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.
- Focus on house-wide paper reduction by 10%
- Identify two additional areas where reuse/recycling can be implemented
- Reduce direct patient care item usage
The recycling department has added 2 offsite locations over the past year. We are now recycling batteries from Speech & Hearing and Dermatology. Alkaline battery recycling has increased 8% in 2020.
We received a 2010 Sterilmed Best Practice for Environmental Excellence Award.
Martha Houlihan, Karen Villanueva-Walsh, Paul Ryan 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.
- Permanently eliminate use of osmium tetroxide and epoxy resin in Electron Microscopy.
Permanently eliminate the use of xylene in the Histology laboratory through purchase of new processor which will result in a decrease in solvent waste.
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, 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.
- Use metrics to study the impact of the new medication distribution processes in the Hospital Pavilion with regard to waste generation and, if successful, mirror in hospital towers
- Comply with updated EPA pharmaceutical waste disposal guidelines, when implemented
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 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.
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, Martin Kroll, Cliff Roggemann, Kathy Terwilliger, John Bruno and Frank Albergo