Healthcare Environmental Issues and Opportunities

The healthcare industry affects the lives of virtually everyone in the United States. According to the Centers for Medicare and Medicaid Services (CMS), healthcare expenditures will account for approximately 17% of the Gross Domestic Product this year. Many activities in the healthcare industry result in land, water or air pollution. Much of the waste is recyclable and consists of paper, cardboard, glass, plastic and metals. There are two other types of solid waste in healthcare: regulated medical waste and hazardous or chemical waste. Additionally, hospitals discharge large amounts of wastewater and release air emissions from their facility operations.

Oftentimes, hospital services are decentralized, departmentalized, or even managed by contracted services. There may be little or no centralization of efforts. There may be minimal regard, knowledge or control over minimizing waste or environmental impact. If healthcare organizations really want to decrease costs and reduce their carbon footprint, they must embrace sustainability with the full support of top management. They must pay close attention to what they purchase and what they discard.

There are many variables affecting healthcare waste minimization:

* The types of products and materials purchased

* The types of waste segregation systems

* The degree to which wastes are identified

* The locations of the waste generation

Healthcare wastes can be categorized as:

* Municipal

* Recycling (Pennsylvania Act 101, for example)

* Regulated medical waste (Bio-hazardous or Red Bag Waste)

* Hazardous waste (listed and characteristic waste, commingled waste, pressurized containers and ignitable gas, and universal waste)

* Universal Waste (Batteries, Fluorescent Bulbs, Electronics, Mercury-containing Equipment)

* Waste water, Storm Water and Air Emissions

Municipal Waste:

The United States healthcare industry generates 6,670 tons of waste per day, most of which is solid or municipal waste. Of this solid waste, more than half is composed of paper and cardboard. Hospitals with excellent recycling programs recycle over 40 percent of their total municipal waste.

Recycling:

Many states mandate commercial and residential recycling of a wide range of materials. For example, Pennsylvania Act 101 mandates recycling in Pennsylvania’s larger municipalities and requires counties to develop municipal waste management plans. The goals of the Act are to reduce Pennsylvania’s municipal waste generation; recycle at least 25% of waste generated; procure and use recycled and recyclable materials in state governmental agencies; and educate the public as to the benefits of recycling and waste reduction.

Municipalities must collect at least 3 of the following materials: clear glass; colored glass; plastics; aluminum; steel and bimetallic cans; high grade office paper; corrugated paper and newsprint. Commercial, municipal and institutional establishments are required to recycle aluminum, high-grade office paper and corrugated paper in addition to other materials chosen by the municipality. Leaf and composting are required to be separated from municipal waste. Businesses, including hospitals, are encouraged to help reduce waste by purchasing products that are durable, repairable, recycled, recyclable and/or have minimal packaging, and to find other uses for surplus goods instead of throwing them away.

Regulated Medical Waste:

Industry best practices for red bag waste are between one and three pounds of red bag waste per patient day, yet many hospitals still treat 25 to 30% percent of their total waste stream as infectious. Bio-hazardous waste includes sharps, pathological waste, blood and blood products, blood-soaked items, and non-regulated chemotherapy waste. Most patients in medical-surgical rooms generate little, if any, infectious waste, however, there may still be reluctance on the part of hospitals to “source-separate” the bio-hazardous waste at the patient’s bedside or at the place of treatment. Some healthcare organizations still consider all waste generated in a patient’s room as red bag waste even when the waste contains no visible blood. Hospitals may fear that they will be cited with a violation should an item of trash be discarded improperly.

Progress in pharmaceutical technology has reduced the need for surgical interventions. Changes in healthcare reimbursements have decreased the length of stay in hospitals and increased home care and outpatient healthcare. Healthcare products are being packaged more efficiently and the use of plastics instead of glass has lessened the weight of many products. Despite all these advances, the widespread purchase and use of “disposables” in healthcare has created large amounts of waste that cannot easily be recycled. Many “single-use” medical devices can be safely sterilized and reprocessed and used many times. This can save healthcare organizations significant dollars by minimizing their need to purchase single use items.

Hazardous Chemical Waste:

The healthcare industry generates only small quantities of hazardous chemicals relative to the amount of municipal solid waste or bio-hazardous waste. Hospitals that own research laboratories generate greater volumes and more diverse types of hazardous chemicals. Healthcare laboratories that perform diagnostic testing often use a large volume of a few chemicals such as xylene, alcohol and formalin in their processes. Some labs recycle and reuse chemicals to avoid the cost associated with hazardous waste disposal and repurchase of new materials. Other labs are equipped with chemical analyzer systems with reagent reservoirs that reduce the total amounts of chemicals used and waste generated.

Wastewater Discharge:

Most healthcare facilities discharge wastewater to Publicly Owned Treatment Works (POTW). Dischargers are classified as major based on an assessment of six characteristics: (1) toxic pollutant potential; (2) waste stream flow volume; (3) conventional pollutant loading; (4) public health impact; (5) water quality factors; and (6) proximity to nearby coastal waters.

Healthcare Wastewater Best Practices include:

* Limit the use of water discharged through conservation and reusing water wherever possible.

* Train employees to use water more efficiently.

* Post signs at all floor drains and sinks to discourage employees from using drains to dispose of oil, vehicle fluids, solvents, and paints.

* Use non-toxic floor cleaners or “Green Chemicals.”

* Consider capping off unused floor drains.

* Prevent any spills and drips from reaching the drain.

* Know where your floor drains discharge.

* Set up a preventive maintenance program for inspecting and cleaning floor drains, traps and oil/water separators.

Air Emissions:

Hospitals may generate air emissions from boilers, emergency generators, sterilization chemicals (ethylene oxide), air conditioning and refrigeration, paint booths, and laboratory fume hoods.

Boilers: Many hospitals operate industrial boilers, which generate criteria pollutants (NOx, SO2, particulates, CO) as well as hazardous air pollutants. NOx emissions from boilers are the most serious criteria air pollutant generated by the healthcare industry. Click here for information regarding EPA’s new HAP regulations for boilers.

Incinerator emissions: As a result of the Medical/Infectious Waste Incinerators HMIWI rule, most facilities no longer have on site-incinerators.

Healthcare Sustainability:

Through training, education, source-separation, environmental purchasing, energy conservation, recycling initiatives and waste minimization, a green initiative will have a major impact on reducing waste and pollution. Healthcare facilities should organize a multi-disciplinary team of healthcare professionals and establish a sustainability program if they haven’t already done so. A Green Team will reduce waste from healthcare operations while saving money. Paying attention to the little things pays big dividends. It is also an important component of any organization’s public relations and marketing arsenal.