Recyclable materials are items that have been discarded but can be re-used. These include paper, cardboard, food containers, metal, glass, batteries, plastic, and printer ink and toner cartridges. Construction debris is also part of the solid waste stream; sometimes these materials can also be recycled. In addition, hospitals are re-using reprocessed single-use medical devices, to cut back on waste. Efforts to reduce our solid waste stream have led to a reduction of food waste. According to U.S. Environmental Protection Agency studies, the annual cost of food waste disposal in the U.S. is about one billion dollars. In 2015, the EPA and the U.S. Department of Agriculture announced a goal of 50 percent food waste reduction by 2030.
- Focus on house-wide paper reduction
- Reduce direct patient care item usage
- Increase recycling as total percent of waste
- Increase construction/demolition debris recycling and metrics
We reduced solid waste through our instrument reprocessing program, reduction of food waste, and internal reuse program for supplies, equipment and furniture. The Department of Patient Advocacy started a book reuse program, where people donate or pick up gently used books to read and enjoy.
The total tonnage for all of our recycling materials for 2017 was 704.8 tons. Recycled solid waste materials included: batteries, computers and electronic waste, fluorescent lamps, ink jet and toner cartridges, metal, paper and plastic. Recycling bins are located throughout the hospital.
We installed a new can crusher machine. The cost will come out of the recycling budget. The collection and recycling of the steel cans will pay for the cost of the can crusher over time. Cans are pulled from our waste stream and sent to our recycling partner for reimbursement.
We no longer bale our cardboard for recycling. We installed a compactor that allows us to capture more cardboard, allowing staff to no longer have to break down the boxes and place them into a baler. This will reduce our solid waste and increase the revenue received for cardboard recycling.
The hospital participated in Recyclemania, a friendly competition that inspired our staff to reduce waste and recycle. We provided education to staff on reducing waste, dealing with surplus equipment and increasing recycling efforts. Schedules were created to structure the effort and coordinate the delivery of recycling containers and t-shirts to participants.
We received a 2010 Sterilmed Best Practice for Environmental Excellence Award.
Martha Houlihan, Karen Villanueva-Walsh and Cliff Roggemann
Hospitals typically generate large quantities of hazardous chemical waste. Hazardous waste is defined and regulated by the United States Environmental Protection Agency and also (in New York State) by 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.
- Investigate waste minimization when feasible. Explore opportunities/best practices.
- Review and update waste determinations using the software program SDSPro
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.) 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. Also, 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.
Chemical waste streams are periodically re-evaluated by Environmental Health and Safety and the hospital’s hazardous waste vendor. For example, an RCRA hazardous waste stream was pH tested and, based on the findings, treatment prior to incineration was no longer necessary yielding a savings to the hospital. This reduced the annual cost for disposal by $5500.
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.
The last remaining wet x-ray processor, in which silver was collected via filtration, was decommissioned in 2017. The hospital is now fully digital.
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.
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.
Kathy Terwilliger, Martin Kroll, Michele Gilleeny-Blabac
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.
- Reduce intravenous and pharmaceutical waste on nursing units, by utilizing just-in-time inventory and dispensing processes.
- Refine and standardize collection of pharmaceutical drugs in surgical and other procedural areas.
- Comply with updated EPA pharmaceutical waste disposal guidelines (finalized ruling tentatively set for May 2018.)
In cooperation with our local Setauket Fire Department, we coordinated a successful Return Unwanted Medicines event at the firehouse – the first official pharmaceutical waste event in Suffolk County. Five hundred pounds of unwanted medicines were dropped off by more than 140 community members. For this effort, we received a proclamation from the Suffolk County Legislature. The event was so successful that it is now conducted twice yearly – in the same location – by the federal Drug Enforcement Agency.
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 will now be 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 has reduced insulin purchases by 77 percent which, given the rising cost of insulin, will save the hospital nearly $300,000 annually.
Overall, all of our sustainability initiatives have been recognized by Practice Greenhealth awards.
Jeannene Strianse, Martin Kroll, Cliff Roggemann, Kathy Terwilliger, John Bruno and Frank Albergo