal costs cut by 60 percent and at the Montreal General.

The Challenge of Managed Care

It comes as no surprise to directors of housekeeping and engineering departments that managed care has affected their operations more than almost any other area of the hospital. I don't know of a single hospital that has not reduced both budget and staff in departments of environmental services and engineering over the last five years. However, I do know of several hospitals that have added doctors' offices or clinics without increasing the staff in the departments of environmental services and engineering.

The directors of these departments are constantly called upon to do more with less. Department directors tell me that they and their staffs are spending more time per month at their jobs than ever before. The department directors of both environmental services and engineering are faced with prioritizing an increasing number of demands. This situation has caused increased anxiety. The anxiety is only heightened by the observation that the "fat" has been squeezed out of the budget. Any additional decreases in budget and staff are going to directly affect the quality of work in maintaining the facility, a responsibility for which directors of environmental services and engineering departments are directly accountable.
 

EPA Incineration Regulation Affects Hospitals

The year 1997 presents a unique challenge to facility managers in the area of medical waste management. Optimistic healthcare managers often attempt to translate challenges as undiscovered opportunities. In most cases, I would disagree with this point of view. Many of the challenges that department directors face are merely that-challenges. There are no opportunities to be found in these challenges, only different methods to reduce costs and quality of services. Until recently, I would have said the same about the medical waste dilemma in which hospitals find themselves in 1997. The Environmental Protection Agency will be placing clean air regulations into effect for hospitals by July 1997. With over 3,000 hospital-based incinerators operating in the U.S., a number of hospitals will be facing a tough decision about whether to contract with a medical waste management company, upgrade the present incinerator, or purchase nonburn medical waste processing equipment. Facility waste managers tell me that all options have the potential of increasing the budgeted costs of medical waste management. Having been a medical waste management director for several years, I know, as does any other medical waste manager, that there are only two ways to decrease the costs of the system:

Provide a less expensive waste processing technology or service.

It's not likely that the facilities having hospital-based medical waste incinerators will find either contracted services or alternative technologies cheaper than what they presently have. If that's the case, those facilities would have changed to one of the two options several years ago, purely on economic considerations.

Reduce the volume of medical waste by an improvement in the segregation of that waste.

Medical waste management directors know that segregation activities in a good majority of the hospitals are very haphazard. Part of the reason for this lies in the difference in the political clout that departments of engineering and housekeeping have in relationship with the clinicians such as physicians and nurses who actually generate the medical waste. At the University of Wisconsin Hospitals and Clinics, I was continuously frustrated because nurses and clinicians would inappropriately throw newspapers and other nonmedical waste into red containers. In my book, Medical Waste Management-A Practical Guide, I reported that the University of Wisconsin Hospitals and Clinics developed a system by which we manually tabulated which departments inappropriately segregated medical waste and reports were, again manually, generated to those departments pointing out the problem. The system was awkward and ineffective, but we still reduced medical waste.

Scanning barcodes for the tracing system are Keith Sopha, Director of Environmental Services, Chedoke-McMaster Hospital Faculty of Health Sciences, Hamilton, Ontario, Canada, and Stephen Walsh, President of WALSH Integrated Environmental Systems, Inc., of Montreal.

Computerized Waste Tracking-A Potent Tool

I was delighted recently to review a technology developed and clinically trialed in Canada. It involves a handheld code-reading device and a computer program that tracks and reports medical waste segregation problems. The company is called Walsh Integrated Environmental Systems and is directed by Mr. Steven Walsh out of Montreal, Canada. The system is simple and effective. Bar codes are placed on the infectious waste receptacles. When a housekeeper picks up infectious waste at that receptacle and notes a procedure violation in segregation of the waste, the employee scans the bar code from the receptacle and then scans the bar code master list that identifies the infraction. For instance, the department may have inappropriately thrown newspapers into the infectious waste bag. The housekeeper then takes the handheld code reader back to the central office where the information is downloaded into a computer that can automatically issue a notice to the department or area that created the violation.

The system is effective because for first time, the departments generating medical waste are held accountable for properly segregating that waste. The major benefit of the system for the department of housekeeping or engineering is that it is so easy to track and respond to violations. At the end of the month or quarter, general reports can be issued which can then be sent to the appropriate committees such as safety or infection control. Trending can be established concerning areas that are repeat procedure violators. This type of product provides a "high tech" solution to the problem of waste segregation. Waste generators who never thought their waste segregation activities were being monitored now know that they are being watched closely. That fact makes a huge difference in how they segregate waste.

Medical Waste Volume Reduced by 40-50%

Montreal General Hospital in Montreal, Canada, has success with this system. Guy Sabourin is the Director of the Department of Housekeeping. "One of our sister hospitals actually installed the technology first," Sabourin reports. "I was very impressed with the results which they experienced. The system was easy to install and use. This was very important because we didn't want to spend a lot of time training our staff in a complicated tracking program."

Sabourin said, "We've had the program in place a little over a year and already we have seen a 40% reduction in the volume of our infectious waste. Our sister hospital, Royal Victorian Hospital, has actually experienced a 50% reduction in the volume of medical waste being generated. The individual waste generators are very impressed with the fact that we can so carefully monitor what is going into the infectious waste bags. We know if any inappropriate waste, such as newspapers or soda cans, are getting disposed of in the infectious waste bags."

Sabourin also likes the report capability and tailored the reporting mechanism to meet needs. He said they wanted to know what percentage of the infectious waste was comprised of animal anatomical, human anatomical and non-anatomical waste, and they generate monthly reports on these categories.

These systems have now created lease programs which allow hospitals to "cash-flow" the purchase. Paul Porteous of Chedoke-McMaster Hospitals has also installed this type of system. Porteous says, "We had heard that other hospitals had experienced a significant savings. The demonstration of the system proved to us that this program really could provide a benefit to our infectious waste management system. We've had the system in place only a short time but we are looking at experiencing a 30% reduction in waste volumes, already."

Service departments like the program because they feel they have control over their own budget. They now have the authority and power to inform waste generators that segregation has not been properly conducted.

Portious also mentioned that training staff was easy because of the way the program is designed.

One of the real advantages of this type of program is that it can generate savings whether the hospital decides to use a waste management firm or their own on-site processing equipment. This allows the time-old problem of inappropriate segregation of medical waste to be efficiently tracked and resolved. That spells savings for hospitals that use this type of system.

Whether hospitals decide to contract with an off-site waste management firm or use their own on-site processing equipment, they should consider using a new waste-tracking software system that can yield substantial savings for hospitals, said University of Iowa Safety Engineer, Michael Garvin.

Garvin recently reviewed the Waste Tracker^TM, which was developed by the Canadian firm Walsh Integrated Environmental Systems Inc., as part of his role as founder of the National Medical Waste Resource Center (NMWRC).

The system is easy to use.  Bar codes are placed in rooms where infectious waste is produced and on the infectious waste receptacles.  When a housekeeper picking up the waste notices a violation in the segregation of waste, that employee merely scans the bar code from the receptacle and then scans the bar code master list which identifies the infraction, Garvin explained.  For the first time, departments that generate medical waste are held accountable for properly segregating that waste, he noted.

At the end of the month or quarter, general reports can be issued and forwarded to internal safety or infection-control committees.  "Waste generators who never thought that their waste segregation activities were being monitored now know that they are being watched very closely," said Garvin.

Montreal General Hospital said it used the Waste Tracker^TM for a little over a year and witnessed a 40-percent reduction in medical waste volume.  The hospital's Guy Sabourin said the program showed what percentage of infectious waste was comprised of animal anatomical, human anatomical and non-anatomical waste.  Sabourin said the software program paid for itself in six months.

Royal Victoria Hospital used the Waste Tracker^TM to produce monthly invoices for every department, including correct weight and destruction costs, cost of boxes, bags and sharps containers, plus an allocation for overhead and the cost of the Waste Tracker^TM itself.  The hospital said it saved $200,000 a year.  According to Garvin, Walsh has created a lease program for the Waste Tracker^TM to allow hospitals to "cash-flow" the purchase of the system.

Another hospital, the Chedoke-McMaster Hospital, installed the software tracking system and experienced a 30-percent to 50-percent waste reduction rate.  The system at Chedoke-McMaster allows reports to be generated each day, and departments failing to segregate waste properly receive a fax alerting them of the problem the next morning.

"The information age has undoubtedly come to infectious waste management," said Garvin.  "Anyone who has worked in a hospital for any length of time knows the impact of that sophisticated of a reporting system.  It allows environmental service departments to quickly respond to problems with segregation of medical waste.  This allows the perennial problem of inappropriate segregation of medical waste to be efficiently tracked and resolved," he said.

On a related note, the National Medical Waste Resource Center was approved Feb. 20 to relocate to the University of Iowa Technology Innovation Center.  NMWRC performs assessment surveys for healthcare institutions to determine their medical waste handling requirements and then selects the technology to meet their needs.  For information, contact:  Michael Garvin, NMWRC, 319-335-4553.

An updated version of a biomedical waste tracking system is earning positive reviews in Montreal. Composed of off-the-shelf hardware, it's designed to be a turnkey operation, said Vice President, Dave Walsh, who runs Walsh Integrated Systems (Montreal) with brother Stephen.

The "Waste Tracker^TM " was put together by Montreal-based Walsh Integrated Systems (Montreal), and The difference from an earlier version is that it allows the hospital to generate waste reports on its own, rather than waiting for the reports from Walsh.

The machine is a handheld computer and scanner. Using bar codes, it allows hospital staff to weigh and record exactly how much waste each department produces.

"It's very easy for staff to use -- they don't have to key anything in," said Guy Sabourin, department head of housekeeping and laundry at Montreal General Hospital.

Recording waste

A quick visual inspection reveals who is putting regular waste in the containers and that information is also recorded. At the end of the day, the data is downloaded and reports generated.

"It records any misuse of the waste stream," said Sabourin, who praises the system for its sequential method. The system pinpoints problem areas, allowing managers to follow up with special attention as needed.

"Ours is an education-based system; we did a lot of work in biomedical waste audits and found more than half of hospital garbage was regular garbage," Walsh told IWN. Disposing of regular waste as biomedical waste is much more expensive.

Reducing costs

The system costs about C$40,000 and can pay for itself in about six months, said Walsh, noting the longest payback was nine months, while the shortest was six weeks. He estimates hospitals can reduce disposal costs by as much as 50 percent. It's in use in seven Canadian hospitals and Walsh is looking to expand internationally.

Sabourin first heard of the system from Montreal General's sister hospital, Royal Victoria, one of the first to use Waste Tracker^TM. "I was somewhat reluctant to use the system," he said, adding he didn't think the hospital had much of a problem with med waste.

The Washes convinced him that Montreal General could save money and make the system pay for itself. "And they were right," said Sabourin, estimating disposal costs are down to C$80,000 annually from C$135,000. (Walsh's site on the World Wide Web is http://www.walshmobile.com).

Stephen Walsh has learned some valuable lessons in the past few years about the importance of specializing when you are doing business in a cutthroat market.

The cofounder of Montreal-based Walsh Integrated Environmental Systems Inc. has focused on an extremely specific area - monitoring the amount of bio-hazardous waste produced by hospitals. That was not in his original plan, but through a process of trial and error, he has hit upon a niche where he thinks a new company can survive and even flourish.

In 1992, when the Montreal resident set up Walsh Integrated with his brother David, he was fresh out of business school and eager to start his own company. After a few months of research, he settled on the waste disposal business. But the brothers learned some hard lessons, fast. Initially, they focused their activities on waste hauling and recycling, but they soon discovered competition was suicidal fierce.

"Many people who get into this industry don't understand their costs," Stephen says. "Those who make money are the ones who drive their trucks the fastest."

In order to develop a viable company, the brothers realized they had to get out of the commodity side of the business and decided to concentrate on waste management.

"We saw an opportunity to differentiate ourselves by helping companies bring their waste disposal costs under control," Stephen explains.

The move led to a number of successful large-scale waste audits for companies such as Noranda Inc., Procter & Gamble Inc. and Northern Telecom Ltd.

But in 1992, during a 12-week waste audit at Montreal's Royal Victoria Hospital, Stephen saw a chance to narrow the company's focus even further, and decided to zero in on the hospital sector and the enormous amounts of bio-hazardous waste that they produce every day.

The waste - everything from blood bags to needles and human tissue - must be handled and disposed of in a strict, regulated manner that costs about 20 times as much as getting rid of regular waste. The thing was, many of the materials that ended up in bio-hazardous containers - pop cans, newspapers, even pizza boxes - didn't need to be there.

"We found that the hospital was spending close to $450,000 a year on bio-hazardous waste disposal, but 65 percent of this material was trash that could have been diverted to the regular waste stream, thereby saving $200,000 a year," says David, the company's vice-president.

Once the problem had been identified, the brothers faced the challenge of developing a solution. The answer they came up with was a device they christened the Waste Tracker^TM.

Stephen assembled the prototype Waste Tracker ^TM with the help of profits from the recycling business, his credit card and an assortment of hardware; a trolley equipped with a bar code reader, modem, computer, scale and an independent mobile electrical system.

Since then the company has invested about $300,000 to develop the system and is expecting revenue to reach $575,000 this year. Stephen says the Waste Tracker^TM should account for as much as 80 percent of the company's revenue in 1997. The Waste Tracker^TM uses bar codes like the kind used at the checkout counter of a grocery store to allow hospital staff to weigh and record exactly how much waste each department produces. A quick visual inspection reveals who is putting regular waste in the containers and that information is also recorded.

At the end of the day, the information is downloaded and hospitals receive weekly reports on how much bio-hazardous waste they are producing, where it is coming from and who is misusing the system.

The result is a reduction in disposal costs by as much as 50 percent.

All seven hospitals that have purchased the Waste Tracker^TM have achieved impressive cost savings. In one year, Royal Victoria Hospital reduced its bio-hazardous waste volume by 36 percent and cut disposal costs by 60 percent.

At Montreal General hospital, where the systems was installed in 1994, it paid for itself in five months, compared with the projected 18 months.

"The Waste Tracker^TM is an excellent and easy to use tool," says the hospital's head of housekeeping, Guy Sabourin. "Not only has it helped us dramatically cut our waste disposal costs, it can highlight problems, report on each department's progress and even give exact cost by area."

Now that they have developed a system that delivers results, the brothers face another challenge - marketing the Waste Tracker^TM to hospitals. Despite the Waste Tracker's success rate, the Walshes say hospital officials are often reluctant to make decisions. Hospitals are very bureaucratic environments and managers often have a "Why bother?" attitude," Stephen says, "Sometimes I feel like a kayak trying to redirect an oil tanker.

To try to speed up the process, the company offers a $5,000 rebate on the device's $40,000 price tag if a hospital buys it within four weeks of the company making its sales pitch.

The efforts are starting to bear fruit. The company recently concluded an agreement to install the Waste Tracker system in Hamilton's five regional hospitals. The new system will allow bio-hazardous waste from all facilities to be monitored from a central location.

Stephen is optimistic about other opportunities for the Waste Tracker^TM, especially in the United States. The company's World Wide Web page has also generated interest from as far away as Ireland.

"The $200,000 that the Waste Tracker^TM can save a hospital may only be a drop in the bucket, but with hundreds of hospitals in Canada - and ten times that many in the U.S. - these drops can add up to big savings," he says.

Computers in the healthcare industry-nothing new you say?  Maybe not, but users such as Montreal's 100-year-old Royal Victoria Hospital are pushing the boundaries to take advantage of an automated data capture systems, Royal Victoria uses ADC to help reduce its biomedical waste expenses and liabilities.

Last spring, the 550-bed healthcare and research facility took a hard look at the biomedical waste it was producing and made some important moves to cut costs, monitor waste and create a safer, more efficient work environment for employees.  With the help of Montreal-based Walsh Integrated Environmental Systems, it completed a thorough waste audit and revamped its waste reduction program to include an electronic waste tracking system.

Walsh combined its six years of experience in the waste management field with an automated data capture system and connected it through a relational database.  The company created the Waste Tracker^TM system to reduce expenditures and liabilities, and increase worker safety.

The collection of biomedical waste is a normal housekeeping function in the healthcare industry.  Before automation at Royal Victoria, some waste information was collected by a cleaner, then transcribed by a housekeeping secretary, okayed by the housekeeping manager and sent to finance where it was allocated to the various departments, and then billed.  The same information was also used to prepare shipping documents and government reports.  Unfortunately, all of the hospital's efforts were spent collecting and maintaining the data, and none were invested in reducing costs and increasing safety.

With the automated system, biomedical waste and all the necessary data for reporting and follow-up purposes, (such as weight, classification, time, data and problems associated with each box or bag of waste) is collected at the same time via bar codes.  Within the hospital, there is a Code 39 bar code check point in every waste-producing room.  As each biomedical waste box is picked up, its source and box ID is scanned by a Symbol Technologies PDT 3100 hand-held laser scanner.  Later on in the storage room, the boxes are weighed with a WeighTronix SC320 scale with a serial interface, scanned with the PDT 3100, and automatically labeled using a "Dangerous Goods Transportation" label printed by a WeighTronix 1155 printer.  Proprietary wiring and communications allow the PDT to communicate with both the printer and the scale at the same time. This allows recording of weights and printing of labels with one cable plugged in.

The information collected is managed in Paradox for Windows and downloaded to the Walsh data processing center each night.  Every night the data is analyzed, and reports are generated and faxed to the appropriate departments in the hospitals.  The data is the basis for a streamlined reporting process, reduced operating costs and a safer environment for the hospital's employees and patients.  "Without Auto ID, this level of detail would have been impossible to collect cleanly, manage efficiently and report upon quickly.  The Waste Tracker system allows an incredible level of detail, which is then translated into cost savings," says Carole Duhamel, Manager Materials Management at Royal Victoria.

"Producing internal and governmental reports is a long, detailed process," says Royal Victoria Hospital's Manager of Housekeeping Sylvie Boudreault.  "With the Waste Tracker^TM, the data we need is collected on a daily basis.  We can configure it to meet all our reporting needs."

Monitoring waste cuts costs

Recent waste management studies show that about 40% of waste in a biomedical waste stream is just normal trash.  "Every time a coke can or glove box ends up in the biomedical waste stream, hospitals are paying 20 times what they should to dispose of it," explains Walsh Integrated Environmental Systems President Stephen Walsh,  for facilities in a cost-cutting mode, that's a hefty price to pay.  With the information produced by the Waste tracker, Royal Victoria Hospital's administration can pinpoint the sources of biomedical waste and monitor the efficiency of each department.  Working with management, Walsh feeds back information on what each department can do to improve quality and minimize cost.  The system gives administrators the information they need to target delinquent departments and make improvements.  The system makes individual departments accountable for their biomedical waste expenditures, thus making the most of the hospital's waste disposal dollar.

"Like all businesses, we were looking for concrete ways to cut costs," explains Duhamel.  "In the healthcare industry, cutting operating costs such as waste disposal is more attractive than cutting patient services."

Since the Waste Tracker's inception, Royal Victoria has cut its volume of waste by 36% and its costs by 60%, from $450,000 annually to $180,000.  The hospital's payback time for the Waste Tracker^TM investment was under six months.

"If we encounter significant fluctuations in the amount of biomedical waste being produced by a department in a given period, we can pinpoint it and find out the reason for the variance," says Duhamel.  Accurate feedback is an essential part of continuous cost savings.  Departments are completely accountable for their own expenses.

The hospital estimates its savings at more than $1 million in the first five years using Waste Tracker^TM.

Reduces liability

Biomedical waste is a potentially hazardous material when handled improperly.  As Walsh explains, "disposal systems are only effective if they are implemented properly and followed up on a regular basis.  Problems can include improperly closed sharp containers, boxes leaking fluid or blood, or heavy boxes which could cause back injuries for employees when lifted."  Any potentially hazardous incidents are documented, and monitored.

By having these reports on a regular basis, hospitals can see the results of their waste reduction efforts.  Management can target departments that are jeopardizing the health and safety of cleaners from improper handling of biomedical waste.

Future systems

The success of the Waste Tracker system has allowed Walsh to expand and modify the system for other applications.  Walsh is currently developing an extension of the system that would allow waste haulers to automate their record collection, including customer activity tracking and planning,  and automated billing.  It is also working on a system using the same approach as Waste Tracker^TM that would allow hospitals to track and manager their lined and related expenses.

In addition, the company is developing a system for laboratories to provide them with on-site chemical management for active, stored and waste chemicals.  One of the features of this systems will be the availability of real-time inventory data that would be accessible to fire departments and emergency response teams.  This information will be faxed to the trucks en route, or will be available to them before they enter the building.

Automated Tracking

A Montreal company uses computer tracking technology to help several large hospitals keep accurate records of their biomedical waste streams.  The goal is to keep an accurate gauge as to what constitutes medical wastes, and to reduce costs for treating it.

The collection of biomedical waste is a normal housekeeping function in the healthcare industry.  Though using computers in this industry isn't a new concept, two Montreal hospitals are pushing the boundaries by having housekeeping employees use hand-held computers while doing regular collection duties.  The computer is also equipped with a bar code reader and label printer.

The Waste Tracker system, designed by Walsh Integrated Environmental Systems Inc., enables employees to collect data in an efficient way.

At each checkpoint, biomedical waste boxes are picked up, labeled, weighed, bar codes zapped in, and the room number recorded.  The information is stored in the computer, and data is downloaded for analysis and reporting.

This information is the basis for a streamlined reporting process as facilities no longer need to rely on transcribing and compiling data from handwritten sheets onto the appropriate reports.  Other advantages include reduced operating costs, and a safer environment for hospital employees and patients.

Reducing Waste Costs

Recent waste management studies show that nearly 40 percent of waste in a biomedical waste stream is just plain trash.  "Every time a Coke can or glove box ends up in the biomedical waste stream, hospitals are paying 12 times what they should be to dispose of it," says Stephen Walsh, President of Walsh Integrated Environmental Systems.  "Essentially, we're reducing costs associated with record keeping management by automating it all, and by getting people to change the way they act in classifying waste."

One facility, the Royal Victoria Hospital, also had thorough waste audit conducted by Walsh, and revamped its waste reduction program to include the electronic tracking system.  The results included increased safety for staff and patients, improved health care, and an annual savings of $200,000.

A Montreal company is using computer tracking technology to help several large hospitals keep accurate records of their biomedical waste streams.  The goal is to keep an accurate gauge as to what constitutes their med wastes, and to reduce their costs for treating it.

Walsh Integrated Systems has gotten positive responses from the two large Montreal hospitals it has sold the system to.

"We've gone to two hospitals and we've sold two systems," said company Vice-president, Dave Walsh.  The hospitals, Royal Victoria and Montreal General, have about 550 beds each.

Hand-held unit

The system, called the Waste Tracker^TM, essentially involves hand-held computers used by housekeeping personnel.  Containers and each room in the hospital are bar-coded, so there is an accurate reading as to where biomedical waste is being generated.

The company, which has developed an expertise in auditing the solid waste and recycling potential at other, non-medical institutions, has as its goal "keeping regulated waste out of the biological waste stream...people want to do something; it's almost like keeping a report card," said Walsh.

"Producing internal and governmental reports is a long, detailed process," said Sylvie Boudreault, Royal Victoria's housekeeping manager.  With the system, "the data we need is collected on a daily basis.  We can configure it to meet all our reporting needs."  The system feeds data into a central unit, which is sent to Walsh via modem, and the computer in turn provides weekly and monthly reports to the hospital as to generation rates and trends, said Steve Walsh, the company's president.  "If somebody wanted to, we could bill each bed or even each patient if necessary," he said.

60% savings reported

The company started in the medical waste field by using its auditing skill in an audit of Royal Victoria's waste stream, said Steve Walsh.  The hospital was spending as much as half the C$450,000 per year it was putting out on medical waste management (including boxes, etc.) on costs other than biomedical waste needs, he said.

The company then built a data base, analyzing  what was in the yellow bags (which are used in Canada instead of red bags) in the various hospital rooms.  There was often extensive misuse of the bags, said Walsh, which were sometimes stuffed with newspapers or their non-biomedical wastes that drove up the hospital's costs.

"Every time a coke can or a glove box ends up in the biomedical waste stream, hospitals are paying 12 times what they should be to dispose of it," said Walsh.  "Essentially, we're reducing costs associated with record-keeping management by automating it all, by getting people to change the way they act in classifying waste."

The hospital is paying about C$28,000 for the system, plus a few hundred dollars a month for reports, said Dave Walsh.  Since it utilized the program last year, Royal Victoria reports a reduction in its biomedical waste stream of about 36%, and its costs by 60% to C$180,000 down from C$450,000 per year.  The hospital ships its biomedical waste off-site to be incinerated by Laidlaw (Burlington, Ont.), Canada's largest waste company.