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VOL. IX NO. 2

apr-JUN 2013

Medical Waste Management www.medicalwastemanagementnews.com

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New York Hospital Queens Becomes King of Cutting Carbon Emissions By Linda Zengen and P.J. Heller

ithin just a few years of New York City Mayor Michael R. Bloomberg challenging healthcare facilities to cut greenhouse gas (GHG) emissions by 30 percent within a decade, one hospital has become an “early achiever” and has already exceeded that goal. New York Hospital Queens, (NYHQ), a 535‑bed tertiary care facility and community teaching hospital in Flushing, reported it has cut its carbon footprint by 31 percent from 2005 levels through energy conservation, recycling, clean air, and waste management strategies and infrastructure projects. In addition to the environmental benefits, the program is saving the hospital approximately $2.5 million a year. “The Mayor’s Carbon Challenge is a forwardthinking program that encouraged New York Hospital Queens to accelerate its sustainability efforts,” says Kevin Mannle, associate vice president for facilities management. “By reducing our environmental impact, we help our buildings and our planet get healthier, which supports the health and well-being of our patients and our community.” “New York Hospital Queens recognizes the critical interdependence between human health and the health of the planet,” the hospital notes on its website. “Our hospital is working to reduce the environmental impact of our building’s energy and water use and is committed to the continued development of greener healthful practices.” Bloomberg in 2007 launched PlaNYC, an ambitious effort designed to strengthen New York’s economy, address climate change, prepare for an increase in population and enhance the quality of life for both residents and visitors. The plan includes improving housing and neighborhoods, parks, public spaces, brown fields, waterways, water supplies, transportation, energy, air quality

and solid waste. One of the goals was to reduce citywide greenhouse gas emissions by 30 percent by 2030. The Mayor’s Carbon Challenge was issued in 2007 to universities and two years later to healthcare facilities. It asked participants to match the city government’s goal of reducing its own greenhouse gas emissions at an accelerated pace of 30 percent in 10 years. Eleven of the city’s largest hospital systems — representing more than 50 individual hospitals, dozens of clinics, outpatient centers, and medical offices — accepted the challenge, as did 17 universities. NYHQ, which has a main campus and more than 18 community medicine sites across the borough, is the only one of the 11 hospital systems to already have met the goal. Four universities have also achieved what Bloomberg calls “early achiever” status. Sustainability efforts are also under way at Broadway theaters and major corporate offices. The program is expected to expand this summer to residential co-ops and condos and city officials are also looking at initiatives addressing solid waste and water. NYHQ cut its carbon footprint through Continued on page 3

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New York Hospital Queens Becomes King of Cutting Carbon Emissions PUBLICATION STAFF

Publisher / Editor Rick Downing

Contributing Editors / Writers P.J. Heller Todd Williams Linda Zengen

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Continued from page 1 numerous efforts, ranging from a recycling program — including an organic waste decomposition system to process food waste — to installing a modular green roof on the hospital’s main campus. A key project was the replacement of a natural gasdriven chiller with an electric chiller. When it signed up for the program, NYHQ initially focused on energy conservation, Mannle recalls. The hospital formed a sustainability council, consisting of 20 people from various departments. The council’s first order of business was to install system controls to regulate heat and air conditioning in areas that were not being utilized at certain times of the day. If an area was unoccupied, there was no need to keep it cooled or heated. Occupancy sensors were also installed to replace light switches. The sensors automatically turn lights on when a person enters a room, such as an office, conference area or break room, and shuts them off when no motion is detected after a set amount of time. The hospital also installed photocells to control electric lighting in areas that receive large amounts of natural light. The photocells detect sunlight and can turn off the electric lights if there is sufficient natural light. The photocells are installed in hallways, waiting rooms and the main entrance. NYHQ has installed more than 500 occupancy sensors and photocell devices. Officials not only saw a reduction in electricity usage but realized carbon savings as well. Air handlers and HVAC systems were areas where additional energy savings were realized. Areas of the workplace were identified that could be shut down during certain times of the day or night. Timers were installed to save energy in those areas. The facilities management department also retro-commissioned a 30-year-old air handling unit. Retrofitting the unit brought it up to current standards, resulting in a 25 percent energy savings. Another project that helped the facility save energy, involved the replacement of a chiller unit. NYHQ’s central chiller plant consisted of three 1,100-ton, gas-fired absorption chillers. To better study equipment performance and chilled water distribution issues, the engineering department commissioned a performance study of the entire plant through the New York State Energy Research & Development Authority (NYSERDA) FlexTech program. Under that program, 50 percent of the study’s cost was reimbursed. When the need arose to replace a unit, the report was used as the basis of design for the replacement chiller. The replacement unit was a 1,200-ton electric centrifugal chiller. A slightly

larger electric unit was chosen based on its higher efficiency and lower operating and maintenance costs, as well as the future flexibility of the central chiller plant. This unit was also smaller in size and fit into the existing footprint. NYHQ once again applied for NYSERDA performance based incentives, this time through the existing facilities program. A 1,200-ton York YK Max E Chiller was selected. The unit qualified for the NYSERDA super efficient electric chiller bonus by exceeding standard energy efficiency criteria by at least 2 percent at full load and by at least 12 percent at part load. This resulted in a rebate to NYHQ of $87,000. The high-efficiency chiller uses 17 percent less electricity than a standard performance unit, resulting in an annual energy savings of more than $33,000. The incremental cost for the higher-efficiency unit was $180,000, yielding an anticipated payback after 5.4 years. The payback was reduced to 2.8 years when the NYSERDA Continued on page 4

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New York Hospital Queens Becomes King of Cutting Carbon Emissions Continued from page 3 rebate was included. Payback on the completed $1.9 million chiller project — after factoring in equipment, construction and architectural and engineering costs as well as the rebate and annual maintenance and energy savings — was expected to be in little more than seven years. The new chiller, installed in less than five months, went on-line June 8, 2011. The switch from a natural gas chiller to an electric unit resulted in lower natural gas consumption and an increase in electricity consumption. After converting both fuels into carbon equivalents, however, officials reported a reduction in carbon emissions attributable to the chiller plant. The new chiller reduced the annual carbon emissions by 7 percent, or 1,655 metric tons, the equivalent to the annual gas emissions from 325 passenger vehicles. The unit improves the overall production of chilled water and air conditioning throughout the campus. It has also improved the efficiency of the central chiller plant and reduced operating costs. Maintenance costs with the new equipment dropped $15,000 per year. In addition to its energy projects, NYHQ instituted recycling and pharmaceutical waste programs and has installed a green roof on the hospital’s main campus in Flushing. Installation of the modular green roof, an area covered with plant life, began in 2012 and today covers about one-half acre of roof space.

The green roof is designed to decrease the Tim J. Ward, dean of the Manhattan College school amount of stormwater and sewer overflow into of engineering. adjacent waterways. Recycling was also a part of NYHQ‘s efforts. “Stormwater runoff can carry sediment, Prior to 2010, the hospital recycled only trash, fertilizers, solvents, and cardboard and paper, according automobile fluids from paved to Barry Johnson, director of “The Mayor’s surfaces into the local waterways. environmental services. The negative impacts of these Today, he reports it is Carbon Challenge elements entering our waterways recycling more than 17 percent of has helped us cut are well documented,” the all waste through a single stream hospital says. “Additionally, in process, with all non-confidential our emissions, New York City the sewer system papers, bottles, cans and glass and the stormwater system are reduce our going into green containers. combined. During heavy storms, All food waste goes into a energy use and this system often reaches capacity bio-digester, an organic waste and a mixture of stormwater and decomposition system that can save money wastewater is discharged into process up to 400 pounds of food in the process.” local waterways.” waste per day, about 4 percent of The green roof project was the hospital’s total waste stream. undertaken in partnership with Manhattan College, NYHQ diverts more than 200,000 pounds of food which received a grant of $660,440 from the New waste from the landfill annually, which reduces its York City Department of Environmental Protection. number of municipal waste pickups. Students will collect and analyze data to determine More than 21 percent of hospital waste is how much water is being captured. diverted from traditional municipal waste streams, The grant was one of five separate awards according to the hospital. totaling $2.6 million for innovative methods of The savings from the recycling programs managing stormwater runoff. helped fund a pharmaceutical waste program, “… The grant project will allow our faculty which prevents hazardous and non-hazardous and students to not only assist in improving the drugs from entering the waste stream. The drugs city’s water stewardship, but design, install and are segregated (hazardous and non-hazardous) in monitor the entire process for four years,” says containers in a satellite location and then taken to a central area where they are sent out for proper disposal. NYHQ also has a “green” operating room. By identifying what can and cannot be recycled, officials have been able to reduce both normal and infectious waste. Prior to the recycling program, an operating room would generate 1.75 red bags of infectious waste and four large trash bags of regular waste, for each case. Aristea Sustainability and Waste Management Solutions After a waste audit, officials found the hospital can help you increase your business performance by integrating new was red bagging items that did not meet the criteria environmental, social and economic practices into your daily operations for infectious waste. They identified items such as and business decision making. Sustainability provides an unprecedented blue wrap, packaging material and waste paper that opportunity to increase profitability, drive innovation, increase efficiency, could go into green recycling bags. These days, infectious waste is down to oneand attract and retain top talent. Turn good intention into profitable action eighth of a bag per case. The OR now removes two while setting your business apart in the eyes of customers, prospects and bags of recycling and one bag of trash per case. employees. “We now deliberately throw all recyclable items in the green bags, using only the red and Aristea Sustainability and Waste Management Solutions white bags for the appropriate garbage,” a hospital will help you on your journey with over 17 years of healthcare and sustainability spokesperson says. experience to offer. We specialize in healthcare, corporate and regulatory compliance, product evaluation, Reducing its carbon footprint is benefiting and waste audits. We can assist in creating or improving programs such as recycling, hazardous materials and waste both the environment and NYHQ, officials say. The management, pharmaceutical waste programs and energy efficiency programs. hospital is a member of the New York-Presbyterian Healthcare System and an affiliate of the Weill Aristea Sustainability and Waste Management Solutions Medical College of Cornell University. Linda Zengen, CEO “The Mayor’s Carbon Challenge has helped us cut our emissions, reduce our energy use and Linda.Zengen@gmail.com / 917-362-5751 save money in the process,” Mannle says.

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Ultraviolet Light Could Be Enlisted in Battle Against Hospital Infections By Todd Williams

lack lights, once a staple of college dorm rooms, now appear to be an effective weapon in the battle against certain drug-resistant bacteria common to hospital acquired infection (HAI). Although of a different wavelength than the old counter culture black lights, ultraviolet light is increasingly seen as a front line defense for cleaning hospital rooms and appears to be more effective in the elimination of disease resistant bacteria such as Clostridium difficile (C. diff), Acinetobacter, and vancomycin-resistant Enterococcus (VRE) than earlier, more common methods including manual cleaning and vaporized hydrogen peroxide. Nearly invisible to the human eye, UV-C is short wave ultraviolet radiation. Recent research confirms that UV-C kills these bacteria commonly found on door handles, bedside tables, toilets and other surfaces in hospital rooms. For decades UV-C light had a track record in purifying food, air and waste and sterilizing medical equipment. In nature, the UV-C wavelength component of sunlight destroys pathogens such as viruses, mold, bacteria and mildew. It does this by breaking through the outer membrane of the microbes reaching the DNA of the microbe, thereby causing modifications. The DNA then transmits incorrect codes, causing the death of the microbes. The same process occurs with the UV-C lamps researchers are studying. According to an October 2012 study presented at IDWeek, a major infectious disease conference, researchers at Duke University Medical Center

and the University of North Carolina Hospital System used UV-C to nearly eliminate the bugs in more than 50 patient rooms at the two medical centers. This study, according to lead researcher Deverick J. Anderson, MD, an assistant professor of medicine at Duke and co-director of the Duke Infection Control Outreach Center, demonstrates that the medical application of UV-C may help reduce the estimated 1.7 million HAIs that occur annually in the United States. The costs associated with treating these infections have been estimated between $4.5 and $11 billion. And to make matters worse, these bacteria are becoming increasingly resistant to antibiotics, making a cleaner hospital environment more important than ever. “We are learning more and more about how much the hospital environment contributes to the spread of these organisms,” Dr. Anderson says. In their study, researchers examined whether UV-C could eliminate three of the most problematic germs, thereby improving the cleanliness of patient rooms. The Duke study covered both intensive care as well as general medical rooms and identified patients with C. diff, a trigger for a serious intestinal condition; Acinetobacter, a cause of pneumonia and serious wound and urinary tract infections; and VRE, an infector of urinary tract, bloodstream, wounds and catheter sites. After these patients were discharged but before standard terminal room Continued on next page

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medical waste management Continued from previous page disinfection by cleaning personnel, researchers took culture samples from specific locations in the rooms including bedside rail, bedside table, chair arm, over bed table, and sink counter. The toilet, shower floor, and floor adjacent to the toilet were also cultured in targeted rooms from which a patient with C. diff infection was discharged. Then a special, eight-bulb UV-C machine was positioned near the center of the room and turned on for up to 45 minutes. Then 15 more cultures were taken from the same locations and compared to the pre-treatment bacteria samples. The results were startling. Fifty-two colony-forming units (CFUs) of Acinetobacter were seen before irradiation, but only 1 CFU afterward – down 98.1 percent. The other two bacteria had nearly the same proportional decrease. Dr. Anderson notes the recent Duke study shows that the use of UV-C “succeeds in both the experimental and real world.” He adds that he doesn’t believe that UV-C should be the only form of cleaning a room, but that is another tool in the fight against HAIs. Unlike traditional antimicrobial cleaning agents, UV light disinfects every surface of the room that is bathed in the light. Traditional hand and machine cleaning methods often miss up to 50 percent of the surfaces, thereby allowing the spread of bacteria. Bathrooms, researchers found, were particularly hard to thoroughly clean. A recent study conducted at the University of North Carolina Health notes, for example, of 20,646 standardized environmental surfaces (14 types of objects) only 9,910 (48 %) were cleaned at terminal room cleaning according to institutional room cleaning policies. This data, coupled with the fact that patients admitted to rooms previously occupied by people infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA), VRE or C. diff are at a significant risk of acquiring these organisms, shows the importance of room cleaning. Chuck Dunn, president of Lumalier Corporation, manufacturer of UV-C lighting equipment, notes there are three primary factors affecting the

performance of ultraviolet light in rooms – the size of the room, the geometry of the room and the color and reflectivity of the wall, ceilings, floors and objects. Lumalier, he notes, donated the UV-C machine for the aforementioned Duke study. This lighting unit, says Dunn, has an array of built-in sensors that measure the light reflecting to the machine. This tells the unit how much light is reaching the room and calculates how long it should stay on to provide a lethal dosage of light. He notes that one of the worst-case scenarios is trying to disinfect a brown door in a white room. The light wants to turn off sooner than necessary due to the reflectivity of the white walls. “We want to improve reflectivity in a room to speed up disinfection time and to ensure every surface is clean, Dunn explains. To that end, he says, his company has also developed a highly reflective paint ingrained with nanoscale inorganic oxides whose crystal structures are transparent to UV-C and act as prisms to make the UV-C light doses more lethal. Dunn explains that while standard white latex paint is 3 to 7 percent reflective of UV-C light, the special coating is 65 percent UV reflective. The UNC study compared a hospital room painted with standard white paint-coated walls versus walls painted with this paint formulated to be reflective of UV-C wavelengths. The cycle time to achieve microbial killing was determined in this room before and after the room was coated with the special paint. According to the UNC research, the cycle time of the lighting array was slightly over five minutes with the coating and over 25 minutes without coating with respect to MRSA. For C. diff spores, the cycle time was about nine and a half minutes with the coating and nearly 44 minutes without the coating. A major disadvantage to both UV-C light systems as well as the more traditional hydrogen peroxide vaporization, according to the UNC study, is that they can only be used for terminal disinfection, not daily use, because the rooms must be emptied of people. Another drawback to hydrogen peroxide systems, the study finds, Continued on page 8

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Ultraviolet Light Could Be Enlisted in Battle Against Hospital Infections

Continued from page 7 is the time required for decontamination. The UV-C system offers faster decontamination (15-20 minutes, compared with 2-5 hours for hydrogen peroxide systems), before the development of this UV-C reflective coating, but with the use of this coating innovation cycle times were 5-10 minutes, which would significantly reduce (by approximately 80%) the room’s downtime before another patient could be admitted. Although UV-C light shows great promise in hospital room disinfection, Dr. Anderson’s study points out that end results of disinfection are greater when the light is used after the room has been cleaned using traditional cleaning protocols. “Because cultures were obtained before and after application of UV-C light in rooms that had not undergone standard cleaning and disinfection, it is possible that the efficacy of UV-C was adversely affected by the presence of dirt and debris on surfaces and equipment,” the study says. It continues to say, “our results suggest that UV-C disinfection may be more effective when used with traditional cleaning protocols. Thus cleaning must remain an important part of terminal room disinfection, but in its absence or on locations missed by cleaning staff, more than 90 percent of pathogenic bacteria will still be killed when an automated UV-C device is used.” “We have a solid foundation to show that this approach (UV-C) succeeds in both experimental and real-world conditions. Now it’s time to see if we can demonstrate that it indeed decreases the rate of infections among patients,” Dr. Anderson concludes.

British Hospital Ventilation Study Findings Show Benefit of Open Windows

ethesda, MD—The popular saying, “Get some fresh air” now has scientific proof. Opening windows in large hospital wards may decrease patients’ risk of airborne infection. The news is according to findings of a new study reported on Medline, the website for The National Institutes of Health. British researchers at the University of Leeds conducted a simulation experiment using carbon dioxide-filled balloons and carbon dioxide detectors to trace how airborne infections spread in a traditional 30-bed hospital ward. They found that ventilation in the ward was generally good when windows were left open, but risks of infection increased fourfold when the windows were closed. “By measuring the concentration of the gas over time, we were able to quantify the exposure at each bed and therefore the potential risk to a patient in that bed,” study team member Laura Pickin said in a University of Leeds news release. “We were also able to use the same data to measure the overall ventilation rate in the ward.” “These wards are still in operation and, although they have often been subdivided into smaller areas with six to eight beds, their ventilation and structure is still fundamentally the same,” lead investigator Cath Noakes, from the University of Leeds’ School of Civil Engineering, said in the news release. The research suggests that energy efficient materials and designs, such as permanently sealed windows, should be considered carefully because they may adversely affect the health of hospital patients.

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EPA Defines “Hazardous Waste Pharmaceuticals” and Begins Rulemaking

ashington, D.C.—On the horizon is rulemaking for pharmaceutical waste that will define for healthcare facilities what’s hazardous and what’s not, as well as set collection and disposal requirements, according to an article on GKLaw.com. The United States Environmental Protection Agency (EPA) has announced it will spell out new rules concerning management and disposal of hazardous waste pharmaceuticals. The public comment phase is scheduled to begin in August 2013. The EPA has not released details about the rulemaking, but it has confirmed that the requirements will only apply to pharmaceutical waste that meets the hazardous waste definition in the 1976 Resource Conservation and Recovery Act (RCRA). In 2008, the EPA proposed a rule to include hazardous pharmaceutical wastes under the definition of “universal waste.” Policymakers thought this would be an effective way to ease the administrative and disposal burdens on healthcare facilities because a relatively small portion of their waste is considered hazardous under RCRA. The EPA has reversed its position, however, citing concerns related to the reduced notification and tracking requirements under the universal waste regulations. States such as Florida and California have enacted their own regulations to make compliance easier for health care facilities. Others, such as Wisconsin, continue to follow RCRA regulations. Until the EPA finalizes a new rule, many healthcare facilities are still required to comply with RCRA regulations. They may be subject to federal or state enforcement if they fail to comply.

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alt Lake City, UT—According to an article on sltrib.com, Utah hospitals are outperforming their peers nationally when it comes to controlling central line infections. The comparison is made in the 2012 Utah Health Plan Quality of Care Report (HEDIS), recently released by Utah’s state Department of Health. Central lines are catheter tubes placed in a large vein in the neck, chest, groin or arm to administer fluids, blood, or medications. Central lines are implemented in forty-eight percent of intensive care patients. The Department of Health report put the associated cost for each bloodstream infection between $3,700 and $29,000. Central line-associated bloodstream infections are estimated at 82,000 occurrences every year in the U.S. intensive care units, causing 28,000 deaths, the report says. In 2011, Utah state hospitals reported 96 central line infections in intensive care patients, a rate that is 37 percent lower than the national standard, or what would be predicted for hospitals of similar size and sophistication, health officials said. The state health department has been collecting data on hospital acquired infections since 2008, but until now, has never identified hospitals by name. The same data can be found on the Hospital Compare web site. Utah State Rep. Jack Draxler pushed for greater disclosure and more consumer friendly presentation, which resulted in the HEDIS report. “Now we just need to spread the word that this resource is out there,” Draxler said. The report includes data on just 14 of the state’s 60 hospitals, those with intensive care units and enough central line patients to accurately judge their performance.

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Teva Pharmaceuticals USA to Pay $2.25M Civil Penalty for Air, Water, and Hazardous Waste Violations at Mexico, Mo., Facility

eva Pharmaceuticals USA Inc. has agreed to pay a $2.25 million civil penalty to settle alleged violations of the federal Clean Air Act (CAA), Clean Water Act (CWA), Resource Conservation and Recovery Act (RCRA), and the State of Missouri’s Air Conservation Law, Clean Water Law, and Hazardous Waste Management Law at the company’s facility in Mexico, Mo., the Justice Department, EPA and the Missouri Department of Natural Resources recently announced. A 2007 inspection of the Missouri facility revealed violations of the CAA. The violations included failure to control emissions of hazardous air pollutants from wastewater and failure to comply with regulations designed to prevent leaks of air pollutants from equipment at the facility. In 2007, an EPA inspection found the Teva facility was discharging pollutants above permitted levels established by the City of Mexico’s Pretreatment Program, in violation of the CWA. In some cases, these pollutants were causing interference with the city’s ability to treat its domestic sewage, leading to pollutant discharges into the Salt River. A 2008 inspection found that Teva was discharging a green effluent that ultimately discolored a portion of the Salt River in November and December 2008. In 2009, an inspection by the Missouri Department of Natural Resources uncovered various RCRA violations. These violations included failure to determine if waste was hazardous, illegal storage of hazardous waste, failure to comply with labeling requirements, and offering hazardous

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waste for transport without a manifest. “This settlement penalizes Teva for multiple violations of U.S. environmental laws when it allowed excess emissions of hazardous air pollutants from Teva’s wastewater treatment facility and excess discharges of pollutants into the City of Mexico, Missouri’s wastewater treatment facility,” said Ignacia S. Moreno, the Assistant Attorney General for the Justice Department’s Environment and Natural Resources Division. “The agreement is protective of human health and the environment because it requires Teva to offset its excess emissions, install modern equipment that will increase the recovery and reuse of hazardous pollutants and reduce air emissions, as well as enhance its leak prevention capability.” In addition to the penalty, Teva will complete other actions at the facility valued at approximately $2.5 million. These include the installation of equipment to recover and reuse approximately 59.5 tons of methylene chloride and reduce other emissions by 19 tons over a five-year period. Teva will also conduct an audit to identify past causes of CWA violations, implement a program to prevent leaks of hazardous air pollutants at the facility, take actions to prevent future violations, and implement an Environmental Management System with third party monitoring. As a result of this Consent Decree, Teva has certified that it is in full compliance with CAA, CWA, RCRA regulations.

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news briefs

Studies Target C. Diff Control

leveland, OH—According to articles published on FierceHealthcare.com and FiercehealthIT.com, the results of a number of studies on preventing and controlling the intestinal “superbug,” Clostridium difficile, or C. diff, point to an important first step: education. C. Diff infection symptoms range from diarrhea to life-threatening inflammation of the colon. The bacterium is linked to 14,000 deaths in the U.S. each year, according to the Centers for Disease Control and Prevention. Older adults in hospitals or in long term care facilities are at high risk and most commonly affected, typically becoming ill after rounds of antibiotic medications upset individuals’ normal intestinal flora. Infants and children are vulnerable, as well. The bacterium’s hardiness is another reason it’s tough to manage. In fact, the discovery that C. diff spores can live for years in the healthcare environment prompted the Centers for Medicare & Medicaid Services to require healthcare facilities to report cases and outbreaks.

Limited Understanding: Scottish research on HAI prevention found that nurses and doctors, particularly those senior staff with significant experience in the field, had weak understanding of C. Diff compared to trainees. Their knowledge of the microbiological characteristics of C. Diff, along with patient risk factors, medical diagnosis and prevention was limited or altogether wrong. Many were confused over proper prevention methods, which made their own cautionary practices with patients inconsistent, and they were concerned about becoming sick themselves. The best results for C. diff elimination were achieved during a 21-month American study that combined instruction, monitoring, and a final phase that employed swab cultures to verify disinfection. The study was conducted at Louis Stokes Cleveland Veterans Affairs Medical Center in Cleveland, Ohio by researchers from Case Western Reserve University School of Medicine. In the last phase, if swab cultures came back positive, the entire room was recleaned and disinfected. At this point, C. diff room infection fell by 89 percent from the baseline. In actual practice at healthcare facilities, the progress toward controlling C. diff has been incremental. A survey of 1,087 members of the Association for Professionals in Infection Control and Epidemiology (APIC) reported the overwhelming majority were increasing their emphasis on environmental cleaning and equipment decontamination practices to address C. diff infection (CDI) over the past three years. One frequently cited problem, however, is that the instituted reporting of C. diff cases has not yet led to streamlined data sharing between departments at individual hospitals, let alone between systems within regions. Preventionists say data sharing should be made easier because it can provide earlier bacteria detection and control measures which can prevent outbreaks.

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apr-JUN 2013 Medical Waste Management 11

news briefs

Curtis Bay Energy Continues to Expand Its Comprehensive Medical Waste Service Platform with the Merger and Acquisition of National Waste Management

urtis Bay Energy, a medical waste disposal company, recently announced that it has acquired assets of National Waste Management Inc., an established Massachusetts medical waste business with a permitted transfer station serving the New England marketplace. Curtis Bay Energy will expand National Waste Management’s medical waste transfer station service offering by providing comprehensive medical waste solutions, including consulting, collection, transportation, and sustainable processing services to the New England market. “The acquisition of the Haverhill, Massachusetts medical waste transfer station is an opportunity for us to continue to expand our comprehensive medical waste service platform in the Northeast marketplace,” said Steve Groenke, CEO for Curtis Bay. Groenke added that Curtis Bay looks forward to bringing innovative and environmentally sustainable medical waste solutions to the New England community while serving customers with economical medical waste disposal services.

CDC Issues H7N9 Bird Flu Recommendations www.bondtech.net

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12 Medical Waste Management

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apr-JUN 2013

tlanta, GA—An article on News.Nurse.com reports that, while no confirmed or probable cases of H7N9 bird flu have been reported in the United States, the Centers for Disease Control and Prevention (CDC) has taken a proactive step. CDC has issued interim recommendations for initial infection control should the avian virus infection occur here in the U.S. The recommendations apply to confirmed cases of avian influenza A (H7N9) virus infection, as well as probable cases and those under investigation in healthcare settings. Reasons for the CDC’s actions include: no safe and effective vaccine developed for the disease to date, 33 fatal cases reported in China (where the flu emerged) and the unknown potential for person-to-person transmission. The higher-level precautionary measures are intended to augment, not replace the standard procedures for infection prevention. Personal protection equipment, such as safety glasses, will be required, and greater attention will be paid to airborne transmission, thus entailing use of respirators for all patient care activities. Settings referenced in the recommendations include but are not limited to acute-care hospitals; long-term care facilities, such as nursing homes and skilled nursing facilities; physicians’ offices; urgent-care centers; outpatient clinics; home healthcare (i.e., care provided at home by professional healthcare providers), and emergency medical services. Settings include specific sites within non-healthcare settings where healthcare is routinely delivered (e.g., a medical clinic embedded within a workplace or school). Other recommendations include specialized patient care protocols, as well as provisions for assigning dedicated patient care staff, sending home possibly exposed, but asymptomatic staff or reassigning them if placed on prophylactic influenza anti-viral medications. Healthcare providers, as defined by the CDC, refer to all persons, paid and unpaid, working in healthcare settings whose activities place them at risk for transmission of respiratory infections from patients. For CDC recommendations and related documents, go to www.cdc.gov/flu/avianflu/h7n9-infection-control.htm?s_cid=seasonalflugovd-003.

news briefs

Impact of Pharma Waste on Waterways Studied

illbrook, NY—According to an article on Phys.org, a newly published study of streams in New York, Maryland and Indiana reveals the complexities of pharmaceutical waste and its effects on aquatic life and water quality. The study results, published in an Ecological Applications paper, indicate a scenario where scientists are just beginning to examine the intricacies of what the lead researcher refers to as “a cocktail of synthetic compounds.” Although the study of pharmaceutical compounds present in drinking water is still new, scientists know that water quality is changing and they say that further investigation is needed to find out how this will affect humans. According to a 2009 Ball State University study led by Melody Bernot, more than 300 pharmaceuticals are being passed by human excretion into sewer systems in the United States alone. Current wastewater filtering systems are not eliminating the compounds before they enter streams and rivers. The latest study, conducted by a team of scientists from Indiana University and Loyola University Chicago, was led by Dr. Emma Rosi-Marshall of the New York-based Cary Institute of Ecosystem Studies. The experiment involved observing the effects of pharmaceuticals on streambed “biofilms,” the slippery coating that covers rocks and pebbles. Biofilms are teaming with organisms, and they contribute to water quality by recycling nutrients and organic matter. They also are a primary food source for invertebrates consumed by fish. Pharmaceutical waste from humans and livestock enters waterways via aging infrastructure and wastewater treatment plants, as well as agricultural runoff. The study’s design included testing and comparing the biofilm impact of six common pharmaceuticals: caffeine, the antibiotic ciprofloxacin, the antidiabetic metformin, two antihistamines used to treat heartburn (cimetidine and ranitidine), and one antihistamine used to treat allergies (diphenhydramine). The drugs were tested alone and in combinations, using pharmaceuticaldiffusing substrates. By testing the effects of the different compounds on the biofilms, the scientists were able to observe responses of algae, fungi, and bacteria that are vital to stream health. Antihistamines, they discovered, have the same drying effect on aquatic life that they do in humans. In streambeds, this impacts fundamental processes, such as photosynthesis. Rosi-Marshall notes, “We know that diphenhydramine is commonly found in the environment. And its effect on biofilms could have repercussions for animals in stream food webs, like insects and fish. We need additional studies looking at the concentrations that cause ecosystem disruption, and how they react with other stressors, such as excess nutrients.”

U.S. Surgical Site Infection Rates Lowest in 30 Countries Studied

hicago, IL—As reported on the website, Osap.org, U.S. hospitals are achieving high success in preventing surgical site infections (SSIs). This news follows results of a five-year study published in the University of Chicago Press’ Infection Control and Hospital Epidemiology. From January 2005 to December 2010, researchers tracked 7,523 SSIs for patients undergoing surgical procedures (SP) in 30 different countries around the world. U.S. rates of SSIs were the lowest of all. The 82 hospitals involved in the study are members of the International Nosocomial Infection Control Consortium (INICC), whose goal is to reduce healthcare associated infections (HAI). SPs were classified into 31 types according to International Classification of Diseases, (Ninth Revision) criteria. SSI rates for most surgical procedures were higher in INICC hospitals than U.S. hospitals that reported data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network. Improved methods of infection control can contribute to patient safety, faster healing of wounds, and decreased use of antibiotics and overall, reduced healthcare costs. SSI rates for INICC hospitals and CDC-NHSN data for certain surgical procedures are shown below.

The study was conducted at hospitals in 66 cities in Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from four continents (America, Asia, Africa, and Europe).

Collection Program Diverts a Ton of Pharmaceutical Waste

Hospitals Divert 100m Pounds from Landfills

ort Collins, CO—In its first year of data collection, the Healthier Hospitals Initiative reports that HHI-member hospitals recycled more than 50 million pounds of materials and reused and recycled an additional 61.5 million pounds of construction and demolition waste. The program’s progress, documented in its 2012 Milestone report was cited in an article on EnvironmentalLeader.com. Launched in April 2012, Healthier Hospitals Initiative is a national campaign to improve health of patients, staff, and the community and to reduce costs and the environmental impact of member hospitals. The waste challenge data in the report was collected from 172 of its 370 HHI-member hospitals. It was one of six key “Challenge” areas: Engaged Leadership, Healthier Food, Leaner Energy, Less Waste, Safer Chemicals, and Smarter Purchasing. Hospital Corporation of America hospitals prevented more than 59 million pounds of construction and demolition debris from entering landfills in 2012 alone. average of 87.59 percent recycling rate. Led by 13 sponsoring health systems that represent more than 500 hospitals with more than $20 billion in purchasing power, and in conjunction with three nonprofit organizations—HCWH, The Center for Health Design and Practice Greenhealth—HHI aims to advocate for environmentally responsible health practices by spurring sustainable change across the health care industry.

untington, IN—The more than 2000 pounds of pharmaceutical waste this city collected in 2012 was converted into energy at a cogeneration plant in Indianapolis, according to an article on HuntingtonCountyTab.com. Beginning in 2011, the city of Huntington purchased five drop boxes, which were placed around town. The drop boxes were funded by the Local Anti-drug Coalition Efforts (LACE) program. In addition to diverting pharma waste from the local landfill and creating energy from it, the program keeps a number of Schedule 1 narcotics off the streets. The drop-offs are monitored by law enforcement officers who remove the waste drugs from the containers. A public awareness program began in 2010, when the federal Drug Enforcement Agency organized the first take-back days. Since then, more than two million pounds of prescription drugs have been collected in communities across the U.S. The DEA’s collection program is part of its larger effort to curb drug abuse. Collecting and channeling pharmaceutical waste also helps address the emerging environmental issues.

Visit us online at www.medicalwastemanagementnews.com.

apr-JUN 2013 Medical Waste Management 13

Product/Equipment Profiles

Bright Technologies Introduces the X3Cycler

r i g h t Technologies, a division of Sebright Products, Inc. recently announced the release of the X3Cycler, as a solution for processing large volumes of full plastic or aluminum liquid containers. The X3Cycler dumps, perforates, dewaters, crushes, and bales all in one compact and integrated system. Large 35-cubic-foot bales, high throughput and corrosion-resistant stainless steel construction are key characteristics of this equipment. The X3Cycler’s cart tipper is designed to accept Gaylords or plastic totes of containers of up to 2.0 cubic yards. The tipper cycles in under a minute, including an automatic cart rinse cycle while inverted in the hopper. The complete system of Cart Tipper, Perforator, and Baler cycles in about two minutes. It can process up to 30 cubic yards or 1200 pounds per hour of plastic or aluminum containers with volume reductions of up to 95 percent. With two eight-inch-bore hydraulic cylinders, the X3Cycler develops up to 250,000 pounds of force to drive out liquids and ensure optimum bale density. And it contains and channels the liquids, eliminating runs and drips. For more details and specifications on the X3Cycler and Sebright’s other products, please visit www.sebrightproducts.com or call 800-253-0532.

Hard Drive Shredder Ideal for Office Use

Safe Aspiration System for Hazardous Waste Liquids in Microbiological and Biomedical Laboratories from INTEGRA

he VACUSAFE Laboratory Aspiration System from INTEGRA is designed to provide simple, reliable and safe aspiration of hazardous waste liquids in Microbiological and Biomedical Laboratories. The VACUSAFE enables Biosafety level 1, 2 and 3 labs to comply with the stringent user safety guidelines for handling contaminated solutions while maximizing productivity and minimizing noise and operational inconveniences. The VACUSAFE is a dedicated stand-alone product for the convenient and safe disposal of almost any biological liquid waste. The VACUSAFE has a range of important safety features including a dependable liquid level sensor to prevent overfilling of the shatterproof waste bottle, an easy-to-replace hydrophobic filter that blocks potentially dangerous aerosols from entering the laboratory workspace and fully autoclavable components to protect you from biohazards. For total containment of hazardous liquids, the compact VACUSAFE includes an integrated pump with vacuum control. For more information on the VACUSAFE please visit www.integra-biosciences.com/sites/vacusafe_1_e.html or call 603-578-5800 or email US@integra-biosciences.com.

Allegheny Introduces 5HD3 Hard Drive Shredder

he new Model 0300 Jackhammer™ Hard Drive Shredder from Security Engineered Machinery (SEM) has a small footprint and is easy to use. Only 37” high, 45” wide, and 21” deep, it destroys hard drives, other electronic devices (cell phones, BlackBerrys®, PDAs, etc.), optical media (CDs and DVDs), and computer backup tapes. Its specially designed sawtooth, hooked cutters can handle 125 to 500 drives per hour (depending on type), reducing them to random 1½” shreds. Fast, safe, clean, quiet, and easy to use, the Model 0300 Jackhammer is specifically designed for the office environment. The Model 0300 Jackhammer is designed for environments requiring secure destruction of lower-volume media, such as data centers, hospitals, and other facilities that need to destroy confidential/sensitive information in accordance with various government regulations and industry standards (HIPAA, FACTA, SOX, PCI DSS, etc.). It satisfies National Security Agency requirements for physical destruction of drives after they have been degaussed by an NSA-listed degausser. A key is required to start the unit, so only authorized personnel can use it.

he new Allegheny 5HD3 Hard Drive Shredder is powered by a 3 Hp motor and high-torque drive train. As compact and rugged as it is affordable, this powerhouse shredder can irretrievably destroy 10 to 12 hard drives per minute—that’s up to 600 hard drives per hour! Allegheny’s 5HD3 Hard Drive Shredder is ideal for secure destruction service providers, Records & Information Management (RIM) centers, and e-scrap recyclers. Features of the Allegheny 5HD3 Hard Drive Shredder: • Cost-effective, secure destruction of hard drives and electronic materials • Available with single- or three-phase power supply • Extremely rugged and durable, with a gravity-feed input chute and aggressive hooked cutters made from heat-treated tool steel • Compact, reliable shredder offering impressive performance with minimal noise and vibration By adding an Allegheny 5HD3 Hard Drive Shredder, your company can add hard drive destruction to its services to meet a growing demand. The 5HD3 shredder can be installed on a truck for mobile on-site destruction of hard drives, PDAs, and other data storage devices.

For more information, contact James T. Norris, Vice President, Norris & Company, 508-510-5626, jim@norrisco.com or visit www.semshred.com.

For more information contact Allegheny Shredders at 800-245-2497, 724-468-4300 or solutions@alleghenyshredders.com or visit www.alleghenyshredders.com

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apr-JUN 2013 Medical Waste Management 15

Medical Waste Management www.medicalwastemanagementnews.com

VOL. IX NO. 2

Serving Healthcare Facility Waste Management Professionals

APR-JUN 2013

TOP STORIES New York Hospital Queens Becomes King of Cutting Carbon Emissions

PAGE 1

Ultraviolet Light Could Be Enlisted In Battle Against Hospital Infections

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EPA Defines “Hazardous Waste Pharmaceuticals” and Begins Rulemaking

PAGE 9

Studies Target C. Diff Control

PAGE 11

CDC Issues H7N9 Bird Flu Recommendations

PAGE 12

Hospitals Divert 100m Pounds from Landfills

PAGE 13

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