Is Your Healthcare Facility "Wasting" Money

Healthcare facilities could very well be literally throwing money away. That may sound like a little bit of an exaggeration, but is it? Proper waste management is not only important for the environment, your patients, and staff, but also for your bottom line.

In most healthcare facilities there are a variety of waste types generated. These include general garbage and recycling, chemical waste, bio-hazard waste, pharmaceutical waste, radioactive waste, “sharps”, even a category called confidential waste which is for documents that may contain HIPAA information. Of course this depends on the type of facility you have, it’s size, the services you provide, and the average number of patients you provide those services to. For this article we will be focused on hospitals. According to the World Health Organization hospitals in the United States generate approximately 1 pound of waste per day per hospital bed totaling 5.9 million tons a year(85 percent  being general waste and the remaining 15 percent is considered hazardous) (2018).

In order to dispose of and treat the different types of waste, most hospitals use an outside vendor for consulting, collecting and providing transport of the wastes, and connections to transfer stations (if applicable) and appropriate treatment facilities.  As expected there are costs associated with these services. Additionally, the different waste types have different treatment processes which in turn can have different price points. These are all necessary expenses. However if proper waste disposal and management doesn’t begin initially at your own facility, you run the risk of needless and excessive spending. The trigger to these extra costs typically begins with the actions of staff members. Let’s take a closer look.

Potential Causes of Avoidable Expenditures

#1) Wrong Items, Wrong Bin, Big Dollars - Hospitals have regular trash and recycling bins that the Housekeeping or Environmental Services Department will collect and dispose into a larger compactor that a local vendor will get and bring to the recycling facility, incinerator plant, or a landfill. The vendor contracted for hazardous, pharmaceutical, radioactive, chemo, and other specialized varieties of waste will give the hospital specific containers for disposal of each type. The vendor will pick up these containers for transport to a treatment plant.

Both hazardous and non-hazardous wastes are weighed before processing. The hospital is then charged the different said set price points by the weight of the containers’ contents. Below is a list of examples of cost/pound for each of the various types of waste due to their treatment methods. Please note these are examples based on my experience and conversations with vendors and may not be the actual cost for some

• Recyle - $0.005 per pound

• Regular Trash - $0.03 per pound

• HIPAA (recycle) - $0.15 per pound

• RMW - Red bag - $0.29 per pound (Autoclave)

• RMW – Red Bag – Incineration Waste (Trace Chemo, Pathological Waste) $00.90 per pound

• Reusable Sharps Waste Service - $0.62 per pound

• Universal Waste (Bulbs) - $0.50 per pound

• Blue Rx Waste  - $1.50 per pound

• Black Rx Waste - $ 2.90 per pound

• Hazardous Waste – (Chemical) - $2.25 – 4.75 per pound

• Black Rx Waste in a 55 Gallon Drum is an average of $300.00 - $500.00 per drum

We will refer to above prices for regular trash vs RMW -Red Bag Incineration Waste in this example of how inappropriate placement of waste can easily increase your costs.

Processing regular trash costs .03 cents per pound. A 32 gallon bin can have a load capacity of 64 pounds totaling $1.92 for trash.RMW costs $0.90 cents a pound. A bin of the same size/ weight would cost $57.60. If general trash (gloves, supply packaging, paper, etc.) is disposed of into the RMW red bin (see images 1 and 2) that will incur unnecessary costs at $0.87 cents per pound. If 50 percent  of a RMW bin is general waste you just spent $28.80 for what should’ve cost $0.96 cents. This practice happens more than one might think and can add up quickly. Think of how many RMW bins there are in a hospital: inpatient units, OR rooms, lab, exam rooms, etc. 

multiplied by the number of those types of rooms, multiplied by the turnover rate of the red bag bin in between each pick up from the vendor. Sharps nothing soft, no liquid, no drugs (no flushing into bin).

#2) Workplace Injuries – Additional unexpected spending can occur when items are placed into the wrong bins or are not handled correctly. Caps not placed back on needles, sharps in bags (not sharps containers), drugs or chemicals dumped into regular bins, etc. can potentially cause your staff to be injured or become ill by exposure to these hazardous materials. This leads to potential spending for workman’s compensation, paid sick or LOA days your staff has lost from possibly being out of work as well as the cost to temporarily replace that staff member. The same can extend to all those involved in the process outside your organization. From the transporter, those at the transfer stations, to the incinerator and garbage facilities. Depending on the level of injury there could be a possibility of legal action.

#3) Fines and Fees:  Much of the waste produced at a hospital is regulated by state health and environmental agencies and federal agencies including but not limited to OSHA, CDC, FDA (for unused medications), DEA (for controlled substances), even the DOT (Department of Transportation). Wastes that fit certain categories under the Resource Conservation and Recovery Act (RCRA) 1976 traced from “cradle” (when the waste is produced) to the “grave” (when it has reached its final destination) and the generator bears all the responsibility. Fines can be implemented for various reasons such as if an employee is found disposing or dumping wastes where they don’t belong, for improper or missing labels, incorrect and / or unsecure packaging, not properly training employees, and improper or lack of documentation (manifests). You can find examples of these violations and their associated fines online.

Clean up and reparations will cost you as well if an incident occurs in a compactor, on the road, at a transfer station or a landfill. Not only have there been cases of spills external to the hospital but also fires at facilities. The damage and repairs may be charged back to your facility.

#4) Linen- Even your linen can get caught up in the waste spending. Linen can very easily fit into a regular garbage or RMW  pail and is much heavier. Sometimes staff may think if a blanket or sheet has been soiled it goes into the RMW bin instead of the linen bin. If this happens you will be paying for your linen 4 times. The initial rental of the linen, improper disposal (as explained above in #1), needing to pay the company for the missing linen, and then the linen to replace what was thrown out.

There are several proactive measures you can implement for waste management cost savings.

• Placement of bins – Be sure to place bins in a way that agree with the workflow of the space. Staff may tens to throw garbage in the nearest bin instead of the proper bin.

• Educating staff – This is extremely critical to meet regulations and to increase awareness and knowledge amongst your organization. Education should not only just occur at orientation but also frequently on a periodic basis. Additionally DOT training is required for those staff handling of safe waste disposal and management (ex: the EVS department).

• Audits – In addition to your vendor conducting their audits, your facility should also be doing their own. They should be included in your facilities Environment of Care rounds and have pop up random spot checks. Findings should be reported out at safety committees, department meetings and leadership meetings.

• Container and Container Opening Size– Make sure to properly assess how large of a bin you need in all areas for each type of waste the areas generate. The openings of the bins are just as important. Too large of an opening leads to opportunities for staff to place larger inappropriate items into it. HIPAA bins especially have been known to have phones, batteries, and other larger non-complaint articles in it.

• Color Coded Containers–Having different colored bins for the various types of waste may be required in your state, but if not it is a good visual cue and reminder to staff