Medical Industry
Waste Prevention Round Table

Seminar #3
Exploring Alternative Products:
Durables and Reusables

May 25, 2000 at Greater Seattle Chamber of Commerce

MINUTES

History of MIRT (the Medical Industry Waste Prevention Round Table)
· established early in 1999
· 7 round tables held in 1999
· survey sent to members in 1999
· holding a series of focused seminars in 2000

Why switch to durables and resuables?
· decreased generation of solid waste
· decreased generation of hazardous waste
· financial savings (especially in the long term)
· only worth doing where health care isn't compromised

Results of the durables survey
· several hospitals use disposable items for which durable alternatives are available
· exam areas did not report the use of any durable items
· most linen items in hospitals are laundered but there are still several items for which disposables are often used

Link to survey

Web resources
· Medical Industry Waste Prevention Round Table
· Memorandum of Understanding between EPA and AHA
· Hospitals for a Healthy Environment
· links to alternative products websites

Model worksheet for comparing durables vs. disposables
· David Stitzhal ran through finance worksheet which was in the handout
· It was suggested that the "use cost" on the form should be broken down further so hospitals can see what all they should be calculating into use costs
· An EPA total costs analysis booklet exists
· You should look at the weight of an item or how many of that item would fill up a dumpster to help calculate landfilling costs
· More emphasis should be put on looking at landfilling costs and avoided haul rates

Video on durable linens - provided by Carol O'Hara of UW Medical Center's Consolidated Laundry
· "REUSABLE TEXTILES: The Responsible Choice-Acute Care" by the American Reusable Textile Association, e-mail: info@arta1.com, web: www.arta1.com (external site) Produced by Green Fire Productions (503) 736-1295.

Presentation by Kathleen Kiernan of Hospital Central Services on laundry services
· Discussed the benefits and hurdles of durable linens
· Addressed the issues surrounding the use of launderable diapers
· Details below

Discussion by Mark Kidd of Legacy Health System regarding their waste reduction and recycling program
· Program highlights
· Actions taken to achieve their current successes
· Details below

Blue Wrap Recycling Program update
· Mark Kidd thanked Ken Calhoun at Kimberly Clark for help with the blue wrap program at Legacy
· Ken discussed the program and explained that all we need up here to get the program going is a centralized sorting site.
· Hospitals are paid pennies per pound based on the blue wrap they are buying as long as they are taking part in the program
· Legacy has hired 8 challenged workers who help with the program and their positions are partially funded by Kimberly Clark
· Ken Calhoun offered to work with any manufacturer to help them put a similar program to the blue wrap in place

Barriers to overcoming reusables and solutions to these barriers
· Quality of care and patient welfare are the single biggest issues
· Giving everyone ownership from the beginning is very important. People don't feel left out later on and it helps spread communication.
· Makes sense to begin to comply now with the MOU rather than wait until compliance might be mandatory Pilot project opportunities
· Details below

What can the MIRT sponsors provide to help hospitals begin to implement the MOU?
· Have MOU information with EPA name on it
· Have an outside auditor come in and help assess the needs of each hospital
· Have the people in the hospital who know the ropes pass the information on to administrators
· Tour Legacy to learn from their process
· Develop a packet of printed resource information (similar to what is already developed) with a contact sheet, roles, #s
· Have all primary contact people come to a seminar and give a short presentation on what they do and what they can offer.
· Make a checklist of what hospitals can recycle (or do to reduce waste) and have them work their way up the ladder. Start with cardboard and work up to the toughies. Give to hospitals and have them fill it out. One page format would be great.

What potential future issues should we all be aware of?
· Diseases are getting worse and when this happens doctors turn to disposables and chemical sensitivities increase
· Infection control people are predicting that 10-15 years all infection control cases may go to some kind of specially enclosed rooms.
· Overuse of antibiotics has caused problems. More infectious waste, more cleaning, more chemicals. This all will increase in complexity as time goes on.
· Attendees were unaware of any initiatives overseas which might effect things here anytime soon

THE DETAILS

Presentation by Kathleen Kiernan of Hospital Central Services on laundry services

Overview
· Hospital Central Services Association launders around 20 million pounds of linen per year
· Kathleen has been in this business since the mid 1980's
· EPA/ AHA MOU was signed in June '98. It has been circulated at the laundries and they have been asked to take this into account for their operations or planning
· Explanation of goals of the MOU
· AHA , ASHES, ASHE and EPA are supposed to support this, primarily by providing education. This has been slow to get started here in Seattle

Reusable textiles
· A lot of people think all bed linens are now cloth now but what about when you go to a clinic and they have paper on a roll. There's still a lot of room for change.
· A popular new disposable item in hospitals is microwaveable wash pads
· Kathleen explained the differences between reusable and durable underpads
· Isolation gowns usually get about 75 uses per item
· One reusable item, which many hospitals do not currently use, is the reusable linen bag. They are designed to go on a hamper stand which costs about $60. Plastic bag companies often give free hamper stands so it's tough to compete with that. The hospitals need to pay for plastic bags when they show up at the laundry as the laundry is having to pay to dispose of them.
· The laundry owns the linens, the hospital has no capitol costs, just service costs
· Staff acceptance is very important. If you don't have this you're in trouble
· Emesis basins and bowls in the surgery packs are all plastic (disposable)
· Hospitals need to make sure they have the capacity to sterilize the laundry goods.
· Nurses often take more (towels) etc. than are needed and then they all need to be washed
· When comparing reusables and disposables you need to look at:
· Total cost

· Patient needs
· Environment/ waste
· Quality of product
· Staff acceptance (convenience)

· Fluid resistant and fluid proof reusable gowns

· They pull fluid resistant gowns after they have degraded .6 ppsi
· There are two levels of protection for gown: highly fluid resistant and fluid proof
· Random hydrostatic testing is done. When one is found which fails they pull the bunch and test them all.
· Audience note: Hospitals are held accountable to define the number of uses an item should undergo before being downgraded or recycled. The laundry is not held accountable

· Diapers · Why are hospitals not using diapers?

· One hospital did use diapers for six months but then the program got dropped. This is probably because heat issues have been a problem. The diaper/liner combos weren't doing well with the high heats in the laundry. Plastic snaps were melting and they couldn't use metal snaps.
· Child diapers ended up being more expensive than the disposables.
· Group Health - Kelsy Creek is using diapers, so are a lot of other local hospitals. Not sure though if they are plain cloth diapers or diaper/liner combos.

Discussion by Mark Kidd of Legacy Health System regarding their Waste Reduction and Recycling Program

Overview

· Mark Kidd is the Recycling Specialist for Legacy Health Systems in Portland , Oregon
· Mark e-mailed out a copy of the Memorandum of Understanding which was established between the Environmental Protection Agency and the American Hospitals Association to everyone in the hospital
· People got excited and formed a task force
· Started brainstorming the issues and how to reach the MOU goals
· Decided on tasks and people took charge of different activities
· Have buy in from all of the different departments and this has been key to having a successful program
· Working with EPA and Oregon DEQ to establish a MIRT type group in the Portland area
· Program started with about two years ago and it's still going strong
· Sees MIRT as the lead group up here with regard to medical waste reduction and recycling
· Want to branch out and work with other Oregon hospitals on waste reduction and recycling
· Legacy is a non-profit organization with 4 main campuses
· Their waste reduction and recycling program was started in the 70's by nurses concerned about waste
· Had an intern come in and conduct a study to determine if they could save money and reduce waste by implementing a full program. The intern determined it would be beneficial.
· John McAlester was the first environmental manager in 1991.
· Legacy now has an environmental multi-disciplinary task force with a business philosophy. Every department from the top on down is represented at the meetings.
· There is a subset task force looking at reuse and durable issues and determining where changes could be made to benefit all
· They are looking at things from a larger standpoint and how to include everyone in the decision process
· The task force is doing a lot of up front cost analysis and they are also looking at the full life cycle of products
· Once a change has been implemented they follow up with cost savings and life cycle usage analyses
· A lot of the feedback on moving to a change comes from the finance and purchasing departments
· There is a new person in Portland with a mobile polystyrene processing system
· Health Care without Harm has been doing a great job in helping hospitals like Legacy deal with waste reduction and recycling issues.
· Mark Kidd mentioned that he has lots of numbers on costs savings from using durables

Actions taken

· Saving 100,000 in surgery room supplies at Legacy - Good Samaritan Hospital by looking for ways to reduce waste
· One reusable trial involved purchasing 5 pairs of reusable SCD boots (inflatable boots for patients). This saved $195,000?? per year.
· In '94 they switched from using disposable mattresses to reusable mattresses saved $81,000 per year. They have found that the mattress last 5-8 years.
· Started buying stuff in bulk and in whatever packaging is recyclable
· Custom packs - identified what in the packs could be eliminated or how they might be redesigned
· Reduced duplicative admitting kits and how they could reduce items in the kit. Also working to find environmentally friendly alternatives to the necessary items in the kits
· Now stopped issuing admin kits. Patient gets a sports bottle with hospital's logo and everything else is on request.
· Replaced many disposable batteries with rechargeables, especially for pagers.
· Still had over a ton of batteries which they recycled last year · Photocopier purchasing language now requires that all copiers have duplexing capabilities
· They have worked with all of the different offices on paper reduction practices and it is paying off.
· Purchased an autoclave and will no be autoclaving haz waste instead of having Stericycle pick it up
· Joined with others, including Health Care Without Harm, to reduce mercury in line with the MOU. Legacy is now virtually mercury free.
· Mark has written case studies on what they are doing and have done. He offered them up to anyone who is interested.
· Legacy is looking at reusing medical devices. For now, any items which have been opened but unused will be re-sterilized and used.
· Mark would like to do what he can to help other hospitals get a good env program going.

Barriers to overcoming reusables and solutions to these barriers

· Quality of care and patient welfare are the single biggest issues
· One concern is, "What is the quality and reliability of the laundry facility cleaning equipment?"
· Another concern is, "What constitutes the criteria for barrier protection?"
· When someone finds something that works you have a hard time getting them to change their mind
· You need to bring the clinicians on board if you are going to get any changes implemented
· Infection control people would like to have each patient have one bed pan, etc for their whole stay but who will clean and maintain it?
· When dealing with medical professionals, you may not be able to convince them that an alternative product is equally good or better than what they have been using
· Having data from EPA helps your case
· A good working relationship with someone in administration or the clinical administration is important.
· People in EH&S often don't have the clout to effectively address the environmental issues with all of the players who need to be involved
· Nursing staff tends to be easier to work with than medical staff for a variety of reasons
· Administration is usually fairly easy to work with too
· A particular doctor with a particular opinion who has the ear of an administrator can catalyze an entire switch over program
· Giving everyone ownership from the beginning is very important. People don't feel left out later on and it helps spread communication.
· You need to change the culture of your hospital in order to really implement the MOU
· Seek out the other point of view and try to understand it. Find out why someone will be concerned about your change beforehand and expect it. One liability problem will blow your cost comparison out of the water.
· It's tough to get into the hospitals because everyone is so busy. People get overwhelmed very fast
· A huge amount of the waste in hospitals is not patient related. A lot of hospitals in the country don't recycle cardboard. Hospitals should start with recycling cardboard and the easier items before they tackle something like blue wrap.
· Swedish has a "use not, wash not" program to try to remind employees that if an item isn't used, it doesn't need to be sent to the laundry
· Swedish has a new product change committee
· Makes sense to begin to comply now with the MOU rather than wait until compliance might be mandatory
· In order to get the employees at Swedish to begin talking about waste reduction and recycling they showed them a short video.
· If you give it to them short, concise and interesting it will sink in better. Follow up with the video and let them know that this is something everyone needs to be helping out with.