Issuu

VOL. VIII NO. 2

APR-JUN 2012

Medical Waste Management www.medicalwastemanagementnews.com

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Innovative American & Canadian Healthcare Providers Embrace Alternative/Renewable Fuels

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Infectious Waste Sterilizing Systems Bondtech Corporation – pg 13 The Mark-Costello Co – pg 10 OnSite Sterilization - pg 16 ReGen – pg 8 STI Biosafe – pg 7

Liquid Disposal Systems Bemis Health Care - pg 12

Shredders Shred-Tech – pg 5 Vecoplan LLC - pg 11

X-Ray Film Recovery Commodity Resource & Environmental, Inc. – pg 9 Ag Medical Systems - pg 15

Harvesting waste to generate electricity and heat is viable as demonstrated by North American hospitals; experts note that opportunities are waiting to be exploited.

Containerized Cogeneration System Photos courtesy of European Power Systems Ltd.

BY IRWIN RAPOPORT

hould North America decide to recycle waste to generate energy, much could be done via biogas and biofuel production to provide power to many public institutions and businesses and by taking such actions, extend the lifespan of landfills and create a paradigm shift in the environmental ethics of people, businesses and institutions. Based in La Crosse, Wisconsin, Gundersen Health System, which operates its main hospital in La Crosse and has regional hospitals and nearly 50 clinics in southeastern Minnesota, northeastern Iowa and western Wisconsin, has embraced energy conservation and alternative energy since 2008. This has resulted in reduced

heating and electricity costs, translating into more money that can be invested in healthcare services and reduced rates for individuals. It also promotes local economic growth. “The goal is to become energy independent by 2014. We started with energy conservation – 10 percent improvement in the first six months, 20 percent 12 months later and we’ve been holding steady at 25 percent,” says Corey Zarecki, Gundersen’s Director of Envision Engineering and Operations. “It’s the right thing to do. Energy conservation initiatives are very quick to implement, there are good paybacks and by reducing our energy consumption, it Continued on page 3

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PUBLICATION STAFF Publisher / Editor Rick Downing Contributing Editors / Writers P. J. Heller Irwin Rapoport Production & Layout Barb Fontanelle Christine Pavelka Advertising Sales Rick Downing Subscription / Circulation Donna Downing Editorial, Circulation & Advertising Office 6075 Hopkins Road Mentor, OH 44060 Ph: 440-257-6453 Fax: 440-257-6459 Email: downassoc2@oh.rr.com For subscription information, please call 440-257-6453. M e d i c a l Wa s t e M a n a ge m e n t (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited. Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95).contact our main office, or mail-in the subscription form with payment. ©

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brings down the amount of renewable energy and environmental protection initiatives. that we need to generate.” “If we can get this one to work as anticipated The non-profit organization is moving or better, then we’ll be able to do it with more fo r wa rd v i a i t s E nv i s i o n ® farmers and those with smaller environmental stewardship and herds,” says Zarecki. energy program. Gundersen He adds that as more We call our uses wind power via two fiveplans are brought forward, program two-sided green. megawatt facilities – one it is easier to bring in Lewiston, Minnesota government and industry Green for the environment and (operational) and another stakeholders together to green for the economy. in Cashton, Wisconsin realize projects. (soon to be commissioned). “We call our program The power generated from t wo - s i d e d g re e n ,” s ay s these facilities and others is sold to the Z a re c k i . “ G re e n fo r t h e local utility company, offsetting power used environment and green for the at Gundersen’s facilities. economy. For the long-term, the projects Solar panels are employed at a child care have to be sustainable and balanced. We’re facility at the hospital to produce 85 percent of constantly learning from our successes and its hot water heating. mistakes. Part of our mission is to help improve The first large biogas project was undertaken the health of the community. Our energy bill in 2009 with the City Brewery in La Crosse, one when we started this program was $6 million mile from the main hospital. The brewery had a and if we can eliminate it, then it can be passed digester and flared the gas it created. on to our patients and the community.” “We installed a cleaning system that allows The Valley Regional Hospital, part of Nova us to capture and clean the gas and send it to a Scotia’s Annapolis Valley Regional Health generator to produce electricity,” says Zarecki. Authority (AVRHA), has been using biomass to “It is connected to the grid and we also capture create steam and provide heat and hot water and the heat from the engine and exhaust and recycle run the laundry service since the facility was built that back to the digester, making that more in 1992. Currently woodchips cover two‑thirds efficient and thus create more methane. Last year of its energy needs, with the remainder provided we generated almost 500,000 kilowatt hours.” by heating oil. A landfill gas project close to Gundersen’s One ton of woodchips costs about $50 and Onalaska Campus (10 miles north of La Crosse) is the equivalent of nearly 400 liters of oil, which is also taking advantage of gas that was being is worth about $370 as of press time. flared. “We are using approximately 750,000 liters “La Crosse County installed a gas pipeline of oil a year,” says Angus Smith, the AVRHA’s (1.5 miles long) to our campus and the gas is Director of Engineering and Maintenance. fed into a generator that produces electricity “[Using woodchips] is a considerable savings and is connected to the grid,” says Zarecki. “The for us.” waste heat and exhaust is captured and sent to The woodchips, which come from the two of our large buildings. We’re essentially offCanadian province’s logging operations, are setting all of our electricity, heat, and domestic purchased via tenders. While the quality of the hot water requirements. The campus is now chips has partially declined due to changes in energy independent.” the logging industry, the supply remains viable A biomass boiler will be installed at the and many industrial plants use them to supply main hospital in late 2012. their energy needs. “We also hope to create a little higher “Our plan is to optimize the woodchip pressure steam and have a back pressure steam boiler,” says Smith. “We’re in the process of turbine to generate electricity,” says Zarecki, who looking at how we can upgrade the boiler, but the adds that a geothermal system is being installed technology is largely the same as it was in 1992.” on its new hospital under construction. Smith notes that as the price of oil remains Gundersen is also working with three in the $100 plus per-barrel range, the generated dairy farmers to pipe manure into a digester savings allow for more funds to be spent on to produce biogas, similar to a waste treatment medical services. plant that will not only generate electricity, but But he adds that burning woodchips is not also compost bedding and/or potting soil and as clean as burning oil and that a cyclone filter at the same time, remove phosphates that could removes the fly ash and other particles. The pollute lakes and rivers, which state departments chips are placed in a bin and automatically fed of the environment and natural resources into the boiler. appreciate. These departments also appreciate Also in Nova Scotia, the Northside General Gundersen’s overall goals in terms of recycling Continued on page 6 APR -JUN 2012 Medical Waste Management

medical waste management

Planning for the Future – CRE’s X-Ray Vision BY P.J. HELLER

arry DeWitt can certainly be excused for not being the biggest fan of digital technology. After all, Commodity Resource and Environmental (CRE), the business he founded 32 years ago and which has grown into one of the world’s leading silver recovery companies, has watched as digital technology has replaced silver-based films in a variety of applications. In graphic arts and publishing, for example, the volume of silver-based film handled by DeWitt’s company has fallen from as much as 30 percent to about 5 percent today as the industry has jettisoned film and transitioned to computer-to-plate technology. Even more dramatic has been the move away from camera film — witness the situation with Eastman Kodak Company which has filed for bankruptcy protection — to digital cameras. “Not many people are shooting film in their cameras any more,” DeWitt notes. “I was the longest holdout on that just because of my business . . . but I’ve had a digital camera now for about eight or nine years.” DeWitt sees much the same thing ultimately happening to X-ray film, even though the volume of that material processed by CRE has steadily

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increased over the last five years. The company currently processes some 2.5 million pounds of X-ray films monthly. Of that amount, about 45 percent is film jackets and associated paperwork with the balance being film for silver recovery. The company also accepts shredded film. The biggest increase in volume, which he describes as a “major spike,” came in 2011, with the financial collapse of Gemark Corp., a major precious-metal refining company in New York. Gemark and seven affiliated companies has since filed for Chapter 7 bankruptcy. “Even though we had steadily grown over the last four or five years at a nice rate, this was a big spike,” DeWitt says of the Gemark material. “We weren’t prepared for it. “We always have contingency plans, a lot of which are based on a crisis in wrong direction,” he adds. “This was a crisis in the right direction.” To handle the increased volume, CRE added three new buildings and increased capacity and ramped up staffing at its plant in Mojave, about 90 minutes from the company’s headquarters in Burbank, Calif. “For awhile we had a horrendous backlog, but once we got the buildings up and the staff trained, we were able to increase production enough to handle not only what was coming in on a regular basis, but to reduce the inventory backlog we accumulated because of the spike in the business,” DeWitt says. By the fall of 2011, the workload stabilized. While hospitals, medical facilities and document management companies still have decades of stored X-ray films that eventually will need to be destroyed, DeWitt sees a diminishing market as digital continues to make inroads. “Five years ago, if you were interviewing me, I would have said it’s a maturing business,” says DeWitt, who uses the same description to describe the situation today. Twenty years ago, he gave the market another 10 years before predicting its demise. Today, he makes the same prediction. As the market changes, with X-ray film eventually going the way of graphic arts and photo films, he expects CRE will change with it. “Hopefully we’re smart enough to plan beyond that,” he says. “We will still be in business but it won’t be in the business we are in now. We’re not in the business as it existed 20 years ago or even 10 years ago. But 10 years from now, we won’t be in the business as it exists today.” “You can’t sit still,” he adds. “You have to keep moving forward. You have to have plans . . .” DeWitt has already made some moves to remain viable in the future. Chief among them was to begin offering document destruction services at CRE for film jackets and radiology reports. “Our primary goal was to get the film with the silver on it, but the marketing part was having the in-house capability to destroy the records that accompany the film,” DeWitt explains. “It gave people more reason to use us as their silver refiner. It has been a very big plus for us.” Along with the effort, CRE became the first silver refiner in the U.S. to be NAID certified. NAID (National Association for Information Destruction) is the international trade association for companies providing information destruction services. CRE also became heavily involved with PRISM (Professional Records & Information Services Management), the trade association for the commercial information management industry. “The X-ray films themselves are not NAID certifiable, but most of the X-ray films we get, whether from a hospital or a records storage company, come in jackets with the X-rays inside the jacket along with all the radiology reports,” he says. “So we started emphasizing our HIPAA (Health Insurance Portability and Accountability Act) compliance, then moved forward with getting certified by NAID.” The company also constructed another building and purchased a shredder and an auto-tie baler. Continued on next page

medical waste management Continued from previous page “We started promoting the fact that not only were we NAID certified but we were the only refiner destroying records in-house, not sending them out or overseas,” DeWitt says. After shredding the documents, the paper is sold to mills in the U.S. DeWitt adds that nothing that is sent to CRE ends up in a landfill. After the silver is removed from X-ray films, the remaining PET plastic is sent to recyclers. And after silver is removed from photo processing chemicals, the resulting industrial waste is sent to evaporation ponds at a waste facility. CRE in the last year also purchased chopping equipment to handle micromedia, such as microfilm and microfiche. It reduces the material to NAID-mandated chop size of one-eighth of an inch. It also installed a grinder for hard drive destruction. Those purchases were all part of phase one of a multi-phase plan for document destruction. The other phases had to be put on hold when business spiked in 2011 due to the Gemark situation. DeWitt notes other reasons why the business has continued to grow, including the fact that smaller, less environmentally friendly refiners have disappeared from the scene. Rising silver prices have also encouraged companies to purge films they are no longer are legally required to maintain. Eliminating those files also frees up much needed valuable space in hospitals, medical facilities and document storage facilities. CRE is able to source those documents based on referrals and its reputation in the industry. Newcomers may find it somewhat more challenging, DeWitt says. That’s because some people got into the market when silver prices were rising, collected the films, and then disappeared without ever paying their clients. “They appear when the market is up and disappear when the market is down,” he says. His advice to medical facilities, hospitals and document storage facilities is “to do your due diligence. Make sure the company you’re dealing with is legitimate.” DeWitt admits it’s difficult to predict where silver prices will go in the future. The swings in silver prices are the result of “so much turmoil right now in Europe and even our own country as far as value of dollar,” he says, adding that many of the increases and decreases in silver prices are due to speculation, just as with the price of oil and other commodities. “These are all commodities . . . a lot of them are highly speculative,” he says. As far as a forecast for 2012, DeWitt puts silver at $35 an ounce. Within three years, he predicts the price will hit $40 an ounce. One prognosticator, he notes, pegged the price of silver at more than $200 an ounce by 2013. “Nobody knows for sure. If I knew all those answers (concerning the price of silver), you’d be calling me long distance to my beach house in the Caribbean,” he says with a laugh. CRE pays clients either “spot pay” or on a “refining basis” for their X-ray film. Spot pay is based on the net weight per ounce of silver in each pound of film multiplied by the CRE Tradable Silver Market on the date of receipt. An average film lot of .04 ounces per pound and a silver market rate of $32.79 would equal a spot payment of $1.31 per net pound; a shipment of 10,000 pounds of film would result in a payment of $13,100. Clients who elect to be paid on a refining basis have their payment based on the net silver yield in the process, minus a per pound refining charge. This can result in higher payments for clients whose films have higher silver content due to age, exposure or brand. CRE guarantees the payment on the refining basis will not be lower than the spot pay. With CRE seemingly well positioned for the future, DeWitt, who is 71 years of age, may take a step back and “slow down.” He has had offers to sell the business in the past and has also looked into the possibility of selling it to the employees, many of whom have been with him for years. With the inroads of digital, there is still one thing that he hasn’t been able to solve. “I haven’t figured out a way to recycle pixels yet,” he says with a laugh. (More information about CRE can be found on its website at www.creweb.com.)

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Innovative American & Canadian Healthcare Providers Embrace Alternative/Renewable Fuels

Continued from page 3 possibility of using biogas and this year construction is expected to Hospital in North Sydney, Cape Breton, part of the Cape Breton Regional begin on the digestion system, which should take about 12 months to Health Authority (CBRHA), will purchase energy from a biogas system become operational. that will derive fuel from 7,000 tons per-year of sewage sludge, food waste “The hospital was quite excited about the process and people at the and compost. CBHRA are always looking for ways to innovate,” says Miller. “They Halifax-based BioGas Energy Inc. designed and will install a system looked at our plant which we have been running for three years and is now to convert the waste via an anaerobic digester. used primarily for research. We’ve tested a variety of materials, including “We’ve created a unit that will capture a number of things,” says Dave carrot, onion, and blueberry waste, as well as mink manure. The authority Miller, a partner and the company’s vice president of business development. has asked us to consider adding another hospital for biogas use, but we “With biogas, we’ll separate and purify the methane and the CO2, but we have to make sure that we have enough waste to provide its fuel needs in also produce a biomass which comes out of the backend, which we will the long-term.” gasify in a unit that creates heat or steam. The mixture of fuels that we BioGas’s system will purify the methane and the CO2 and strip it out will use, 60 percent will be from organics from the industrial/institutional/ for sale as a commodity. commercial sector, as well as biosolids from a sewage treatment plant and “A lot of anaerobic digesters built in Canada take the biogas and burn ‘compost overs,’ a material that is screened out by compost plants.” it to generate electricity,” says Miller, “but what happens with that process The digester will either be located off-site from the hospital and the is that the methane burns and the CO2 is released into the atmosphere.” methane will be shipped to it via “bullets” or a gasification unit will be There is a possibility for BioGas to sell the liquid stream as a fertilizer placed adjacent to the hospital. to farmers as most of the pathogens have been removed during the process; The goal is to completely replace the one million liters of no. 2 and to put it through the sewage system to be processed as water if the fuel oil with biogas. A 20-year agreement has been signed with the BOD is low enough. regional municipality to secure the waste material and another 20-year The company is also in discussions regarding five new possible projects agreement will soon be signed with the CBRHA to purchase energy from in Nova Scotia and neighboring provinces. BioGas’s system is a proven Miller’s company. The hospital is expected to save between $100,000 and success with the food industry and those who have a need for a large $150,000 annually. thermal load. Should the system receive more waste than it can handle, Miller “We can take this anywhere,” says Miller, who adds that this is the first notes that he “would look at a third party technology. We know how far hospital project he has worked on. “Our system is different from digestion we can go with our system.” TheWaste CBHRA contacted BioGas 2.5Advt:Layout years ago to discuss the Medical Mgt Mag 5.125h x 8.375w Color 1 7/16/2010 4:26 PM Page 1 Continued on next page

No Room For Error Do you know what the new pharmaceutical regulations are? Clean Harbors does and can help keep you in compliance. Since 1980, Clean Harbors has been providing comprehensive and customized waste management services to hospitals and healthcare institutions across North America. For more information call 888.304.7035 or email healthcareservices@cleanharbors.com www.cleanharbors.com/healthcare E X P E RT I N - H O U S E 6

P H A R M AC E U T I CA L

Medical Waste Management APR -JUN 2012

H A Z A R D O U S

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medical waste management Continued from previous page systems used in Ontario and British Columbia because they tend to be farmbased and do nothing but take biogas and create electricity that they sell to the grid because there are feed-in tariffs, whereas, with our system we can use multiple waste streams, mix and match and create recipes to find the best mix to provide the highest yield of biogas, as well as multiple revenue streams.” While Mississauga, Ontario-based European Power Systems Ltd. has not been involved in hospital projects, its president and CEO, Jan Buijk, Ing., says the potential to develop opportunities to generate biogas and biofuels are many and should be pursued. “All our sales last year were biogas and landfill gas projects,” he says. “We definitely see a move to put as little into landfill sites and to start equalizing organic materials and this could be done with anaerobic digesters and composting facilities. We sold a project last year to Fraser Richmond Soil and Fiber in Richmond, British Columbia where green municipal waste goes through a composting process that produces methane for use in our cogeneration system.” European Power Systems specializes in developing cogeneration projects that use biogas for the generation of power and heat, also referred to as combined heat and power (CHP) systems. These state of the art cogeneration systems are manufactured by 2G-Energietechnik from Germany who have worldwide already supplied more than 3000 such systems. Buijk notes that as more projects are approved and fulfill their potential, it is easier to bring various stakeholders together to work out the details and permit process because there is recognized consensus to

use more alternative fuels and help the environment. This is reflected by provincial governments that are pursuing strategies to develop alternative fuel projects and produce more of its power needs domestically. The State of California has led the way in the United States on this front. “The Ontario government created a Green Energy Act and following that, started [various] programs where a rate structure was created that will pay a premium for renewable resources such as wind, solar, water power, landfill and biogas,” says Buijk. This is helping to facilitate the transition from fossil to renewable fuels and projects are being developed in response to it.” And as technologies improve to better harvest renewable resources to create energy, “the more widespread the use is and the more attractive the economics are,” says Buijk, “and the more reliable these will get.” B e c a u s e t h e wa s t e g e n e rat e d by i n d u s t r y, c o m m e r c e a n d t h e residential sectors is constant and stable, he adds that it makes sense to create systems to harvest these materials and divert them to processing centers. “It’s all about the resources out there that can be utilized,” says Buijk. Zarecki agrees with Buijk, who serves on the Department of Energy’s Hospital Energy Alliance Steering Committee. “We are trying to promote conservation and alternative energy use with all healthcare systems across the country,” he says. “I came to Gundersen in 2008 and alternative energy was a little side thing that we started working on. It turned out to be an opportunity to really work on something that not only saves money, but is something that can really change the country and ultimately the world in reducing health care costs, improving our energy independence and improving the environment.” Continued on page 8

www.STIBiosafe.com APR -JUN 2012 Medical Waste Management

medical waste management

California Nonprofit Wins Award for Environmentalism

Innovative American & Canadian Healthcare Providers Embrace Alternative/Renewable Fuels Continued from page 7

Gundersen is also spreading the message to other hospitals via a consulting service it started to provide information on how to lower costs by conserving energy and how to successfully initiate alternative energy projects. As it expanded its renewable energy program, it began to receive many information requests from the medical community. “We do it at a reasonable price to cover our costs,” says Zarecki, “and that they have somebody they can trust – we’re somebody in the healthcare industry who knows what works and what doesn’t. If they get serious about conservation, they almost always ask about renewable energy.”

an Leandro, Ca—MedShare, a nonprofit agency that collects and redistributes surplus medical supplies, recently won Acterra’s 2012 Business Environmental Award for innovation with its plan to keep medical waste out of landfills. The non-profit diverted 228 tons of surplus such as sutures, gloves, gauze and syringes from local landfills in 2011. MedShare has more than 30 Northern California hospitals participating in its innovative program to collect reusable medical equipment and supplies that would otherwise be discarded and redistribute them to health care facilities in developing countries and to community-based health care clinics in its home state. Donating systems include KaiserPermanente, Sutter Health and Dignity. In its 14 years, the organization says it has shipped 750 cargo containers of supplies to hospitals in 93 developing nations, accounting for more than two million cubic feet of landfill space saved. The organization’s headquarters and its first distribution center opened in Atlanta in 1998, and the San Leandro distribution center is its second. For more information visit www. sanleandro.patch.com.

Links on Alternative Fuel Use by Institutions and Businesses The following links shed light on the use of alternative and biofuels in the United States and Canada, as well as providing information and definitions of various technologies. From the Department of Energy www.eere.energy.gov/buildings/energysmarthospitals/ From the Gundersen Health System http://www.gundluth.org:80/?id=4653&sid=1 From the Government of Nova Scotia http://www.gov.ns.ca/energy/renewables/public-education/bioenergy.asp https://nsrenewables.ca:44309/bioenergy-definitions From Go Green Canada http://gogreencanada.ucoz.com/index/biofuels_and_bioenergy/0-110 European Power Systems Ltd. www.epsenergy.ca

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news briefs

Feds First Settlement on a Data Breach Costs BXBS of TN $1.5 Million

ashington—BlueCross BlueShield of Tennessee will pay $1.5 million in the federal government’s first case resulting from a health care data breach reported under a part of the 2009 stimulus bill. It is the first action resulting from a breach report required by the Health Information Technology for Economic and Clinical Health Act, part of the 2009 stimulus package. Some 57 external hard drives were stolen from a BlueCross BlueShield of Tennessee Chattanooga call center in 2009 and data on them included Social Security numbers, sound recordings and screen captures from customer service calls. The drives were never recovered, but there been no indication the data was misused. The company did not formally admit wrongdoing in the matter. This fine is on top of what the insurer spent notifying customers and changing data security practices, a reported $17 million dealing with the breach of personal information belonging to more than 1 million people. That includes some $1.5 million paid to the U.S. Dept. of Health and Human Services Office of Civil Rights in a settlement. The company paid for one year of credit monitoring and protection for those people, with more intensive services for those whose Social Security numbers were stolen, and $6 million to encrypt every piece of stored data, as well as ensuring employees are trained to protect privacy. “This settlement sends an important message that OCR expects health plans and health care providers to have in place a carefully designed, delivered and monitored HIPAA compliance program,” OCR Director Leon Rodriguez said in a news release. For more information visit www.ama-assn.org.

New Robotic Drug Delivery System Maximizes Resources, Reduces Errors and Waste

sheville, TN—Mission Health recently debuted a central fill pharmacy using one of the country’s first Robotic IV Automation systems, or RIVA, using high-speed robotics, packaging machines and carousels to fill patient medication orders. The million-dollar technology lets the system produce in-house, individualized syringes and IV bags, and RIVA barcodes individual packages, so delivery is faster, safer and easier to verify. The system thus works to reduce medical waste caused by having unused portions of medication and keep the meds viable longer. RIVA can make varying sizes of IV bags and portion out meds in a sterile environment, so meds can last longer with less risk for infection from humans. This is good for not only the health system but for society as a whole because it is claimed there are inadequate supplies of almost 200 medications used in surgeries and hospitalizations. The pharmacy will eventually become the main hub for all medications and serve the entire health system. For more information visit www.citizentimes.com.

Pennsylvania Hospital Goes Green with Building Practices, Recycling

o r t h C e n t r a l , PA — E va n g e l i c a l Community Hospital is working to reduce its carbon footprint in ways that include recycling over 155 tons of recyclable cardboard, magazines and catalogs, newspaper, office paper, clear glass, aluminum cans, and plastics as well as copper, antifreeze, batteries, computer systems, fluorescent tubes, and used oil. It has also constructed a new Surgical and Cardiovascular Expansion that opens this summer to include water efficient landscaping, daylighting, equipment efficiency, flooring with no petroleum-based adhesives, low-VOC paint, lighting and thermal control. The elements included in the design, construction and renovation of the building let the hospital operate more efficiently in the future and integrate green strategies and initiatives right from the start. The changes are the result of employee efforts, led by a Green Team committee that started in 2009, to reduce the hospital’s impact on the environment and advocate for actions to reduce energy. The team continues to work toward that goal. The campus of the hospital is also free from tobacco and cigarette butt waste. Fo r m o r e i n f o r m a t i o n v i s i t w w w. northcentralpa.com.

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news briefs

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ccording to a report in Plastics News (www.plasticsnews.com), Kimberly-Clark Corp and the recycler, TerraCycle, will be adding gloves to the mix of recycled hospital clean room and laboratory garments that are made into plastic lumber, park benches, and picnic tables. TerraCycle collects, converts, and resells all waste materials as either bulk plastics or as consumer products made with recycled content. Since the two companies began the pilot recycling program in October 2011, participating clean rooms and laboratories have contributed more than 7,000 pounds of garment waste, including coveralls, hoods, boot covers, hair nets, and masks. Requests for the collection of recyclables is increasing and the companies say they expect to recycle some 350,000 pounds in coming months. To participate in the recycling program, companies can contact approved Kimberly-Clark Professional distributors to receive a package that has everything required to start garment recycling in their facilities. The package includes a bar code system for tracking and reporting of each customer’s waste reduction.

Gallup Hospital Cited for Hazardous Waste Handling

allup, NM—The Gallup Indian Medical Center has been fined $36,000 by the state Environmental Department, according to the Gallup Independent. Violations include improperly bagging and transporting infectious waste. The 99-bed hospital, one of the largest in the U.S. Indian Health Service, treats American Indians and Alaskan Natives. For more information visit www.krqe.com.

CVS Hit with $13.75 Million Settlement for Hazmat Violations

www.bomaccarts.com 10 Medical Waste Management APR -JUN 2012

ccording to The Daily News (www.dailynews.com), Rhode Islandbased CVS Pharmacy, Inc. agreed to a $13.75 million settlement for violating California environmental laws. The company also has put in place environmental policies and training at all stores and hired contractors to handle hazardous waste. CVS allegedly violated regulations for safe storage, handling and disposal of pharmaceutical, pharmacy waste, photographic chemicals and waste generated from spills and customer returns of hazardous products. California health inspectors and prosecutors began looking into the chain’s hazardous material handling practices in 2010, after a similar investigation in Connecticut turned up problems with stores there. After California inspectors found and recorded evidence of violations going back more than seven years, they worked with CVS stores to correct storage, handling, transport and waste disposal practices to ensure compliance. The settlement agreement was ordered by Ventura County Superior Court Judge Barbara Lane and negotiated by the Ventura, Los Angeles and San Diego county District Attorneys, and Los Angeles City Attorney Carmen Trutanich, on behalf of 45 different jurisdictions. Under the agreement, Trutanich’s office and other lead negotiators each will receive $950,000 in civil penalties. Dozens of fire and environmental health departments across the state will receive smaller amounts for participating in the investigation. CVS is permanently enjoined from violations of state environmental laws. “CVS came to the table early and worked quickly to get into compliance,’’ said Santa Clara County Deputy District Attorney Tina Nunes-Ober. “The result is a cleaner, safer environment and a level playing field for all similarly situated businesses.”

news briefs

Dignity Health Practices Green Health by Eliminating Plastics Dyes

OCR Audits Target Healthcare Entities Now, Partners in the Future

anta Cruz, CA—Some 1,200 hospitals are now members of Practice GreenHealth (PGH), a nonprofit that is promoting environmental practices in the health care industry. They use their purchasing power to compel makers of medical products to manufacture them with safer chemicals. Practice GreenHealth has now signed on 15 businesses, including Medline and Johnson & Johnson, to green the supply chain by identifying problematic materials and working to find alternatives that reduce or eliminate negative environmental effects. Dignity Health, the fifth-largest health care system in the nation, is one of these PGH health care systems, and it says it is the first that will move to use dyefree plastic products such as bed pans, wash basins and drinking cups by the end of May. During the past five years, water use has been reduced systemwide by 9.8 percent, according to Dignity Health data, and it hope by 2020 to cut systemwide energy use 20%, buy 35% of energy from renewable sources, and cut greenhouse gas emissions 40% at each hospital. One hospital, Dignity’s Dominican Hospital in Santa Cruz, has been recognized by the State of California for its recycling efforts and organic garden. The hospital uses intravenous bags made without phthalates, a chemical that produces developmental and reproductive system damage in lab animals. Such phthalates as well as 179 other chemicals that cause cancer in humans or animals, had been found in umbilical cord blood from newborns treated in NICUs,. Dignity Health has also diverted in 2011 almost 100 tons of medical equipment from landfills, saving $5.6 million. It eliminated 1.3 tons of red plastic and 73,000 tons of corrugated packaging waste through the use of reusable sharps containers. For more information visit www.mercurynews.com.

leveland—The nationwide audit program of the Office of Civil Rights (OCR) to find and correct violations to HIPAA/ HITECH compliance have never been higher for medical care providers, insurers and the businesses that support them, says Stacy Chubak Hinners, an attorney at Buckley King LPA, in a recent issue of Corporate Compliance Insights. The act extended oversight of HIPAA to business associates of covered entities like billing agencies, law firms and accountants and made them subject to even larger criminal and civil penalties under a four-tier system. Last year, says Hinners, OCR reached a $1 million settlement against Massachusetts General Hospital after an employee left records of sixty-six patients on a subway and imposed an $865,000 fine against the University of California Los Angeles Health System when some employees looked at celebrity patients’ medical records. This year, enforcement and penalties are expected to grow even higher under a proactive Privacy & Security Audit Program, as KPMG conducts random audits under a $9 million contract, this year for health care providers, insurers and clearinghouses but to be extended after this to other business partners. It is important for covered entities and their business partners to be ready by ensuring that HIPAA privacy and security protocols are in place and updated to HITECH’s requirements, that employees are following them, and that compliance efforts be documented and accessible. Go to www.corporatecomplianceinsights.com/hipaa-compliance-why-stakeshigher-now-than-ever-before for more.

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news briefs

Study: Do Digital Records Cut Health Costs?

esearch published in Health Affairs (www.healthaffairs.org) has found that doctors using computers to track tests, like X-rays and MRI, ordered far more tests than doctors relying on paper records. The study showed physicians with computerized access to previous image results ordered tests on 18% of their visits, vs. 12.9% for those doctors without the technology, a 40% higher rate. The gap was 70% for more expensive image tests such as MRIs and computerized tomography scans. The research was based on a survey by the National Center for Health Statistics using data from more than 28,000 patient visits by more than 1,100 doctors. This means, to some, that computerized patient records may not be the road to cutting health care costs. It has been promulgated by the RAND Corporation that electronic health records could generate as much as $80 billion a year in cost savings as a way to justify the amount of federal spending that has gone into a switch to digital health records. The data were from the National Ambulatory Medical Care Survey, which is an assessment of how medical care is practiced and included any kind of tracking images, no matter how old or isolated the function, while today’s electronic health records are meant to give doctors an integrated view of a patient’s care. The study did not ask why physicians in computerized offices ordered more tests and is seen as a minority opinion when other studies are looked at. A study published last year in Health Affairs surveyed articles in professional journals in recent years on electronic health records and found 92% were positive about the efficiency and quality of care offered by electronic records.

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12 Medical Waste Management APR -JUN 2012

Report: Does HIPAA Add to Security? Trends in Security Explored

ashington—A new report, the 2012 HIMSS Analytics Report: Security of Patient Data, the third part of Kroll’s bi-annual survey of healthcare providers, finds that a decade and a half after the Health Insurance Portability and Accountability Act that increasing compliance with the act has not contributed to increased security of healthcare data. It reports a rise in data breaches in the past few years in the face of increased regulatory activity concerning reporting and auditing procedures. The report was commissioned by Kroll Advisory Solutions. Respondents in the 2012 survey said they were more prepared than before to meet data security risks, a 6.40 rating on a scale of one to seven, compared to 6.06 in 2010 and 5.88 in 2008. Some 96% of respondents reported that they had held a formal risk analysis at their organization in the past year. Despite this, more respondents, 27%, reported a security breach during the year, up from 19% in 2010 and 13% in 2008. The 2012 reports that human error remains the greatest threat to healthcare data security, with 79% of security breaches perpetrated by employees, and 56% of reported breaches due to unauthorized access to information by an employee. The mobility of patient data due to new technologies such as mobile devices is another leading factor in healthcare data breaches. Plus, due to outsourcing of patient data, third party breaches are up. Some 18% of breaches were due to third parties access, and 28% said “sharing information with external parties” is cause of risk to data, up from 18% in 2010 and 6% in 2008. Lisa Gallagher, senior director of privacy and security for the Healthcare Information and Management Systems Society, said “Healthcare organizations need to ensure that their business associates are taking every precaution to safeguard this information. We know that most security breaches often are the result of actions taken by employees, so background checks, employee training and continued monitoring of policies and procedures are steps all covered entities should ensure are taken by their business associates.” There continues to be confusion about who is responsible for data security. When asked which individual within their organization was responsible for the security of patient data, the answers ranged dramatically. Responsibility is becoming more widespread throughout the industry, and everyone from cleaners to physicians comes into contact with patient data in formats from computers to paper records to mobile devices. A copy of the 2012 HIMSS Analytics Report: Security of Patient Data can be found at www.krolladvisorysolutions.com.

news briefs

Are Privacy Curtains Source of Hospital Infections?

esearch recently published by the American Journal for Infection Control (www.ajicjournal.org) reveals 92% of hospital privacy curtains were contaminated with potentially dangerous bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococcus) within one week of being laundered. This research, conducted at the University of Iowa Carver College of Medicine, advances a growing body of knowledge pointing to contaminated surfaces within the patient environment as a potentially strong contributor to healthcare-associated infections. The same research group recently submitted for publication a follow-up, randomized, controlled study, examining the effectiveness of PurThread privacy curtains in a clinical setting. The study, titled, “Hospital Privacy Curtains are Frequently and Rapidly Contaminated with Potentially Pathogenic Bacteria,” monitored 43 privacy curtains over a three-week period in a medical ward, surgical intensive care unit and a medical ICU. Privacy curtains were chosen for the study as they are frequently touched by healthcare workers before coming in contact with patients, and because the curtains are difficult to clean and disinfect. As such, in most hospitals, privacy curtains are infrequently changed, often only after dirt is visible. Studies show 20%-40% of HAIs can be traced to the contamination of healthcare worker’s hands. The immediate action healthcare workers can take today is to wash their hands after touching privacy curtains and before touching the patient. In addition, a developing market for antimicrobial products, for both soft and hard surfaces, holds the potential to help hospitals continuously reduce infectious material on frequently touched surfaces.

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Drug-Resistant Microbes are Found in Soils Due to Use of Antibiotics in Animal Care

arsaw, Poland—According to a study by researchers at the University of Warsaw, antibiotics used in animals are being seen as the culprit in the rising incidence of drug-resistant bacterial diseases among humans, as these antibiotic-proof pathogens are found in the soils of the natural environment. The researchers tested soil samples from farms, gardens, composted soil and forest soil and found that the biggest diversity of antibiotic-resistant bacteria was found in vegetable garden and fruit orchard soils which had been treated with manure from antibiotic-fed animals. The soils not treated with manure, such as forest soil and plant compost, carried the lowest levels of drug-resistant microbes, and bacteria resistant to multiple drugs was found only in the vegetable garden soil. Although antibiotic residues are created naturally in soils, the rate of resistance to human drugs was higher in the soil treated with manure than the rate that occurred naturally in soils. Of the bacterial cultures examined in the study, 43% were resistant to streptomycin, 35% to erythromycin and 10% to tetracycline. Domestically, some 80% of all antibiotics are used for food animals. First author Magdelena Popowska said that the findings “should assist in the development of regulations regarding the use of antibiotics in the broader environment e.g. in plant protection products, fish farming and industry,” and that the use of antibiotics “should be restricted to dangerous bacterial infections, and to strict medical supervision. This cannot be emphasized strongly enough.” The FDA recommends that drugs important to human medicine not be used for animal growth promotion and be supervised by a veterinarian when used to prevent or treat animal disease, but these guidelines have not been finalized. The FDA withdrew its plan to ban tetracycline from use in animal feed last year.

www.bondtech.net APR -JUN 2012 Medical Waste Management 13

news briefs

Florida Residents Fight Integrated Waste Management Incinerator

Healthier Hospitals Initiative

acksonville, FL—A proposed medical waste incinerator facility in Baker County, being planned by the Pennsylvania-based Integrated Waste Management Systems, is being opposed by some county residents. A Baker County Press poll found 54% of respondents said any new development or jobs would be welcome, and only 29% were worried about the potential impacts to the environment. The project is being touted as a job creator, and the country only has 57 active bio-medical waste facilities, with Florida having only one left for open use. IWMS did extensive needs analysis of areas with multiple major medical facilities and access to major interstate systems, including Georgia and Ohio, but Baker County won out. IWMS representatives said the facility complies with very stringent 2009 federal air emissions regulations, which become fully effective in 2014. In addition, they intend to implement a number of safety protocols to manage potential risks. For more information visit www.bakercountypress.com.

Medical Suppliers Shirking Green Duties, Says Report

recent study by Green Research, “Benchmarking Sustainability Goals and Practices: Medical Equipment and Supplies,” found only four of the top 10 manufacturers of medical equipment and supplies have publically announced any environmental sustainability goals. They are Baxter International, BD, Covidien and Medtronic, all of whom have released specific, quantitative goals. Boston Scientific, Smith & Nephew, St. Jude Medical, Stryker, Thermo Fisher Scientific and Zimmer Holdings have not released any such goals. Waste management was the biggest environmental area addressed by the four, and they expressed only three goals related to greenhouse gas emissions, which many other industries find a higher priority. Sustainability also included issues such as social, ethical and social responsibility programs, but the environmental goals are the ones most often quantified. And even though the companies have set environmental goals, they are usually focused on internal operations. Green Research also examined how the manufacturers show sustainability program information on their websites. Baxter and Medtronic provided the most comprehensive information about thirdparty assurance, reporting of key data and provision of sustainability contact information. The report did praise Stryker and BD for creating businesses that reclaim, recycle or remanufacture used medical products, which also helps hospitals reduce waste and creates a new revenue stream. The report can be purchased at shop.greenresearch.com/products/benchmarkingsustainability-goals-and-practices-medical-equipment-and-supplies.

Central Line Infections Decline in U.S. Hospitals

tlanta, GA—According to a recent Reuters article, data from the Centers for Disease Control and Prevention point to a significant reduction in “central line” bloodstream infections. “Nationwide, there was a 32 percent decline in central line bloodstream infections from 20092010,” says Dr. Scott Fridkin, deputy chief of the surveillance branch in the CDC’s Division of Health Care Quality Promotion. A central line is a treatment tube that is inserted into a large neck or chest vein. Improper insertion and hygiene procedures can heighten the risk of germs entering the body and causing serious bloodstream infections. Fridkin notes that the decline was even greater–35 percent–for intensive care patients. The reduction in the infections caused by central line and other surgical procedures can be attributed to improved national and state prevention efforts, the doctor believes. More than 5,000 acute-care hospitals report data to the National Health Care Safety Network. Launched in 2006, the system allows hospitals to compare their infection rates. For more information visit www.chicagotribune.com.

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14 Medical Waste Management APR -JUN 2012

oston—A project called the Healthier Hospitals Initiative (HHI) involves over 500 hospitals across the country representing over $20 billion in buying power, using that power to lower energy costs, reduce waste, encourage recycling and buy “environmentally preferable” materials as a continuation of the green building initiative. The Healthier Hospitals Initiative partnership is being coordinated by Practice Greenhealth, Health Care Without Harm, and the Center for Health Design. HHI’s sponsoring health systems include Advocate Health Care, Bon Secours Health System, Catholic Health Initiatives, Dignity Health, Hospital Corp. of America, Inova Health System, Kaiser Permanente, MedStar Health, Partners HealthCare, Tenet Health Systems, and Vanguard Health Systems. Until 2015, HHI will gather data to explore the effect its activity is making on the health of patients, workers and communities, as well as on reducing health care costs. Kaiser Permanente estimates HHI can help it save about $26 million annually, and Dignity Health claims a savings of $5.4 million in 2010 by increasing the amount of reusable products it purchased for its hospitals and clinics. One hospital system, Partners Healthcare, has plans to cut energy consumption by at least 25% by 2014, and one of its hospitals has eliminated bottled water and now uses filtered tap water to save the cost per serving of water from 98 to 2 cents. It is negotiating a contract to replace polyvinyl chloride used in IV bags and tubing with other materials because of fears based on European Union studies that chemicals used in PVC can create health problems. Partners feels that about 85% of the PVC it uses in the IV bag systems can be replaced and that it can save millions of dollars by lessening use of PVC. Partners is also looking at replacing vinyl composition tile with rubber flooring as it is deemed more comfortable and less expensive to maintain, and vinyl wall covering with coatings that are more “breathable.” . Partners’ Brigham & Women’s Hospital in one month used 23,000 medical devices that were sterilized and reprocessed instead of single-use. The FDA has a list of products and manufacturers of products approved for reprocessing which can be sent to a third-party, sterilized, repackaged, FDAtested, and returned, saving about 60%. Partners also works to reduce solid waste, with Massachusetts General Hospital generating 800 tons of solid waste per month, with 49 tons of that plastic, but the hospital hopes to improve that amount. Finding space to accommodate the recycling and getting approval from infectious control staff are the two biggest challenges. Partners currently does not use compostable plastics, although significant amounts of food waste generated in meal preparation are being composted, and the system wants to find biobased plastics that are not cost prohibitive. One worry is verifying antimicrobial claims of materials producers. For more information visit www.commonhealth. wbur.org.

www.AMSsilverrebate.com APR -JUN 2012 Medical Waste Management 15

Medical Waste Management Serving Healthcare Facility Waste Management Professionals

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VOL. VIII NO. 2

APR-JUN 2012

TOP STORIES Innovative American and Canadian Healthcare Providers Embrace Alternative/ Renewable Fuels

PAGE 1

Planning for the Future – CRE’s X-Ray Vision

PAGE 4

Feds First Settlement on a Data Breach Costs BXBS of TN $1.5 Million

PAGE 9

Study: Do Digital Records Cut Health Costs?

PAGE 12

Medical Suppliers Shirking Green Duties, Says Report

PAGE 14

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