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INSIDE THE CURRENT ISSUE

April 2008

Central Services


 

Infection Control Update

Turning waste
into energy

Sarasota-FL, based Global Energy Solutions - (GES) Thermal Converter system is a complete waste to renewable energy process capable of destroying virtually any type of regulated medical waste from hospitals and medical clinics, including pharmaceutical, chemotherapy and pathogenic waste, as well as regular municipal solid waste (MSW).

Jeffrey Lukas, director of institutional and commercial applications for GES, noted the Thermal Converter system uses proprietary technology to destroy waste in a process that differs from incineration in that the "waste is not burned which dramatically reduces air emissions and residual." He explained, "we will destroy 100 percent of the waste, changing it to its simplest elemental form, and leaving a 2 to 3 percent residual of vitrified glass which is inert, sterile, non toxic and non leachable. And the residual is 100 percent reusable in lightweight cinderblocks and road bed fill." This eliminates landfill "tipping fees" and transport charges associated with dumping residual waste from autoclave systems.

The system also requires less energy to operate than a traditional autoclave. Once the system has been brought to a 3200° F operating temperature, the system temperature is self-sustained simply by feeding waste into it. Moreover, the Thermal Converter system produces energy as a byproduct. Depending on the size of the unit, the Thermal Converter is capable of producing large amounts of steam and electricity. For instance, a 6-ton per day unit can produce high-quality steam that could be useful for sterilization or laundry services in a hospital, while a 72-ton unit, (which would fit into a space of approximately 900 sq. ft.) could produce enough energy to light up a large hospital. "Should the hospital want to do that, we could generate enough power to run the entire hospital and sell it back to them at a negotiated rate that may be lower than what the power company charges. Plus because the hospital is no longer hooked to the power grid, they already have their emergency backup, saving them staffing, maintenance and capital costs of operating separate emergency generators."

Lukas noted that GES has a mobile Thermal Converter that can handle 72 tons per day and could prove particularly valuable in a disaster situation. "GES can bring the unit into the area, destroying virtually any type of waste and when the waste is gone, we can move it on to the next site. At present we’re being looked at by a number of state agencies that are in hurricane areas for that very reason."

He added, "Another benefit that the hospital has with our system is that there is no capital cost, as (GES) will fund the whole facility. We work on a joint venture with the hospital. The system would be at the hospital site or an offsite supply chain management warehouse where GES would build it, maintain it, operate it, and then share, through a negotiated contract with the hospital, revenues that would make it worth their while." See www.teamges.com.

Waste reduction:
Ways to get leaner and greener in the SPD

By Julie E. Williamson

Waste reduction and environmental stewardship is a topic that’s gaining momentum with healthcare organizations, and for good reason. Statistics show that healthcare organizations are, figuratively speaking, drowning in their own waste stream.

Ecolab Asepti-Solid detergents reduce packaging waste,
detergent waste, and back injuries to SPD staff

According to the Nightingale Institute for Health and the Environment, healthcare — with its dizzying array of products and technologies — generates one of the most complex waste streams in American industry (perhaps as many as ten or more). Although waste disposal costs vary across institutions, it’s been estimated that solid waste or trash (such as paper and cardboard boxes) costs roughly two to six cents per pound for disposal. Regulated medical waste – that is deemed
infectious or biohazardous – can run anywhere from 19 to 40-plus cents per pound for disposal, and hazardous waste, which includes chemicals, some types of batteries, mercury, solvents, etc., costs from $1 to $6 per pound for disposal. When one takes into consideration that, at a conservative estimate, U.S. hospitals generate more than 6,600 tons of waste each day as the byproduct of providing quality, round the clock patient care, the associated costs of managing that waste is enough to make virtually any healthcare worker’s head spin.

Not surprisingly, surgical services tops the list of healthcare’s largest waste contributors, representing both an ecological and economical incentive for facilities to make a concerted, coordinated effort to tap it for significant waste reduction.

While reducing and, whenever possible, eliminating waste in the operating room is a sound strategy – and one that will garner significant, if not immediate, benefits, it’s important that those surgical services-focused waste reduction efforts extend to Central Service as well. While CS may not be a revenue-generating department, it’s nonetheless one that can contribute greatly to the facility’s overall waste stream. Unfortunately, like many other departments, CS is one that often pays too little attention to the impact its waste has on the bottom line and the environment. Because environmental services or facilities management is usually in charge of waste disposal, the impact of the waste (financial or otherwise) often goes unnoticed by those who actually generate it.

Tom Badrick, sustainability coordinator for Legacy Health Systems, pictured at the facility’s 8,600 sq. ft. recycling center where waste from each LHS facility is transported and diligently sorted.

"Every department needs to be more aware of the waste it generates and how that waste can be minimized," stressed Tom Badrick, sustainability coordinator for Legacy Health Systems, Portland, OR. "There are always ways to make a positive impact, but it takes a commitment and a solid plan. It isn’t really a struggle getting people to think about [waste reduction]. The challenge is putting the ball in motion and actually doing it."

Badrick is one who’s more than willing to accept such a challenge. For the past six years, it’s been his job to "green up" LHS, which is comprised of six hospitals on five campuses, 11 primary care clinics, and numerous specialty clinics, and is the largest Oregon-based not-for-profit healthcare organization. In light of its ongoing efforts and well-documented success, LHS has become a nationally recognized leader in environmental achievement and green consciousness, and even earned the 2007 H2E Sustained Environmental Leadership award from Hospitals for a Healthy Environment. In fact, the recycling program has become such a model for success that it generates savings in excess of $300,000 each year through disposal fee avoidance alone, and is even generating money for the health system thanks to its extensive recycling initiatives. At the heart of the organization’s recycling program is its own impressive 8,600 square-foot recycling center where waste from each LHS facility is transported and diligently sorted.

Badrick has become so proficient at waste reduction and recycling, he even assists other hospitals and Portland-area neighborhoods with their own efforts.

Although waste reduction can take on many different forms and shouldn’t be viewed as a one size fits all process (or one that can be successfully be implemented overnight), Badrick and other industry insiders did highlight several key ways CS and purchasing departments can start making a difference now.

Read on to learn how to take the plunge and start tackling your department’s waste stream.

Do you know your true waste costs?

Make no mistake, when it comes to waste disposal costs, ignorance certainly isn’t bliss. Unfortunately, many healthcare organizations are neither fully aware of these expenses nor the fact that, in many cases, their current contracts and waste disposal programs are costing them far more than they should.

Although some hospitals may be actively involved in negotiating contracts, reading the fine print and calculating waste disposal expenses, there are many others that are falling short in the due diligence department, explained Nick Johnson, director of consulting for Old Seville Expense Reduction Company, Inc., Gulf Breeze, FL.

"Often, they want to save money, but they just don’t know how to get there," he said, noting that many hospitals either fail to keep track of their contracts or neglect the fine print and often difficult to interpret clauses of automatic renewal contracts ("evergreen" contracts) that can result in hidden rate increases and other negative outcomes that can hamstring a facility’s expense reduction efforts.

In some cases, hospitals may have their own large compactors, but are throwing their money away along with the trash because the compactors are being emptied when they’re only half-full. Johnson described one facility that had a small compactor and was paying a whopping $9,000 per month for trash to be picked up once a week.

Certainly, recycling can help. "It’s a big emphasis for us," he said, adding that a big part of Old Seville’s business is to help ensure that customers are doing more to become "green" and are making the most of their efforts. "There are lots of cardboard boxes in healthcare, [for example], and if half of a hospital’s trash is cardboard, it makes sense to separate it out." He added that if recycled in large enough volume, rebates may even be available.

Still, Johnson said the best way healthcare organizations can reduce their waste-related costs is to carefully examine their contracts – paying especially close attention to those that are about to expire – and then either shop around for a better contract or negotiate for a better rate or program with the current vendor. Seeking the services of a waste reduction company, can also pay big dividends. Old Seville’s consultants, for example, read the fine print in contracts to help their healthcare partners sidestep unnecessary or climbing expenses. And due to economies of scale and its extensive database and pre-existing relationships with national waste haulers, the company can identify the lowest market price suited to each facility’s unique waste disposal needs, while also working to renegotiate contracts to reflect those prices. Aside from that, Old Seville will also handle service issues (including missed pick-ups and other problems) with the vendors it puts in place for hospitals.

"And we don't get paid for our services unless we are able to drive savings," added Johnson.

Start at the top:
Pay-offs of selective purchasing

It’s often said that what is up must also come down, and that’s certainly true with waste. Experts stress that the most successful waste reduction efforts are those that target waste both upstream and downstream.

Minimizing upstream waste requires thoughtful purchasing and partnerships with vendors who share in the facility’s waste reduction goals – or, in the very least, don’t work against the efforts. Of course, product standardization can also go a long way. After all, the fewer number of products entering the facility and taking up space on the shelves also translates into less transport and packaging waste on the backend.

"Everything that goes out as waste came in through contracts," noted Sarah O’Brien, champion coordinator for Hospitals for a Healthy Environment (H2E), Lyme, NH. "Waste reduction starts with purchasing."

H2E stresses the importance of environmentally preferable purchasing – a concept defined and encouraged by the U.S. Environmental Protection Agency. Put simply, an environmentally preferable product is a good or service that has a lesser or reduced effect on human health and the environment when compared with other products that serve the same purpose.

In the realm of CS, these products can be anything from safer, more eco-friendly detergents that truly do get the job with a measured dose and minimal effort, to more efficient, energy- and utility-conserving washers and sterilizers that, again, live up to their promise of doing more with less. Ideally, it can also mean that products are ecologically and economically packaged — think fewer shipping pallets and cardboard boxes, and fewer bottles and wrappers, all of which consume valuable space and contribute greatly to a costly waste stream (case in point: according to the EPA, cardboard and other paper materials represent almost half of a typical hospital’s solid waste stream).

The first step is to carefully assessing the amount waste that exists within the facility (a waste audit, if you will) and then identifying ways to minimize it. "Hospitals often overwhelm themselves by thinking they have to do everything at once. But if they take a step back and break it down [into digestible pieces], it’ll be easier to identify areas where significant change and savings can be realized quite quickly," explained George Dempster, a former sterile processing manager for Boulder Community Hospital in Boulder, CO, who now operates Summit Consulting Services LLC. "There are many ways to reduce waste and make a huge impact."

The good news is a growing number of group purchasing organizations and vendors are actively embracing waste reduction and are looking for ways to minimize their own environmental footprint, while also serving as more effective partners with their healthcare customers.

True blue savings: the benefits of blue wrap reduction

SPDs, take note: turning your attention to blue wrap is one of the most effective and immediate ways to reduce waste, drive value and perhaps even earn a much-deserved pat on the back from the C-level execs.

The pay-offs can indeed be significant. According to the Nightingale Institute, and as reported by the U.S. Environmental Protection Agency, approximately 19 percent of the waste stream generated by surgical services is blue sterile wrap. Made of polypropylene (plastic #5), blue wrap is resistant to chemicals and wear – and also to subsequent breakdown in a landfill – and cannot be reused. But it can be recycled, and it’s a practice that should at least be explored by hospitals.

The practicality of implementing a blue wrap recycling program depends upon some key factors. For starters, it involves identifying a local market for polypropylene or #5 plastics. "Without a regional recycler, it is unlikely that a program will be economically feasible," acknowledges the EPA. "It is inefficient to ship the material significant distances for recycling because of the relatively low market value of #5 plastics and the high volume and low weight of the material." Establishing a low-cost collection and transport system is also essential, as is the generation of a significant quantity to warrant vendor cooperation. As the EPA explains, although arrangements can be made with local recyclers to supply blue sterile wrap and plastic film collection containers at little or no cost to a hospital, the facility must also generate enough used polypropylene to make the program worthwhile.

Kimberly-Clark’s KimGuard sterilization wrap

That’s not to say that recycling efforts can’t be highly successful, however. Legacy Health System, for example, is actively involved in blue wrap reduction and recycling, and because of its own recycling center, economies of scale and well-established relationships with recycling partners and vendors, such as Kimberly-Clark and Owens & Minor, the healthcare organization is able to help other facilities with their own blue wrap recycling efforts.

Legacy Health’s operating room staff initiated the blue wrap recycling efforts, and since the program’s inception in the early 1990s, it’s been estimated that more than 800 tons of blue wrap have been diverted from landfills.

For K-C’s part, a fixed annual contribution is awarded to Legacy Health for every pound that’s recycled to the healthcare organization.As Judson Boothe, marketing director of North America, medical supplies, K-C Health Care, explained, because of Legacy Health’s efforts (and most notably, those of Legacy Health’s sustainability coordinator Tom Badrick) more than 80 percent of blue wrap sold in the Portland area is recycled.

Owens & Minor facilitates the recycling efforts by transporting material from a number of Portland-area hospitals to Legacy Health’s recycling center.

Even if facilities aren’t yet able to recycle their blue wrap, they can still find success by minimizing its use. In fact, sources agreed that achieving such a goal is possible no matter what the type or size of the healthcare organization.

"I absolutely believe every hospital can be successful at reducing blue wrap. The inspired leaders who choose to take this on, and any waste reduction project, must allow for the very natural and initial reaction of ‘It can’t be done,’" assured Julie Moyle, surgery manager for Boulder Community Hospital, Boulder, CO. The hospital was able to significantly reduce blue wrap use by investing in hard-shell sterilization containers. Today, the hospital negotiates for sterilization containers for every instrument-related purchase the hospital makes.

Moyle reasoned that specialty facilities, such as orthopedic hospitals, need to put the pressure on their various vendors to supply a sterilization container for their instrumentation. "This is a good example of incorporating environmentally-friendly selection criteria into the purchasing process, which should include the affected surgeons. I would find it hard to believe that orthopedic implant vendors do not have the dollars necessary to accommodate such a request."

Aside from being able to divert 2.1 tons of blue wrap from the local landfill each year, Boulder Community Hospital also enjoys an adjusted annual cost savings (expense of blue wrap minus container expense) of $41,000. Thanks to the efforts of Boulder Community Hospital SPD technician Edin Bajric, who recently came up with a plan to use a large peel pouch instead of blue wrap for setting up towel packs for sterilization, even more savings are being realized.

"Even though the OR staff thought it wouldn’t work at first, they agreed to try it," noted Moyle. "Now we’re saving over $3000 a year in blue wrap, and perhaps even more importantly, are eliminating the blue wrap that would have gone to the landfill."

 

Irving, TX-based Novation, for example, has been addressing environmentalism and waste reduction for years, and has made a concerted effort to educate its member hospitals to identify areas of improvement. Aside from focusing its efforts on mercury elimination and the identification and reduction of PVC use throughout hospitals, Novation has also sought the expertise of H2E for help in determining what to ask and do in the contract bidding process to drive more effective partnerships with vendors that are also committed to environmental stewardship and waste reduction.

"People need to think about these contracts and how those fit into their environmental stewardship [efforts]," stressed Steven Lucio Lucio, director of clinical solutions for Novation. "We can [take some of the burden off the hospital] if we can do it for them." Novation, through a partnership with Medical Action Industries, will also be promoting the recycling of disposable surgical towels. Through the Medical Action towel recovery program towels will be collected, boxed, shipped and recycled into non-medical products.

For Ecolab, environmental stewardship and sustainability goes beyond "green" by taking a more comprehensive approach that consider the total impact of its products – from manufacturing and transport to use and disposal so they are formulated to provide ease of application, increased user safety, energy and water economy, and reduced end-of-life disposal and packaging waste.

"In Ecolab’s experience, an infection control practitioner or CS manager is going to make the right overall decision with respect to sustainability – with patient safety first, efficacy second, balanced with a total impact approach on the environment," noted Eric Willman, Ph.D., R&D program leader, instrument care, Ecolab Healthcare, St. Paul, MN. Specifically for the sterile processing customer, Ecolab offers solid detergents as a replacement for conventional 15- and 30-gallon plastic drums of detergent. The solid blocks are shrink-wrapped for transit and diluted at the point-of-use with a simple dispensing system.

"A typical three washer SPD customer will generate only 21 pounds of packaging waste per year with solid chemistry compared to 375 pounds when using 15-gallon drums," Willman continued, adding that the packaging waste for solids is about one-third less than super-concentrated liquid detergents that have recently become an option for these departments. An added plus of solid products, he explained, is that they are diluted in the dispenser so no product is wasted.

Added Badrick: Any time you have an automated feed system for chemicals that will help reduce unnecessary waste caused by excessive use. "Some people subscribe to the more is better philosophy. If a product doesn’t seem to be working well or fast enough, staff may be inclined to use more. Obviously, that’s wasteful and [potentially dangerous]."

Again, such a point underscores the need for a well-implemented product and vendor evaluation process.

"Eco-friendly products can sometimes cost more, but the added expense is negated if the products actually work better," said Sharon Green-Golden, CRCST, manager of sterile processing for Bon Secours Mary Immaculate Hospital, Newport News, VA. Upon realizing that employees were having to apply – and reapply – its "budget" instrument spray to loosen bioburden, she finally scrapped it for a much more effective enzymatic spray. "Switching to this product was worth every penny. It cost more initially, but it proved more cost-effective in the end. If you have an inexpensive Product A, but you have to keep spraying for it to do the job, then you’re not realizing any savings. You’re wasting product and money."

Bon Secours’ sterile processing department is finding other ways to reduce waste as well – including giving up its plastic graduates, basins and medication cups and going back to reusable, stainless steel ones.

"The plastic items were all going in the trash, and that’s obviously not a good thing for the environment or [our waste stream]," Green-Golden added. "It made sense for us to go back to reprocessing."

That’s not to say facilities relying on disposable products can’t be waste conscious, however. Although Kimberly Clark Health Care, Roswell, GA, has built its business around disposables, the company also prides itself on being one of the leading companies in the world when it comes to sustainability.

"Disposables do create waste, but you can minimize that by recycling," explained Judson Boothe, Marketing Director of North America, Medical Supplies, K-C Health Care. Through its own extensive recycling, many of K-C’s plants generate zero outgoing waste, and the company is even willing to engage in discussions with hospitals and other third parties interested in exploring and expanding upon their own recycling opportunities to determine how those goals can be realized (K-C has been a key partner in Legacy Health’s recycling program, for example).

K-C has also built sustainability into the development of its products. "This includes moving into a fully synthetic glove portfolio to reduce the environmental impact and user problems associated with latex," said Boothe.

Waste reduction and increased efficiency in CS can also be driven through ongoing education and utilization reviews (both of which are offered free of charge by many vendor partners).

As Dempster put it: "If you don’t know what you’re using and how you’re using it, you can’t expect to be effective at reducing waste and driving positive change."

Tapping the true reuse potential

Regardless of a healthcare organization’s stance on the issue of single-use device reprocessing, it’s tough to argue that the practice – in spite of any lingering controversy – can significantly curb waste and expense.

Statistically speaking, reprocessing’s environmental and economical impact is tough to ignore. Maple Grove, MN-based SterilMed Inc. points out that reprocessing eliminates approximately 2,000 tons of medical waste annually and generates more than $150 million in annual savings for healthcare providers. "More than 3,000 hospitals use reprocessed devices every day," said SterilMed president and CEO Brian Sullivan, adding that single use device reprocessing is standard practice in 70 percent of U.S. hospitals.

http://www.ascenths.com/, based in Phoenix, reports that in 2007 alone it enabled its partners to eliminate 1,684 tons of waste from their local landfills, resulting in savings of nearly $1 million – up 31 percent from the approximately 1,283 tons diverted in 2006. Since the company’s inception, Ascent has eliminated more than 11,000 tons of waste from making its way to landfills.

State-of-the-art reprocessing technologies are now making it possible to supply more than 8,000 different Class I and Class II SUDs in 15 major device categories; SterilMed has determined that approximately 90 percent of total saving opportunity is typically in these top 15 categories. Today, reprocessed SUDs include, but aren’t limited to, trocars, harmonic scalpel, laparascopic instruments like graspers, forceps and cutting forceps, compression sleeves, and orthopedic devices like shavers, saw blades and drill bit. And reprocessing companies’ list of FDA 510(k)-approved reprocessed devices continues to grow on a regular basis. SterilMed, for example, recently received FDA 510(k) clearance to market endoscopic scissor tips under K073613, Sullivan noted. According to Ascent, the addition of the Valleylab LigaSure V laparoscope sealing device will eliminate 2.5 tons from landfills across the country in just the first year it is reprocessed by Ascent.

Each item a hospital adds to its reprocessing portfolio can generate significant savings. When Bon Secours Mary Immaculate Hospital, Newport News, VA, began reprocessing sequential compression devices, for example, the savings were immediate. "For one month, September 2007, we saved $7882 in having sequential compression devices and tourniquets reprocessed."

These days, customers can get a relatively clear picture of their potential savings –even before they take the leap. Ascent has developed an analytical tool that compares Ascent’s database of cleared and approved devices by manufacturer, product model and number, and description to the hospital’s purchase master.

"We are able to provide the facility with a very specific report of potential savings by product number and level of participation," explained Arthur Goodrich, Ascent’s vice president of business development. Ascent reviews projected savings reports with its hospital partners quarterly to ensure that maximum savings are realized.

Although reprocessing companies help hospitals reduce their waste streams, these firms themselves are also committed to adopting and implementing eco-friendly practices. All devices sent to SterilMed are reprocessed for reuse or given to a medical recycling/waste management company, which sorts and recycles all metal and plastic from medical devices in a manner fully compliant with government regulations. Added Sullivan: "We use environmentally responsible chemicals wherever possible and recycle over 50 percent of our solid waste."

Ascent is undergoing an extensive process evaluation to identify areas for improved environmental responsibility. According to Goodrich, this includes the packaging materials used with its products and the chemicals for reprocessing, as well as internal practices, such as recycling initiatives throughout Ascent’s building for paper, cans, plastics, toner cartridges, and more. "We strive to ‘walk the walk’ relative to our promotion of environmental sustainability within the healthcare arena."

More ways to stretch reuse efforts (beyond SUDs)

• Donate surplus or expired, but unused products to charitable organizations.

• Disposable items opened, yet unused during surgery can be reprocessed by a qualified, regulated third party reprocessing company. Bon Secours Mary Immaculate Hospital in Newport News, VA, cuts down on waste by having unused trocars and gown packs reprocessed.

• If blue wrap recycling programs are unavailable, get creative. Boulder Community Hospital, for example, collects the wrap in a designated recycle/reuse cart and then makes it available to hospital employees who can use the wrap as drop cloths, packing material or for other purposes.

 


www.hpnonline.com

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Copyright © 2016
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         Clinical intelligence for supply chain leadership