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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



November 2015

Products & Services

New Technology

Johns Hopkins and DuPont join forces to produce an improved Ebola Protection Suit

The Johns Hopkins University and DuPont have signed license and collaboration agreements allowing DuPont to commercialize a garment with innovative features from Johns Hopkins to help protect people on the front lines of the Ebola crisis and future deadly infectious disease outbreaks. DuPont intends to have the first of these garments available in the marketplace during the first half of 2016.

The collaboration between the major research university and the international science and engineering company began in response to the humanitarian need identified by the U.S. Agency for International Development (USAID) during the recent Ebola outbreak in West Africa

In December, the USAID selected the new Johns Hopkins prototype protective garment, made of a DuPont advanced material, as one of the first five projects to receive funding to address the healthcare challenge posed by Ebola.

The prototype garment was developed by the Johns Hopkins Center for Bioengineering Innovation and Design (CBID), with input from global health partner, Jhpiego, a Johns Hopkins affiliate. Incorporating some elements from the Johns Hopkins prototype, the garment design from DuPont will feature a rear zipper and a "cocoon-style" removal, or doffing, process that requires far fewer steps to reduce risk. The DuPont garment may include an integrated hood with a large clear visor.

The collaboration with DuPont will expedite wide market access for the garment. Under the agreements, Johns Hopkins will assist DuPont in evaluating prototype garments produced by DuPont and will aid in the preparation of information for users. DuPont will be responsible for all aspects of commercialization. Further terms of the agreements were not disclosed.

"This unique collaboration," said Youseph Yazdi, executive director of CBID, "brings together the biomedical ingenuity of Johns Hopkins, the global healthcare experience of Jhpiego and the strategic industrial innovations of DuPont to help save lives worldwide. Although this project was triggered by the recent Ebola outbreak, we believe the improved protective suit’s design will be impactful in future infectious disease outbreaks as well."

Leslie Mancuso, president and CEO of Jhpiego, said the new garment will help ensure that frontline health workers can respond safely and with and with confidence to any new infectious disease outbreak.

The garments could be available in the marketplace in the first half of 2016.


Kicking less waste to the curb

Eco-minded waste management improves efficiencies,
keeps bottom line green

by Valerie J. Dimond

Janet Howard

Not only are we squeezing natural resources from every corner of the earth, but the planet is also buckling under the weight of our mounting trash - and the U.S. healthcare system is one of its biggest offenders. The good news is that healthcare facilities are starting to wake up to their waste, which accounts for more than 5.9 million tons annually.

"Hospitals generate a whopping 29 tons of total waste per staffed bed per day or 86 pounds per OR per year," said Janet Howard, Director of Member Engagement, Practice Greenhealth, a nonprofit member organization.

Brian Bravo, Corporate Procurement Officer and Director of Materials Man­agement, Broward Health, a large integrated delivery network, says in 2011 he realized it was time to rethink the way the facility was handling its waste and explore options for improvement.

Brian Bravo

"We have such a big impact here in our county that we should strive to really be responsible with everything that we do," said Bravo. "That, if anything, was probably the biggest push. Let’s be good stewards and let’s get an environmental program in place that we can really report on and show data that we are actually working a responsible program."

Broward always had some type of waste management protocol in place but it was fragmented across facilities and lacked structure and consistent compliance.

"Everybody was doing their own thing. We had certain things with various vendors, whether it be red bag with one and municipal waste with another, recyclable with another or records management destruction with another," explained Bravo. "Those were the things we were looking at … we said if we’re really going to make this work, how can we consolidate, how can we achieve greater savings by standardizing with one company and will they be able to report on everything they’re doing for us?" The answer was yes.

Consolidate and save

Bravo sought counsel from a vetern waste management company, which lead to the adoption of an Integrated Waste Stream Solution (IWSS), a growing SUD reprocessing program, and a laser-focused effort to reduce operating room (OR) waste. As a result, Broward Health has diverted 6,322,690 pounds of waste from landfills and saved $3,366,113 to date.

"We engaged the other facilities and said OK, let’s start putting these programs together," said Bravo. "It took off right away. If one facility was doing something and another wasn’t, they caught on right away and started implementing the program immediately."

Trevor Rotondo

Trevor Rotondo, Manager, Environmental Contracting Services, HealthTrust, believes going green definitely translates into savings.

"If a healthcare facility reduces the amount of waste it produces, the environment isn’t the only beneficiary," he asserted. "The facility also spends less per adjusted patient day ― just what every CFO wants to hear."

Rotondo says consider a typical hospital with 100,000 patient days per year generating 20 pounds of solid waste a day. If that hospital pays 4 cents per pound for removal but diverts 25 percent of its solid waste into a single-stream recycling program, where items are sorted offsite at a materials recovery facility, for example, they could save $20,000 annually.

On the other hand, Rotondo says sorting certain items onsite can also improve the bottom line. Leasing or buying a bailer to separate cardboard is one example.

"I’ve seen one facility lease a commercial shredding machine, in lieu of outsourcing destruction of confidential documents, and then sell the shred to the leasing company to make recycled paper," he said. "Between money saved and earned, the facility turned a decent profit even after labor and load costs. Electronic waste also has resale value, as does X-ray film for silver extraction."

Knowing how to identify and implement the right waste management strategy is key. In some cases, selecting a single-point oversight plan - consolidating all waste using one vendor - is the best option.

"The challenge in healthcare waste is multi dimensional - the multiple types of plastics, for one, challenge recycling for both identifying the type of plastic and marketing the plastic successfully," said Howard. "Hospitals look to turn-key solutions, vendors that can help them maximize opportunities for segregation, recycling, refurbishment and responsible disposal."

Rotondo says when one client implemented a single point oversight initiative they increased recyclables significantly and saved $15,0000 per year after required equipment costs. "Another client, a large teaching hospital, saved $400,000 (40 percent) using this same approach," he said.

Data is the decision-driver

Bravo is quick to point out that one of the crucial drivers behind Broward’s success was having strong, legitimate data to support the new waste management initiatives, distribute effective education, and influence change - whether it was in board meetings or in the environmental services and clinical atmosphere, where success hinges on compliance.

Howard says when hospitals involve staff early and often in waste reduction efforts, changes in "on-the-job behavior" are easier to achieve. Waste management companies that are positioned to provide the data can help make it happen.

"As data collection and analysis techniques have matured over the past several years, it’s become increasingly clear that providing the right data at the right time to the right people can have a significant effect on waste reduction,"Howard said.

Rich D’addario, Corporate Vice President, Stericycle Inc., says 50,000 sites are using its new waste management education and compliance software, SteriVantage, which Stericycle launched in 2013. The add-on is a customizable portal designed to help managers improve off-site safety and compliance at multiple locations, a burgeoning trend.

"2015 is on pace to notch the most U.S. hospital deals since 1999, with 71 announced through the end of August," said D’addario, citing statistics from Irving Levin Associates. "In 2010, there were 72 hospital acquisitions. Last year, there were 100. Healthcare is increasingly being delivered more in outpatient and non-acute centers. As hospitals began buying family practice clinics, specialty practices, and other non-acute care offices, this led to a need to standardize compliance training across multiple offices and to document when staff completed it." 

SteriVantage provides Department of Transportation training for employees who have to sign shipping manifests when transporting regulated medical waste (RMW); bloodborne pathogen training for staff that may come into contact with or be exposed to blood; and modules for handling pharmaceutical waste, HIPPA training, and more.

"The tool is only sold to healthcare facilities so unlike other generic training programs it focuses on healthcare practices that are affected by a litany of regulations," D’addario said.

DIY - managing RMW onsite

More hospitals are also moving away from incineration and haul and dump services in lieu of healthier, more sustainable options. One way is to process and dispose of medical waste onsite using newer, cleaner technologies that do the job efficiently, economically, and with less harm to the environment.

"Haul and dump disposal models have become increasingly expensive and have become laden with extraneous fees and add-on charges making them more expensive; this is problematic in the environment of cost containment in healthcare," said Michael P. Smith, Regional Sales Director, Red Bag Solutions.

Red Bag Solution’s Steam Sterilization System

"The EPA is closing down aging incinerators and not recertifying many other incinerators to burn waste. This will drive up the cost for vendors who haul the waste to the remaining incinerating sites as they travel greater distances to handle the waste," Smith continued. "President Obama has issued an Executive Order (EO#13514) to aid the environment which requires governmental agencies and hospitals to reduce and divert the volume of waste being sent to the landfill by 50 percent."

Red Bag Solutions offers a closed system that simultaneously macerates and sterilizes regulated medical waste onsite using steam and hot water, transforming it into an airy, confetti-like material that reduces volume and weight up to 90 percent and 30 percent respectively. The remaining waste, now sterile, can be disposed of as municipal waste rather than contaminated waste - good for the wallet and the environment.

"At the end of the processing cycle the end product has been and is guaranteed sterile," Smith asserted. "The Red Bag machine kills pathogens and viruses including (but not limited to) HIV, Ebola, H1-N1, TB and polio while allowing the facility to improve their pandemic preparedness protocol."

Clean Waste Systems offers another onsite waste management solution called the OMW-1000, a patented medical waste processing technology that uses ozone to treat and grind RMW waste, including red bag, pathological, and sharps, in a self-contained, all-enclosed system.

OMW-1000 by Clean Waste Systems

Steve Pellegrene, Vice President, Sales and Business Development, says the machine harnesses high levels of ozone to treat and then safely destruct the ozone back into oxygen. "We wanted to create a system that treats medical waste in a way that is safe, easy to operate, reliable and positive for our environment which is unlike current technologies being used," he said. "In comparison to other medical waste treatment technologies that use high amounts of energy and resources to generate steam or heat and deal with terrible odor issues, the OMW-1000 uses very little electricity and water and deodorizes the waste with its ozone as well. We keep hearing how hospitals want to provide effective care while ‘doing no harm,’ now, with our system the healthcare industry can reduce their environmental footprint and save money."

Simon Jasmin, Vice President, Sales & Marketing, AMB Ecosteryl, Americas, says they offer a friendlier alternative to autoclaving for handling RMW including hospital and laboratory waste, solid and liquid medical waste, pathological waste, sharps containers and more. The fully-automatic process functions via a combination of microwave energy, shredding and moist heat to disinfect waste. The digital touch screen monitors efficiency and productivity with a Wi-Fi connection that can be operated off-site in real-time.

The AMB Ecosteryl 125

"The technology is very flexible and it can be used only a few hours per day or continuously 24/7," said Jasmin. "Energy costs of microwave units are minimal compared to autoclave boilers, not to mention the water and gas consumption. The Ecosteryl systems are now found on every continent, approved in most U.S. states and processes nearly 50 percent of all waste (60,000 tons) treated every year in France."2

Food for thought

Frank E. Celli, CEO of BioHitech America, says healthcare facilities also seek ways to reduce and/or better manage their food waste. Some will have no choice as more states and counties pass laws to reduce the amount of organic food waste in landfills.

"We are encouraged by the continued regulatory growth we are reading about throughout the country and find that hospitals are the most proactive in getting ahead of these legislations," said Celli. "Hospitals understand the financial, operational, and social benefits of managing their food waste more efficiently and sustainably."

Eco-Safe Digester by BioHitech

BioHitech America’s Eco-Safe Digester converts solid food matter into a disposable earth-friendly liquid that won’t cause harm to municipal sewer systems and wastewater treatment facilities. Celli says on an annual basis, a 1,000-bed facility that uses the Eco-Safe Digester can divert 180 tons of food waste (enough to fill 18 garbage trucks), eliminate 126 metric tons of carbon, avoid the deforestation of 3,230 mature trees, preserve 4,860 cubic feet of landfill space, and decrease fuel use by 14,178 gallons. The data capture and analytics component is also a huge help to those who want to see where their waste efforts and dollars are going.

"The missing component in a successful waste management strategy is the data, something that has long been ignored by waste haulers and now being requested by customers," said Celli. "By utilizing our Eco-Safe Digester, hospitals can measure their waste in real-time and compare across a number of locations driving efficiencies and creating a safer environment for their employees."

Another way to reduce solid food waste is simply to recycle it back into the soil.

In 2013, FOR Solutions LLC introduced a technology that healthcare facilities can use onsite to transform discarded or uneaten food into nutrient-dense compost in less than a week.

"I argue that composting discarded or uneaten food is the epitome, if not the only true form, of recycling," said FOR Solutions Founder and Executive Chairman Nicholas J. Smith-Sebasto, Ph.D. "If we were to compost all of the discarded or uneaten food generated in the United States (tens of millions of tons) annually using the FOR Solutions technology, the amount of greenhouse gas emissions that could be avoided would be roughly the same as if we removed millions of cars from the road. Additionally, the restoration of degraded soils will improve our ability to grow food."

FOR Solutions Digester

FOR Solutions sells five different systems with processing capacities ranging from 2,500 pounds a week to 40, 000 pounds. For most hospitals, Smith-Sebasto suggests Models 500 and 1000, which process 2,500 and 5,000 pounds a week respectively.

"Many hospitals have landscaped grounds where the compost may be used," he said. "The compost may also become a revenue generator for the hospital. High-quality, nutrient-dense compost often sells for $50/ton or more. It could also be provided to gardeners in the community for free or at a reduced cost."

Hospitals interested in exploring FOR Solutions food recycling technology can obtain a free "Return on Investment-Return on Environment Report" that assesses and evaluates the economic and environmental benefits of integrating the technology. To get one a facility would need to provide the amount of discarded food generated per day and number of days per week, current disposal method (transported to a landfill, incinerator, composting facility, etc.) and the cost, as well as the distance from where the discarded food is generated.

Fluid management options

The Medi-Vac Fluid Managment line
by Cardinal Health

David Stroud, Director, Medical Products and Services Marketing, Cardinal Health, says fluid management continues to evolve, particularly with respect to finding efficient, cost effective disposal methods. "Customers are often challenged with developing internal protocols to manage fluid waste, and ensuring employees consistently follow all regulatory protocols related to managing fluid waste," he said. "These challenges have become more prevalent not only for environmental health and safety staff, who have traditionally dealt with managing fluid waste, but also infection control and operating room personnel who are now focusing on cost containment, staff safety and regulatory compliance increases."

With over 40 years of experience, Stroud says Cardinal Health offers the Medi-Vac family of Fluid Management products for delivering safe, efficient fluid waste collection. He says the suction canisters are manufactured in the U.S. and supported by decades of R&D expertise. 

The Stryker Neptune 2

Nate Miersma, Director, Marketing, Surgical Safety & Efficiency, Stryker, suggests Stryker’s Neptune Waste Man­agement System with SealShut technology for collecting fluids.

The cart-based collection and disposal system has an on-board vacuum system that collects large volumes of fluid while providing strong, consistent vacuum pressure to the surgical field. This completely closed system prevents exposure to potentially infectious waste once it is collected and the hands-free docking lets circulating staff push a rover and walk away.

"The system automatically detects the presence of the Neptune rover, selects the default docking cycle and empties and cleans the unit without any further interaction," explained Miersma, noting that it also comes with an integrated surgical smoke evacuation system.

Clever containment products

The Pactosafe 4.0 from Paxxo Inc. is a portable, closed system waste handling and heat-sealing unit that safely holds used PPE, swabs, prep mats, chemo and antibiotic administration discards, spill waste materials, biological, clinical and infectious materials until ready for disposal.

Pactosafe by Paxxo

Chris Pettigrew, Sales Manager-Longopac Fill, Paxxo Inc., says the mobile unit can be rolled directly next to an infusion center chair or bed to receive waste when an infusion is completed. The Pactosafe 4.0 also prevents aerosolization of hazardous materials, eliminating bad odors and cross-contamination.

"It allows for the user to make a bag size that fits the waste being disposed with foot pedal/touch free activation allowing section-by-section, bag-by-bag sealing," said Pettigrew. "It takes the sealing requirement to a much higher level than current bagging closure systems. When considering the potential risk to the healthcare worker, the patient and infection control aspects of the environment, it is considered a very cost efficient and effective way of disposing of hazardous waste."

Public restrooms are another area where healthcare facilities can zero in on waste, particularly paper waste.

The ecotrash PTC (Paper Towel Com­pac­tor) by Compaction Technologies Inc. collects paper towels and compacts them at a ratio of 8-to-1, according to Marketing Director Kari Ahlstrom.

"Using seven less bags every time you change the trash can equate to thousands less over the course of a year," she said. "This is a tremendous reduction in a facility’s carbon footprint."

ecotrash PTC
by Compaction Technologies

The company also provides ZeroWaste bins, fully compostable and/or recyclable containers that can be used in place of plastic bag-lined tubs. When used together Ahlstrom says the products completely eliminate plastic bags from the environment and improve workflow in the EVS department.

Rallying for reusables

Rotundo (HealthTrust) says facilities that switch from disposable sharps to a reusable sharps disposal program are also reporting good environmental results and savings.

"Ongoing operational costs of a reusable sharps program are offset by reduced volume of medical waste sent to the landfill ― up to 30 percent less, based on the experience of ServiceTrust clients," Rotondo said.

Reprocessing single-use devices (SUDs), now considered an acceptable and safe way to reduce waste, also continues to gain momentum, according to Bill Scott, Senior Director, Marketing, Stryker Sustainability Solutions (SSS).

Scott says after the collection bins ship out for reprocessing, the devices are sorted, disassembled, cleaned and inspected.

"Devices are then 100 percent function-tested and sterilized based on FDA standards prior to distribution to our customers," Scott said, adding that the comapny also provides data profiles to help facilities track use and spend. Bravo says Broward adopted its own SUD program a couple years ago and continues to invest in its growth.

"It’s been very successful and part of that success is the communication with the clinicians," he said. "In the beginning they were very, very resistant but little by little they got on board. We still continue to grow the program. The way we measure this is basically by savings."

Green purchasing

While great strides have been made to track, divert, recycle, and reduce overall healthcare waste, Howard says suppliers and buyers must make eco-friendly products widely available and their use wide-spread.

"Those on the most leading edge are now recognizing that what exits the back door of a facility as waste came in through the front as purchased supplies and equipment," said Howard. "They know that in order to maximize hospital and healthcare waste reduction, you have to move to the front end and adopt environmentally preferable purchasing that takes into account how a product will be disposed, before you even purchase it."

Bravo follows that same track and says it’s time to do the right thing. Effective, affordable, greener healthcare products and services are there if you look for them.

"Maybe in the early years, when environmentally-friendly products were coming out, they were quite expensive, but now it’s such a big initiative in many institutions that there’s a lot of competition," Bravo asserted. "If you look at the market today you could find competitive products that are earth-friendly."


1. Practice Greenhealth, Waste, https://practicegreenhealth.org/topics/waste.

2. Data on file with AMB Ecosteryl.