Tulane Hospital taking steps to reduce medical waste

Whatever happened to the red bags and bins labeled “biohazard waste” once found in every doctor’s office, patient room and clinic at Tulane Medical Center?

In its bid to go green, the hospital says, it had to remove some of the red.

Tulane is about nine months into a two-pronged initiative to reduce its regulated medical waste and cutting costs.

“It’s something that the company is taking very seriously. This is the direction that we’re moving in, the green way,” said Hiral Patel, assistant administrator of Tulane’s environmental services division. “This program touches on all elements. First and foremost was reducing the carbon footprint, for sure. Then it’s about cost savings.”

Before the initiative was launched in March, Tulane logged about 7.7 pounds per adjusted patient day of regulated medical waste, the kind of potentially infectious materials that by law must be discarded in red bags separately from regular trash.

The hospital produced the most waste of any of the 18 hospitals, outpatient centers, physician clinics and ambulatory centers in the HCA MidAmerica Division, which includes Kansas, Louisiana, Mississippi and Missouri, said Justin Jett, director of environmental services for Tulane Medical Center.

But the hospital discovered that its number was inflated. Instead of just regulated medical waste, audits revealed that doctors, nurses, patients and hospital and clinic visitors were tossing food wrappers, bandages, Styrofoam cups and other regular trash into the bins designated for biohazardous trash. It is against the law to remove items from the bags designated biohazard.

“The average person doesn’t know the difference between them,” Patel said. “If the white one is full, they’ll just throw it in the red one. At that point you don’t have any real way to distinguish what is what.”

So Tulane removed the bags and bins from patient rooms, clinics and other places of general access and put them in central locations, accessible only to medical staff who have now been trained on what should and shouldn’t be placed inside.

In November, the medical center produced just 2.9 pounds of regulated medical waste per adjusted patient day, the lowest amount in its HCA division, Jett said. The goal is to drop below 2 pounds by March.

The operational change is one of two steps Tulane has taken this year to lessen its environmental impact.

The healthcare industry has long had a garbage problem. Though no organization tracks just how much waste hospitals produce, most estimates are in the millions of tons a year.

Practice Greenhealth, a nonprofit organization that advocates for less waste in the health care sector, puts the number at about 5.9 million tons per year. That figure is conservative, said Kaeleigh Sheehan, project manager for Project Greenhealth’s Greening the Operating Room initiative, because it counts only hospitals that have already taken steps to reduce waste production. About one-third of all medical waste is generated in the operating room, Shaheen said.

Healthcare providers across the country have been trying to bring the figure down.

Some, for instance, are now reusing medical devices that are declared as “single use” by manufacturers but are cleared by the Food and Drug Administration to be used more than once. The equipment is sterilized by a third party and sold to hospitals at a discount. Others are carefully monitoring new purchases to cut incineration and landfill fees.

Regulated medical waste must be transported separately from regular trash and must be incinerated before it is taken to a landfill, a step not required in the normal waste disposal process. It costs about eight times more to dispose of regular medical waste than regular trash, Shaheen said.

Tulane is tackling waste by making both behavioral and operational changes, through a partnership with Illinois-based Stericycle, the largest player in the medical waste disposal industry.

Stericyle now reuses the hospital’s “sharps” containers — bins that hold discarded needles.

Traditionally, nurses or technicians would retrieve the containers when they became full and then toss the entire bin and its contents.

Now, a Stericyle employee disposes of the needles and the containers are sterilized and reused.

Not only does that free up hospital staff to give more time to patients, but it also allows the hospital to get 600 uses, instead of a single use, out of one sharps container, Jett said.

The program is preventing about 15,715 containers from going to the landfill each year, which has cut $16,778 from the hospital’s expenses, Jett said.

The second change has the potential for even greater savings.

“There’s a lot of misunderstanding about what is medical waste,” Jett said.

Bloody gauze so saturated that it can be wrung out qualifies. A bandage with blood on it, the likes of which could be found in any household, does not.

“If a nurse changes a bandage with dry blood on it, it’s just regular waste,” Jett said. “If you throw a Styrofoam cup in a regulated medical waste bin, you’re then having a much bigger waste impact on that cost, on the environment. We’ve had to retrain and re-educate everyone on what is supposed to be medical waste, and what’s regular waste.”

To reinforce the point, Tulane has removed the red regulated medical waste bags from patient rooms and patient care areas, where not much regulated medical waste is generated, Jett said.

The shift is already having an impact. Before the program started, Stericyle had to pick up regulated medical waste from Tulane twice a day. Now the company comes twice a week, he said.

Tulane expects to generate 290,137 pounds of regulated medical waste in 2013, down from 641,665 in 2012. The reduction will amount to more than $60,000 in savings, Jett said.

Editor’s note: This story was updated Dec. 16 to reflect that Stericycle reuses sharps containers and needles, rather than recycling them.