Stony Brook Medicine is committed to supporting sustainability efforts and reducing our carbon footprint, one initiative is the reduction of the amount of paper used and the recycling of the paper we do use. We can all do our part to reduce waste and save resources in our daily work areas. Our sustainability programs not only benefit our planet, but also our employees and communities.
- RMW: 10% reduction of incinerated waste (red bag) by removing red containers from areas that do not generate, typically, heavily soiled bodily fluid. This will entail re-education of Hospital staff on the appropriate use of red bag waste containers. This reduction is not designed to include the OR, at this time.
- Recycling: to include paper and plastic. The recycling program will move to an "all paper" recycling model via the confidential gray bins. The campaign will be rolled out to the entire facility to promote recycling of all PHI, general and superficial paper items. Gray bins will be distributed to areas that need and areas that have will be encouraged to use it for all paper. The Recycling department will begin to use blue recycling liners in the blue recycling bins to reinvigorate the current plastic recycling initiative. Housekeeping will begin to recycle all plastic waste generated from chemical containers and small equipment using blue liners. Plastic recycled waste is collected twice per week.
- Other recycling efforts: the use of reusable ICRA wall. Project management will begin to mitigate the use of plastic barriers for construction projects, where applicable. When plastic barriers are used, they will be recycled with plastic recycling rather than with construction waste.
Goals from 2022 include a reduction in paper of 10% and an 11.6 reduction was realized. The Recycling program was expanded to 33 Research Way and 8 Tech Drive. A new way to review C&D waste was implemented in 2022.
In August 2021, SBUH Product Management Committee approved new paper towels. Smaller sized paper towels were replaced with a larger size paper towel that fits paper towel holder so there is less waste (savings of at least $46K per year) and new towels are made from 100% recyclable paper. The old smaller towels were dispensed in greater numbers because when one towel was pulled, many others would fall out of dispenser.
Our Emergency Management manual went green in 2021. Its format changed from paper manuals printed annually to reusable flipbooks, saving a significant amount of paper. Typically, four boxes of paper were used each year to print out the manuals. With 10 reams of 500 sheets each per box, totaling 20,000 sheets of paper saved annually!!
We received a 2010 Sterilmed Best Practice for Environmental Excellence Award.
*Nikki Hamblin, Martha Houlihan, Paul Ryan, Karen Villanueva-Walsh
Hospitals typically generate large quantities of hazardous chemical waste. Hazardous waste is defined and regulated by the United States Environmental Protection Agency and/or the NYS Department of Environmental Conservation. Much of the non-pharmaceutical chemical waste generated is solvent waste (such as alcohol and xylene) from laboratories. To protect patients, visitors and staff, and to preserve the natural environment, healthcare facilities strive to minimize the quantity of hazardous chemicals they purchase, use, and discard. Hospitals also are investigating non-hazardous alternatives for materials classified as hazardous.
- Evaluate current laboratory procedures, equipment, and reagents/consumables for opportunities to reduce or eliminate hazardous chemicals or recycle consumables.
Before Stony Brook Medicine initiates new clinical procedures or instrumentation, first we consider hazardous waste that might be generated. As part of that effort, the Department of Laboratories uses a checklist when requesting capital equipment. The checklist includes “Issues to be Considered Prior to Implementation”, and a hazard analysis is undertaken to determine safety precautions (electrical safety, proper disposal of chemical and dry/liquid hazardous waste, and chemical hazards.) This hazard assessment, including the impact of waste is weighted before acquisition. For example, in the Core and Histology Labs, laboratory equipment that generated hazardous waste was replaced with newer instrumentation that no longer generated hazardous waste.
Chemical waste streams are periodically re-evaluated by Environmental Health and Safety and the hospital’s hazardous waste vendor. We select disposal options that may have lesser environmental impact. For example, as an alternative to incineration, our laboratory xylene and alcohol waste was used for energy recovery (specifically, fuel blending), which means it is used as a fuel for industrial processes.
The Plant Operation department uses low volatile organic compound (VOC) latex paint in the hospital. The Cabinet Shop uses low VOC adhesives and sustainable plywood and medium density fiberboard, when constructing furniture.
Last year we were able to distribute two large pallets of soon-to-expire off-spec donated hand sanitizer to support staff for use. This avoided the 1.6 tons of potential waste handling and was appreciated by recipients.
The Radiation Safety group had 1,200 pounds of unusable lead composite vests recycled by Veolia.
We use the software program SDSPro to inventory the approximately 3,000 chemical products used in the hospital. Safety Data Sheets provide product safety information, including personal protective equipment to wear when using the product, what to do in case of a spill or exposure, and how to safely dispose of the product. Because Safety Data Sheets are periodically updated, we strive to keep this information current. We do this not only for safety, but also to handle waste more efficiently. For example, it’s less costly to dispose of non-hazardous waste, so we need access to the most up-to-date information. In 2021, we added a new PSF Laboratory EOC Inspection survey question and track responses: Staff can explain how to access departmental chemical inventory, Safety Data Sheets and waste determinations in the SDSPro database.
We are virtually a mercury-free hospital. Mercury is a potent neurotoxin and developmental toxin. Even at low levels it can impact human health. Healthcare facilities are often a major contributor to emissions of mercury that end up in the air we all breathe. By eliminating mercury, we’ve taken an important step to protect vulnerable populations, like pregnant women and young children, from the damaging effects of mercury pollution. The hospital received the Making Medicine Mercury Free Award, a prestigious national honor from Hospitals for a Healthy Environment (H2E.) H2E is a nonprofit group that works to improve healthcare’s environmental performance. Hospitals that receive this award meet stringent benchmarks for mercury elimination.
The hospital received the Environmental Protection Agency’s Environmental Quality Award. EPA honors individuals and organizations who have contributed significantly to improving the environment. To be selected, nominees must have contributed to improving environmental quality, demonstrated a high achievement in the award category, created unique or location-specific benefits, produced results that are sustainable or reproducible, or increased public involvement in environmental action. To receive this award, we highlighted our efforts in mercury reduction, recycling and environmental awareness.
*Martin Kroll, Ellen O'Hare, Taryn Schwarz
There is widespread concern over pharmaceuticals that have gotten into the environment, particularly drinking water. Environmentally sensitive handling of a hospital’s pharmaceutical waste is shaped by many factors: safety for patients and staff; federal, state and local regulations; whether the waste is classified as RCRA hazardous (drugs are classified RCRA depending on four factors: how corrosive, toxic, ignitable or reactive they are); and whether the waste is DEA-controlled substances.
1. Reduce overall pharmaceutical waste by 10%. Measured quarterly using manifests from the reverse distributor.
2. Reduce propofol waste by 20%. Measured using disposal records.
Under the direction of the Departments of Pharmacy and Healthcare Environmental Health & Safety (EH&S), we implemented a pharmaceutical waste management policy. A review of the hospital’s formulary identified which pharmaceuticals were RCRA (drugs are classified RCRA depending on four factors: how corrosive, toxic, ignitable or reactive they are.) This review now is conducted annually.
We collect waste streams that are disposed of by incineration. This includes RCRA meds and non-RCRA meds. (Although non-RCRA pharmaceutical waste doesn’t meet the definition of hazardous waste, we still consider it to be dangerous to human health and the environment. We have increased our collection of non-RCRA waste. The hospital also manages this waste stream as “incinerate only”, to protect the environment.) Our total pharmaceutical waste collection has increased by 43 percent during the past three years.
The hospital has changed its disposal of DEA-controlled substances from sink drain disposal to collection containers that render the drugs irretrievable. This waste stream is now destroyed by incineration.
In October 2017, the pharmacy initiated a program to reduce unnecessary insulin waste throughout the hospital. The program began with the long-acting insulin, insulin glargine (brand name Lantus). Instead of dispensing one vial per patient, the pharmacy is utilizing the hospital's automated dispensing machines (Pyxis), coupled with custom bar-coded labels, to allow nurses to withdraw single doses of insulin for patients and label the individual insulin syringe right at the Pyxis. This allows bedside barcode scanning for insulin and also minimizes waste (due to more efficient use of each vial of insulin.) After four months, the project had reduced insulin purchases by 77 percent with an estimated annual savings of nearly $300,000.
Pharmacy continued partnering with "Less Waste" and eliminated printing out paper medication requests and implement an electronic medication request functionality in 2020. Pharmacy initially reduced paper spend by $5,384 per year by reducing usage by 132 cases per year. In 2021, paper use was further decreased – the pharmacy reduced pre-2020 usage by 260 cases. This equates to 1.3 million fewer sheets of paper and a savings of $10,600.
Overall, all of our sustainability initiatives have been consistently recognized by Practice Greenhealth recognition awards and the NYSDEC Environmental Excellence Award received in 2018. The insulin reduction initiative was identified as a Best Practice by Practice Greenhealth and is expected to be featured on their website during the Spring of 2019.
*Jeannene Strianse, *Marty Kroll, Frank Albergo, Claudia Alfiero, Mary Capuano, Emily Neuburger, Ellen O’Hare, Sandy Sardinha, Hansneet Sarang