Issuu

VOL. IX NO. 3

JUL-SEP 2013

Medical Waste Management www.medicalwastemanagementnews.com

Serving Healthcare Facility Waste Management Professionals

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By Todd Williams

edical waste management is perhaps the least desirable item that has to be dealt with by hospitals. It is also one of the most important functions a hospital has to address. As modern hospitals have increased in size and patient capacity, the labor- intensive collection and disposal of waste have become more difficult and thus more expensive. To meet this problem, various methods of waste collection have been tried to varying degrees of success. Of course, the methods of collection differ from facility to facility with most still relying on manual labor. In an increasing number of hospitals, especially large facilities, the use of Automated Guided Vehicle Systems (AGVS) is becoming more and more popular. First introduced back in the late 1960’s as a labor-saving way of material handling in places as diverse as printing plants and automotive manufacturing, these robotic systems began to be adopted by hospitals as a way to distribute supplies and collect both medical waste and general trash. According to Ed Schachinger, president of The Schachinger Group, a Fairfax, VA-based consulting firm specializing in materials handling and management, including waste management, there are now approximately 30 hospitals in the US of some 300 to 350 hospitals worldwide that use AGV systems.

Typically, The Schachinger Group provides its hospital clients physical and economic feasibility studies followed by functional and space programming. It then designs and writes specifications for highly sophisticated materials and waste management systems including AGVS. “We create the specifications and then a set of drawings. Vendors then bid on the system and we consult with the hospital as to which system is best suited for its needs,” Schachinger noted. He said a 700-800-bed hospital needs between 35-45 AGVs while a 1,000-bed hospital needs over 50 vehicles. AGVs are integrated robotic systems employing self-powered wheeled vehicles that pick up and deliver waste and materials on a pre-programmed, guided route, according to Bob Baker, Manager of Technical Services at The Schachinger Group. The vehicles can follow a path of buried magnets, an eye-safe laser system that follows wall-mounted targets using triangulation to fix the position of the vehicle enabling it to follow a defined path, or a contour following system that knows the hospital layout and identifies landmarks to navigate. The vehicles generally stay within one-half to one-quarter inch of their planned route. Also the robot is in constant wireless communication with a central command station. According to Baker, in most hospitals medical Continued on page 3

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medical waste management

Automated Guided Vehicle Systems –

a Hands off Approach to Removing Medical Waste Continued from page 1

PUBLICATION STAFF

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Contributing Editors / Writers P.J. Heller Todd Williams

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“red bag” waste is collected from patient rooms by hand, put into carts and transported to a central collection point for either on-site disposal or pick up for off-site disposal. This old way of doing things can cause a risk of contamination to surfaces such as elevator buttons and doors when the employee handling the waste touches these surfaces. Also, in large facilities the employee may have to push a cart a great distance to reach the final destination. Of course, the use of vertical chutes to drop red bags is unworkable and illegal because of the risk of contamination. With AGV systems, bags are brought to a utility room on each patient floor where they are manually transferred to a collection point in specially designed carts to await robot pick-up. About two or three times a day the robotic vehicle arrives, picks up the waste loaded cart, and works its way to the main waste collection point. There the bags are hand-sorted and either sent to an on-site autoclave or incinerator, or held for off-site pick-up and disposal, Baker explained. “The AGVs are demand driven, not scheduled. Each vehicle will scan a bar code on the cart to insure that it is picking up medical waste and not something else. The waste is taken to its final destination where the cart is unloaded. The robot then drops off the dirty cart to a washing area for about three minutes. There it then picks up a clean cart and is off to its next assignment,” Baker said. AGV systems normally send the robot with its now clean cart to an area where it does double duty by taking supplies or food back to the patient floors for distribution, and once again to bring waste back down, thus completing the cycle. In the Cleveland (Ohio) Clinic’s Service Center, over 1,000 such carts are carried by 81 five-foot long AGVs, including waste carts, food carts, linen carts and heavy equipment carts. All the carts carry a radio frequency identification tag in order to ensure the right cart is going to the correct location on the proper robot. Also workers scan bar codes on the carts with hand-held devices to verify the proper delivery specifications for the material, noted Schachinger. Dave Miano of Bostwick Design Partnership, Cleveland, project architect for the Cleveland Clinic Service Center construction job, said in just one day the robots travel over 1,000 miles on nearly 5,000 trips. The longest round trip from the Service Center through a tunnel to the hospital is nearly three-quarters of a mile long. Schachinger called the robots “very efficient,” noting the entire system works on a demand basis rather than a fixed schedule. “Sometimes all 81 robots are out. But normally about 65 vehicles are online at any given time,” he added. According to Baker, in all AGVSs the robots

occasionally move offline to recharge their NiCad batteries. Termed “opportunity charging,” this process occurs after every 1,000-2,000 linear feet of travel. Most AGVs can take on several job assignments before recharging. Baker explained that AGVs need monthly preventative maintenance including cleaning and inspecting the undercarriage and circuits as well as a battery change out for full cycle charging. Another important part of the inspection is a check of the laser bumpers. These bumpers constantly scan the robot’s path for objects and people, ordering the AGV to immediately stop to avoid collisions. The detection field is 10-foot wide for full speed travel down to as narrow as 18 inches for elevators. Sensors also enable the robots to move around stationary objects. AGVs use their own, narrow elevators that are off limits to humans. In the six-floor, 750-bed Greenville (South Carolina) Memorial Hospital, the 41 robots make use of narrow, dedicated AGV elevators that are devoid of all buttons, making them unable to be used by people. According to Mike Bailey, Director of Environmental Services for the entire Greenville Health System, there has been an AGVS at Memorial Hospital since the late 1970s. This system is one of the two oldest hospital systems in the nation. When first installed, the robots operated by following a signal emitted from a buried wire line. When the system was upgraded several years ago it was changed to laser guided telemetry, Bailey said. “The robots operate about three to four hours before recharging in 15 minutes. If a unit’s charge is totally depleted it may take up to 30 minutes to attain a full charge. Thirty two to 34 AGVs are operating at any given time in a 24-hour cycle. It is a very safe and reliable system,” Bailey added. Bailey said Greenville’s AGVS cost about $10-$15 million to install and about $1 million per year to operate. Schachinger said a system Continued on page 6

JUL-SEP 2013 Medical Waste Management

medical waste management

Clinic Group Finds Cure for Exam Room Waste By P.J. Heller

he detritus left behind after a patient leaves a doctor’s exam room can add up to a costly and major headache for medical institutions. Items such as exam table paper and paper drapes for patients, paper towels and tissues, wooden tongue depressors, cotton balls and swabs, paper cups and soiled paper and cardboard, have all typically been tossed into a regular trash container, then subsequently hauled away for eventual John Stampe, environmental services manager at Sansum Clinic, stands at blue recycling Dumpster. disposal in a landfill. Sansum Clinic, the largest independent At left is yellow Dumpster for compostable materials. Photos by P.J. Heller. nonprofit provider of outpatient services between Los Angeles and San Francisco, has found a cure be composted in the city’s foodscraps program,” the Pesetas Lane clinic that it is being expanded for much of this waste material by adding an Tierney notes. “This program is most commonly in September to the company’s Hitchcock Urgent innovative composting program to its recycling associated with food waste from restaurants and Care and Pediatrics center in Santa Barbara, then efforts at one of its major facilities. schools but also accepts paper materials that cannot in early 2014 to the large Pueblo Multi-specialty The result has not only saved the company commonly be recycled in the blue bin.” Clinic, also in Santa Barbara, followed by a rollout money, but has dramatically reduced the amount “For us, it was things like exam room paper, in June 2014 at the company’s Lompoc Urgent of trash going to the landfill from its Pesetas tissue and other papers,” Stampe agrees. “It meant Care and Multi-specialty facility in northern Santa Lane multi-specialty clinic while substantially retraining the staff on how to dispose of those items.” Barbara County. increasing the amount of material being recycled Working with the clinic staff, the city of Santa The nonprofit Sansum Clinic operates 23 and composted. Barbara and waste hauler MarBorg Disposal, facilities between Carpinteria and Santa Maria In January 2011, for example, 75 percent of Sansum essentially launched a pilot program on California’s central coast. Its 180 physicians the waste from the Santa Barbara, Calif., clinic at the 66,000-square-foot Pesetas Lane facility. provide medical care to more than 150,000 patients went to the landfill while 25 percent was recycled. Sansum spent $5,000 to get the program underway, — 600,000 visits — annually. Services range from Today, approximately 33 percent of trash, or purchasing trash cans, biodegradable bags and lids. primary care to more than 30 specialties, ranging approximately 16 cubic yards a week, goes to The savings were immediate. from pediatrics to geriatrics. Sansum employs the landfill, while 22 percent (8 cubic yards per MarBorg reduced its trash hauling fee from approximately 1,200 people. week) is composted and another 44 (12 cubic yards $2,200 per month to $1,600, meaning that the In the works is a planned merge in October weekly) percent is recycled. program’s cost would be recouped in less than one with Cottage Health Systems, which operates three The composting program began Jan. 15, 2012. year. Since then, however, the city renegotiated its hospitals in Santa Barbara, Goleta and Santa Ynez. Earlier this year, Sansum was honored with contract with MarBorg and the savings have been When completed, the new organization will have one of the city’s Spirit of Service Awards for its trimmed to $245 per month. some 4,200 employees. waste reduction efforts in the business sector. Even so, Stampe says, Sansum has no While all of Sansum’s facilities recycle, “They’ve done a really good job,” says intention of curtailing the program. the push to implement a composting program at Neive Tierney, recycling “The important thing is it’s not so much about Pesetas Lane came from specialist with the city of the money,” he says. “The important thing is that former employee Kathleen Santa Barbara Sansum has always been conscious about trying Rodriguez, according to John Stampe, to recycle. When we determined that we could be Stampe. environmental services taking about 66 percent less trash to the landfill, “She was an manager at Sansum, is the [Sansum] board said that was great.” environmentalist and always convinced that the amount of Sansum is headquartered in Santa Barbara, pushed for recycling,” he trash going to the landfill can which is often credited as the birthplace of the recalls. “She asked about be reduced even further. modern-day environmental movement. That taking it to the next level, “I think we could reduce fact may have helped ease the way for both the which was composting. I said the amount going to the recycling and composting programs. it was a big step for us.” landfill by 10 percent if we “Santa Barbara is very environmentally It was also a step that take it to the next level,” says aware,” Stampe agrees. some see primarily geared Stampe, who has worked He reports that patients often enquire about to food scraps and aimed in facilities management the yellow trash bins in the exam rooms, and are at restaurants and food for 35 years and today excited to learn that they are for composting waste processing facilities. Sansum, handles all environmental materials. Staff at the clinic also “bought into it” which operates outpatient issues at Sansum, from although he notes it has been difficult to get some facilities, does not generate hazardous waste to document Medical assistant Christine Miles much, if any, food waste. doctors out of their habits and routines when it destruction. discards exam table paper in a yellow came to waste disposal. “A large part of The composting program compost container at Sansum Clinic’s Sansum’s waste is table paper A typical thing that a doctor will do is to take a has proven so successful at Pesetas Lane Multi-specialty Clinic. Continued on page 7 and paper towels, which can 4

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JUL-SEP 2013

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including the vehicles, carts, elevators and cartwashers will range from around $1.4 million for a limited shuttle system moving a few hundred carts per day and running point to point between two or three locations to $16 million for a large installation moving about 4,000 carts a day. “Generally,” Schachinger said, to do the same functions at the same levels of service the costs for a fully manual system will be about 60 percent of the costs for the AGV for elevators, carts, etcetera.” He noted that when an AGVS is added to the project design at the programming and concept phases there is a greater opportunity for space savings equaling or exceeding the costs of the system. For example, he explained that at the Cleveland Clinic a manual system that would have provided equal material handling service would have required 35,000 more square feet of space than with the AGVS. Generally, Schachinger noted, the number of beds and the configuration of the facility will determine the cost. A 250-bed facility is usually the starting point for using an AGVS, he said. Schachinger suggested that hospitals considering robotic material handling systems have a detailed materials handling study with a life cycle cost analysis done for the project. These studies are particularly important when the hospital is contemplating installing the AGVS in an existing building. “Can the building accept the system ‘as is?’ How much would be the cost for physical changes to the building?” he said. Schachinger cited studies that show for more than 70 percent of the cases there might have been a significant financial saving with an AGV, but the existing building would not support the installation without significant and “deal breaking costs” and/ or “operational compromises. Although the cost of the system is extremely important, he added that there is a “quality benefit” derived from the use of robots. “AGVs handle material better. They’re safer when dealing with medical waste. And they work 24 hours a day. They don’t take breaks or get injured lifting,” he added. Photos courtesy of The Schachinger Group, http://theschachingergroup.com.

medical waste management

Clinic Group Finds Cure for Exam Room Waste Continued from page 4

piece of paper he or she is holding in a gloved hand and throw it in the trash along with his glove. “The paper is compostable; the latex glove is not. So we had to get them to change that habit,” Stampe says. Adding the yellow bins to the exam rooms was another challenge that Stampe faced. When he first started adding the bins to the rooms, the rooms began to look like a trash loading dock. “I’m seeing four streams of trash coming from one small 10-by-12 exam room,” he says. “I’m going, “No, no, we can’t do this.” An audit of each room was conducted to determine the type and amount of trash being generated, resulting in some cases of a bin being removed if it wasn’t needed. And a clever design change to the existing trash and recycling cans — using a small clip-on can that could fit inside or outside the blue recycling can — also helped lessen the impact of the bins. The design change was also aimed at “promoting and encouraging recycle, recycle, recycle,” Stampe says. The yellow compost bins are either the size of regular desk-side office trash containers or else taller and thinner models. Some bins near the sink in exam rooms are clearly labelled “paper towels only.” The yellow compost bins have not been placed in public areas of the clinic due to concerns about separating waste streams. With recyclables, items are separated at a

“The motive is to help the community recycle ... We’re trying to help the community help the environment.” MarBorg processing plant in Santa Barbara. “Compostables are not [checked],” Stampe explains. “You cannot make a mistake. You can’t go, ‘Oops, my mistake. I put in plastic,’ because it wrecks everything they do at the composting facility in Santa Maria. They don’t have people looking at it.” The compost bins are lined with biodegradable bags. Those bags are expensive, so rather than being replaced every day, they may just be emptied into 4-cubic-yard yellow Dumpsters. Stampe says a key component of the program was to get the clinic’s outside nighttime janitorial service to agree to the extra workload. The same company provides a crew to take care of the building and empty the trash during the day. “They were more than enthusiastic,” he reports. “They were going to pass the [composting] idea on to their other customers.” “One could say it was almost a ‘perfect storm’ for the start of a composting program,” Tierney says. “It had all the right elements. Enthusiastic staff dedicated to making a difference, a large waste stream of table paper and paper towels, and janitorial staff that was up for the task.”

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Stampe also is hoping to promote the composting and recycling efforts to others. He is president of the central coast chapter of the International Facilities Management Association and is looking forward to doing a presentation to its members. Meantime, Sansum is looking ahead to adding composting programs to three other facilities. The Pueblo Street facility nearly the same size as Pesetas Lane, while the Hitchcock Way and Lompoc facilities are 20,000 and 30,000 square feet respectively. “All of our locations recycle, but it [composting] doesn’t make sense for some facilities,” Stampe says. Items being recycled can include hard plastic ear cones and breathing apparatuses, IV bags and plastic tubing, empty sterile wipe containers and film plastic packaging and paper inserts. Cost savings, Stampe adds, isn’t the motive behind the recycling and composting programs. “The motive is to help the community recycle,” he says. “The company, from the very top down, is very environmentally sensitive. We’re trying to help the community help the environment.”

www.mark-costello.com JUL-SEP 2013 Medical Waste Management

news briefs

Organic Waste Information Resource for Ontario Hospitals Released

ntario, Canada—A new case study by six Ontario health care organizations that compares pros and cons of organic waste management options is an important step toward increasing the amount of waste recycled and diverted from landfills, according to an article on GreenHealthcare.ca. The case study was done by Children’s Hospital of Eastern Ontario (CHEO), the Ottawa Hospital, Ross Memorial Hospital in Lindsay, Homewood Health (Guelph), St. Michael’s Hospital (Toronto) and Cornwall Community Hospital. The information contrasting on-site open-air composters, vermicomposting, macerators, dehydrators, and in-vessel composters will be valuable to healthcare facilities of all types, the Ontario Hospital Association hopes. Diverting and treating organic waste within health care facilities is still in the early stages across Canada, where organizational commitment and the availability of funding, resources (such as haulers and other support services) vary, according to the Ontario Hospital Association’s report, 2012 Green Hospital Champion Fund: Opportunities to Green Ontario’s Hospitals. “Ontario hospitals are challenged by the absence of a universallyaccepted waste audit standard, resulting in poor comparison between hospitals and low assurance of the effectiveness of project-specific diversion claims.”

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Louisville Hospitals Launch Recycling Program

ouisville, KY—An article on Bizjournals.com reports that a new composting program started by Sts. Mary & Elizabeth Hospital has diverted 1.5 tons of food waste from landfills in a very short time. The initiative, which began in May, is an important effort in supporting the city’s sustainability plan, which is aimed at a 50 percent reduction in landfill waste by 2025. The hospital, which belongs to the KentuckyOne Health system, said it is launching the program because healthcare is one of the biggest consumers of resources. Additionally, research suggests a link between environmental health and chronic disease, a hospital news release states. A general recycling effort got underway in July at the hospital. A specialty waste program, which includes disposable surgical drapes and IV bags, is planned, as well. Along with the program, KentuckyOne Health has signed on to a national Healthier Hospitals Initiative. “Not only does it make good business sense, this work aligns with our mission of building a healthier community,” Alice Bridges, Vice President of Healthy Communities for KentuckyOne Health told media. “Approximately 75 percent of all health care costs are for the treatment of chronic diseases, so by addressing the root causes, we can play a crucial role in reducing the burden of chronic disease.”

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PVCMed Alliance to Participate in Swedish Waste Management Project

he PVCMed Alliance recently announced that it will co-finance and participate in a Swedish waste management project running until January 2014. The aim is to establishing a sustainable management system for medical plastic waste through close collaboration between various stakeholders and field projects. Every day a vast quantity of plastics from healthcare is used and disposed of worldwide. The PVCMed Alliance has joined the Swedish Environmental Institute, Swedish Regional and County Councils, waste companies, research institutes and chemical companies to set up a sustainable management system of this particular type of plastic waste. All parties involved will work closely to develop a “roadmap” for increased recycling of plastics from healthcare. This includes identifying products and packaging that can already be easily sorted and recycled with high quality, but also investigate how to further develop plastic recycling systems in order to make them more efficient and relevant. Additionally, several case studies will be conducted within, amongst others, the Sahlgrenska University Hospital in Gothenburg, the Karolinska University Hospital and Södersjukhuset in Stockholm. The PVCMed is an alliance of the PVC medical industry chain represented by PVC resin & plasticiser producers and PVC converters to proactively engage in PVC and healthcare related debates. The Alliance’s aim is to provide a focal point for communication with healthcare professionals and regulators about PVC-based healthcare applications, and their fundamental role in quality of healthcare, safety and costefficiency, while being environmentally responsible.

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Detecting Pharma Waste in Environment Made Easier

reiberg, Germany—Detecting pharmaceutical waste in the environment has been challenging, but a new technique developed by German scientists will make it easier, according to an article on DigitalJournal.com. Using fluorescence resonance energy transfer (FRET), researchers at Helmholtz-Zentrum Dresden-Rossendorf laboratory (HZDR) demonstrated the presence of medicines in rivers and streams. The compounds have been found to affect water quality and impact aquatic life. FRET involves applying fluorescent dyes on a nanostructured surface consisting of bacterial proteins. The scientists tested red and green dyes. If the analyzed sample glowed red, the water was free of pharmaceuticals. If it turned green, pharmaceutical compounds were present. As more and more sophisticated pharmaceutical products are used and end up in the environment – mainly through wastewater -- the risk of chemicals remaining in the water supply increases (according to the U.S. Environmental Protection Agency).

Antimicrobial Resistance Threatens Healthcare Systems Worldwide

ondon, England—According to an article on ScienceDaily.com, antimicrobial resistance is a looming issue that must be dealt with worldwide. In response to healthcare community concerns, the UK’s Department of Health has developed a plan. The UK Antimicrobial Resistance Strategy and Action Plan suggests new ways of looking at antimicrobial resistance and calls for public, NHS and government programs to address changes. One standard practice, that of prescribing antimicrobials should be reassessed, the Plan notes. From surgeries such as hip replacement, Caesarian sections and removal of cancer tissue, antibiotics add little cost and prevent infections, but they may provide false reassurances, the plan says. “Waiting for the burden to become substantial before taking action may mean waiting until it is too late. Rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen.” The problems are global and the terminology complex, but the importance is clear, the Plan authors say, and they call for more attention to routine infection control and clinical care.

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Medical Waste Disposal Company Thief Sentenced

utte, MT—Two men were recently sentenced in U.S. District court here for theft of prescription medications from a medical waste disposal company where they both had worked, according to an article on Missoulian.com. The case began, prosecutors told The Missoulian, when the men’s landlord found a five-gallon bucket containing prescription medication. In August 2011, police officers seized over 61,500 pills, including controlled and noncontrolled substances. The medical waste disposal company was not named in the article. The state of Montana began a drug “take back” program, Operation Medicine Cabinet Montana, in 2010. Since then, several tons of unwanted or expired prescription drugs have been collected. The program is sponsored by the Montana Department of Justice, in coordination with local law enforcement and U.S. Drug Enforcement Agency (DEA). In 2011, the Attorney General’s Office began assisting local law enforcement agencies who qualified for grant funding for setting up permanent prescription drug drop locations.

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news briefs

Contaminated Ultrasound Gel Found At Detroit Health System

etroit, MI—A study conducted at Beaumont Health System near Detroit has tied a 2011 healthcare associated infection (HAI) outbreak to P. aeruginosa-contaminated ultrasound gel, ScienceDaily.com reports. During routine infection control monitoring, an outbreak was confirmed when sixteen cardiovascular ICU patients came down with respiratory tract infections. The infections were traced to the bacterium, P. aeruginosa, which causes bloodstream and respiratory infections in immune-compromised individuals. The outbreak was found to have originated in bottles of ultrasound transmission gel used during cardiovascular surgery. The hospital replaced the gel sourced from Pharmaceutical Innovations with new product and no further cases occurred. When the researchers found p. aeruginosa present in unopened containers of Pharmaceutical Innovations product, they proved contamination had occurred during the manufacturing process at the plant and not as a result of hospital procedures. Subsequently, the FDA issued a warning about the gel, alerting the risk of infection posed by the product and instructing healthcare providers and systems not to use the infected products. “Ultrasound is a critical healthcare tool used every day in both diagnostic and interventional procedures,” said Paul Chittick, MD, lead author of the study. “Although contaminated gel has been the cause of several documented outbreaks of infection, its potential role as a vehicle for spreading infections to patients is frequently overlooked.” The Beaumont study resulted in recommendations for use of ultrasound gel, such as the need for development of sterile, single-dose ultrasound gel packages to be used for all invasive procedures. Additionally, new guidelines for appropriate storage and warming methods were developed. The study findings are published in the August 2013 issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

Vancouver General Hospital Combats HAI, Wins Innovation Award

ancouver, B.C.—Vancouver General Hospital has been testing ultraviolet light-emitting housekeeping robots with success. Now, according to CBC.ca, researchers there have won an international award for yet another infection control innovation, “nasal photodisinfection.” VGH’S team of scientists has been awarded $11,000 in prize money from the International Consortium for Prevention and Infection Control (ICPIC) for their groundbreaking research. Nasal photodisinfection involves swabbing the inside of a patient’s nose with a blue dye prior to surgery. Germ cells – even drug resistant ones - absorb the dye. When an ultraviolet light is shone on them, they are destroyed in large numbers. “What we know is surgical site infections usually come from bacteria already living on the patient, on their skin and in their nose,” said Dr. Titus Wong, a medical microbiologist at VGH. “After surgery, some of these bacteria can go into these incisions and cause infections.” The results of the 12-month pilot project were impressive: in the 5000 patients studied, post-surgical infections were reduced by almost 40 per cent. The hospital saved $1.3 million in post-surgical infections and re-admissions, the study team calculated. Photodisinfection saves time and money, according to Wong. The traditional method of applying antibiotic ointment takes five to seven days to work, while it increases drug resistance and associated treatment costs. The $11,000 in prize money will be invested in infection control research at the hospital. The nasal photo disinfection technology was developed by Ondine Biomedical, a Vancouver-based company.

Multi-Tasking! Vecoplan’s Universal Shredders Pull Double Duty! IT’S A MEDICAL WASTE SHREDDER... • • • • •

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COMING IN NOVEMBER Sponsored By

2013 Medical Waste Management’s Hospital Sustainability & Waste Management Assessment Training Program Registration Cost: $395 (program is limited to 145 attendees)

Program Highlights Include: •

Six steps to implementing a successful waste assessment at your healthcare facility, and its role in Green Building Rating systems.

•

How to effectively work with clinicians to get them to actively participate in your facility’s sustainability program.

•

Greening your operating room: creating a program without spending money to save money.

•

Establishing a successful multi-material recycling program. This session will also compare single-stream and co-mingled recycling options.

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Reducing regulated medical waste at your facility: how to work with staff to break old habits and implement new ideas that will enable you to reduce your regulated waste volume.

•

How to set-up a facility based pharmaceutical waste recovery program. Also, understanding your responsibility under the Resource Conservation and Recovery Act (RCRA).

•

Food Waste Recycling: a comprehensive overview of how your facility can establish a food waste recycling program, from collection to processing.

•

HIPAA In-depth: a national law firm, specializing in HIPPA regulations, will help you better understand your responsibility under the new HIPAA rules.

•

Energy Conservation: a case study presentation on how one hospital system greatly reduced its energy costs.

To register contact Rick Downing at 440-257-6453 or email to RickDowning@oh.rr.com. 14 Medical Waste Management JUL-SEP 2013

news briefs

HHS and WellPoint Reach $1.7 Million Settlement for HIPAA Breach

ondon, England—DataGuidance.com’s PrivacyWeek reports that WellPoint Inc. will pay the US government $1.7 million in fines related to a security breach that occurred on the insurance giant’s Internet enrollment website. The settlement agreement was struck between WellPoint and The USA Department of Health and Human Services (HHS) Office for Civil Rights (OCR). Cited are potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. The online breach, which occurred between October 23, 2009 and March 7, 2010, involved compromised health data of 612,051 individuals, including names, Social Security Numbers, telephone numbers, and health information. The breach was reported on March 8, 2010 but the company did not begin contacting affected individuals until June of the same year. Also, a class action suit was filed and the state of Indiana imposed a $100,000 fine on the company and its subsidiary, Anthem Blue Cross Blue Shield. The online exposure affected 32,000 Indiana residents. Wellpoint agreed to pay for up to two years of identity theft monitoring, as well as $50,000 for any theft that could be traced to the breach, according to a 2011 article on InformationWeek.com. A 2009 Indiana law requires companies to notify the state of certain data breaches. In its 2012 investigation, the OCR noted that Wellpoint’s online database access policies and procedures fell short of the HIPAA Security Rule. Inadequate software upgrade risks and user verification safeguards were cited. The agency urged “caution when implementing information systems changes, particularly those involving updates to Web-based applications or portals used to provide access to consumers’ health data using the Internet.” The settlement sends a warning to business associates, including subcontractors who create and maintain websites and portals on behalf of HIPAA-covered entities because those companies also fall under the HIPAA omnibus rule changes.

Whistleblower Suit Settlement Reached on Shred Size Noncompliance

hiladelphia, PA—A Pennrecord.com article reports that two of the nation’s largest commercial shredding services have reached a settlement agreement with the United States government for failing to comply with federal shred size standards. The qui tam (whistleblower) case was brought against Shred-It Inc. and Iron Mountain, Inc. by Douglas Knisely, owner of a paper shredding business based in Pennsylvania. Knisely charged that the two companies (both US government contractors) did not cut government documents to the size required under the General Services Administration’s standards, which was specified in their contracts. The basis for the case was false and fraudulent claims for payment under the rules of the False Claims Act. In a qui tam case, a private individual who assists a prosecution can receive all or part of any penalty imposed. Court records do not indicate the amount Knisely might receive. Under the terms of the settlement agreement, Iron Mountain would pay the federal government $800,000 while Shred-It would pay $300,000, according to Zane David Memeger, the U.S. Attorney for the Eastern District of Pennsylvania. Both companies also agreed to pay attorneys’ fees stemming from the litigation. Court records indicate a third defendant, Cintas Corp. was named in the suit but was not a party to the settlement agreement. “Defendants’ failure to shred government documents using shredders designed to meet the size specifications mandated in their contracts with the United States potentially exposes sensitive, private and sometimes classified government information to persons not authorized to receive such information,” the complaint stated.

www.redbag.com JUL-SEP 2013 Medical Waste Management 15

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news briefs

Vietnam Approves $8m Project For Medical Waste Management

anoi, Vietnam—Vietnamese Prime Minister, Nguyen Tan Dung, has approved an $8-million (USD) project to manage medical waste, according to a Voice of Vietnam article on StoxPlus.com. Funded by the Global Environment Facility (GEF) through the World Bank (WB), the project will look at preventative strategies, such as pollution management, and ways to minimize persistent organic pollutants (POPs), persistent toxic substances and mercury. GEF is contributing $7 million (USD) in non-refundable aid, while $1 million (USD) is coming from Vietnam’s Ministry of Health and Ministry of Natural Resources and Environment. An independently operating financial organization, the GEF links 183 countries with international institutions, civil society organizations (CSOs), and the private sector to act as partners in addressing global environmental issues while supporting national sustainable development initiatives. Today the GEF is the largest public funder of projects to improve the global environment, providing grants for projects related to biodiversity, climate change, international waters, land degradation, the ozone layer, and persistent organic pollutants. Since 1991, the GEF has provided $11.5 billion (USD) in grants to developing countries and countries with economies in transition, leveraging $57 billion (USD) in co-financing for over 3,215 projects in over 165 countries. Through its Small Grants Programme (SGP), the GEF has also made more than 16,030 small grants directly to civil society and community-based organizations, totaling $653.2 million (USD).

Public Health Experts Agree On Priority Actions for MERS-CoV

eneva, Switzerland—Xinhuanet.com reports that public health officials who met in Cairo this summer have developed a list of seven priority actions for preventing a world-wide epidemic of MERS. Led by the World Health Organization (WHO), more than 100 experts from the Middle East, North Africa and Europe met earlier this summer to discuss a range of epidemic prevention strategies emphasizing fast and complete reporting of cases that include documentation of contact histories, clinical care and treatment outcomes. The experts agreed that uniform data collection methods are crucial. Priorities set at the meeting included: 1. Surveillance 2. Mass gatherings preparation 3. Clinical management of cases 4. Laboratory diagnostics 5. Infection control 6. Communications 7. International Health Regulation (2005) reporting. In May, the Ministry of Health in Saudi Arabia reported four laboratoryconfirmed cases with MERS-CoV, including three female health care workers who cared for two previously confirmed MERS-CoV cases. In mid-July a laboratory-confirmed case of MERS-CoV was reported in United Arab Emirates. Globally, from September 2012 to date, WHO has been informed of a total of 82 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.

Subscribe to our online edition of Medical Waste Management. Contact us at downassoc2@oh.rr.com. IT’S FREE!

Aggressive Interventions Can Greatly Reduce C.Diff

Coronavirus Epidemic Research Continues

lenville, IL—A Newswise.com article reports the publication of a promising study that shows aggressive infection control can greatly reduce the incidence of Clostridium difficile (C. diff). Using these infection control methods, one hospital cut its C. diff infection rate by 44 percent in two years. The study’s investigators conducted a tiered infection control program at a 50-bed long-term acute care center with the goal of decreasing the incidence rate of C. diff by 15 percent within six months. The comprehensive program included a combination of training, specific methods for environmental cleaning and disinfection, diagnostics and surveillance, and other infection control measures. The study was published in the Journal for Healthcare Quality, the peer reviewed publication of the National Association for Healthcare Quality (NAHQ), www.nahq.org. One cleaning procedure involved switching from cotton string mops to microfiber mops. The method was found to vastly improve the removal of organisms associated with hospital-acquired infections (HAI). The researchers discovered that by testing unformed stools, infection outbreaks could be caught at the very beginning, monitored and, as a result, more easily controlled. That, along with contact isolation for all patients with a positive diagnosis of C. diff made a significant impact. A combination of patient room signage, a reduction in antimicrobial therapies and certain antibiotics (clindamycin and cephalosporins), instituting a strict adherence to hand washing and providing hygiene instructions for visitors also helped reduce transmission of C. diff between patients and the community. Prior to starting the C. diff control program, the hospital’s incidence rate was 56.52. After 12 months, the rate had dropped to 34.36 and fell to 31.51 after two years. The overall C. diff incidence at the end of 24 months decreased by 44.25 percent.

ondon, England—According to an article on CBC.Canada.ca, the findings of British and French studies on the Middle East Respiratory Syndrome (MERS) coronavirus show a significant drop in cases. The researchers agreed that the virus has not reached pandemic potential and possibly, it may simply die out. Coronaviruses are a large family of viruses that includes those that may cause a range of illnesses in humans, from the common cold to SARS. Viruses of this family also cause a number of animal diseases. Initially compared to severe acute respiratory syndrome (SARS) when it emerged in Saudi Arabia last year, MERS does not spread as easily, British and Saudi scientists found. SARS killed nearly 800 people worldwide starting with a 2002 outbreak in China. The World Health Organization (WHO) puts the latest global toll at 45 deaths from 90 laboratory-confirmed cases. The new research, published in The Lancet Infectious Diseases journal, is the largest case series to date. It documents 47 cases of confirmed MERS infections from Saudi Arabia between Sept. 1, 2012 and June 15, 2013. MERS can cause a broad range of symptoms, including coughing, fever and pneumonia. The virus emerged last year in Saudi Arabia and spread from the Gulf to France, Germany, Italy, Tunisia and Britain. Since it was first identified in early 2012, ninety cases have been reported. Rapidly spreading SARS infected more than 8,000 people between November 2002 and July 2003. While the SARS virus attaches to receptors in the nose, throat and upper respiratory tract, MERS virus remains confined to the deeper lung passages. Scientists believe this is why MERS does not spread so easily from one person to the next. They also concluded the virus is more likely to be contracted by people with diabetes and heart or kidney disease.

JUL-SEP 2013 Medical Waste Management 17

news briefs

Utah Environmental Group Urged Shutdown of Stericycle Incinerator

alt Lake City, UT—According to an article on DeseretNews.com, Utah Physicians for a Healthy Environment are urging government officials to take a closer look at a medical waste incinerator plant operated by Stericycle. At the same time, a dispute over air quality compliance issues is brewing. In June, the physician’s group asked the state Division of Air Quality (DAQ) to hold a public hearing on the Illinois-based company’s permit because of the amount and concentrations of emissions coming from the plant. In May, the plant’s staff reported to DAQ that hazardous pollutants released from the stacks were above permit limits. After its review, DAQ issued a notice of violation (NOV) against Stericycle alleging the company operated out of compliance with its permit by failing to report numerous deviations, including those which exceeded the permitted limits of dioxin/furan, as well as nitrogen oxides emissions and hydrochloric acid. On June 14, 2013, Stericycle submitted its 15-day response to the NOV and requested a 30-day extension for further response. The company’s response to the Notice of Violation states: “Stericycle believes that it has undertaken all actions necessary to demonstrate and maintain compliance with all applicable requirements as required by the Order. In addition, Stericycle is proposing to do additional stack

testing to provide further assurance of ongoing compliance with applicable emission limits. It is Stericycle’s intention to fully comply with the Order and all applicable requirements including reporting, testing and notification requirements as set forth in the Title V Operating Permit. Stericycle has installed additional controls, implemented more robust monitoring and preventative maintenance procedures, and verified key operating parameters and controls in order to ensure compliance with emission limits. The most recent stack testing results for each air pollutant have demonstrated compliance with emission limits. (Additional, pollutant-specific information is provided below for NOx, dioxin/ furan, and HCl emissions.)” Under its permit, Stericycle may burn up to 2,500 pounds of medical waste per hour and 7,000 tons of waste per year. The waste, though classified as nonhazardous, consists, in part, of human tissue from hospitals and clinics, and waste from mortuaries and veterinary clinics. It contains blood-borne pathogens and other matter critics say would be best disposed of in a landfill or treated via autoclave. To the concerned residents who live near the facility, the company maintains it has been a good neighbor. And, in July, Stericycle updated the plant’s pollution-scrubbing equipment to meet air quality and testing requirements.

Product/Equipment Profiles Vecoplan Introduces VAZ 1800 Rotary Waste Shredder

INTEGRA Introduces VACUSAFE Laboratory Aspiration System

ecoplan’s VAZ 1800 industrial shredder was designed to process a wide range of wastes for reclamation, recycling, and RDF applications. These include MSW, C&D waste, plastics, carpet, w o o d , medical waste, paper, and cardboard. T h e VA Z 1 8 0 0 features a larger rotor diameter and taller feed ram that dramatically improves the throughput and overall processing efficiency of bulky scrap materials, and other large dimension waste products. The VAZ 1800 features true dump and run operation, so entire containers of waste can be fed into its hopper. The hopper, on a VAZ 1800, has a volume capacity of 10.25 cubic yards and a 70”x82” in feed opening. Its 25” diameter rotor has 84-126 cutting inserts, is powered by a 150-200 HP motor, turns at 125 rpms, and is fed by a 10 HP two speed hydraulic feed ram.

h e VA C U S A F E Laboratory Aspiration System 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 l i q u i d l e v e l s e n s o r to prevent overfilling of the shatterproof waste bottle, an easyto-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 thereby eliminating the risk of contaminating house vacuum pipelines and reducing environmental impact caused by evaporation of volatile elements). The air outlet can be connected to silicon tubing to direct exhaust air into a safety hood or through an additional HEPA filter to produce a totally closed system. Self-closing quick connectors prevent the escape of drops or aerosols when disconnected the waste bottle and tubing.

For more information contact Vecoplan at: Phone: 336-861-6070; Email: info@vecoplallc.com or visit our website at www.VecoplanLLC.com.

For further information on the VACUSAFE please visit www.integra-biosciences.com or call +41-81-286-9530; Email: info@integra-biosciences.com.

18 Medical Waste Management JUL-SEP 2013

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JUL-SEP 2013 Medical Waste Management 19

Medical Waste Management www.medicalwastemanagementnews.com

VOL. IX NO. 3

Serving Healthcare Facility Waste Management Professionals

JUL-SEP 2013