According to a study published in the Journal of the American Medical Association in 2009, U.S. healthcare facilities generate an average of 7,000 tons of waste a day—per patient, that’s 26 pounds a day. Healthcare is also responsible for 8 percent of the country’s carbon footprint. While healthcare facilities are expected to improve the overall health of their communities, increasingly their day-to-day sustainability practices demonstrate they have broadened that charge to include greater care for the environment.
Today, many hospitals have addressed statistics like those cited above by rethinking their approaches to handling hazardous waste, cleaning with harmful chemicals and using fossil fuels for energy.
Adopting new practices that ensure sustainability in these areas provides a valuable return on facilities’ investments by improving the health of patients, facility staff, surrounding communities, the environment and, at times, even the bottom line. The potential savings can be significant: A 2012 study from the University of Illinois-Chicago’s School of Public Health examining nine hospitals/health systems that developed more environmentally sustainable operations forecasted that total savings to the hospital industry, if it broadly adopted similar green practices, could exceed $5.4 billion over five years and $15 billion over 10 years.
Proper Disposal of Pharmaceutical Waste
Consumers have been educated to find alternatives to flushing or putting unused pharmaceuticals down the drain. After a 2008 report that trace amounts of pharmaceuticals were found in the drinking water of 46 million Americans, the number of programs to protect water supplies from medicinal contaminants increased. Hospitals’ pharmaceutical waste programs are open to inspections by regulatory agencies such as the Joint Commission, the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA). These rules are the minimal baseline for some environmentally minded hospitals.
Numerous hospitals have implemented pharmaceutical waste programs that take into account each medication’s persistence, bioaccumulation and toxicity in order to dispose of them properly. At Redmond Regional Medical Center in Rome, Georgia, leaders contracted with Stericycle, one of HCA’s suppliers in this space, to implement the pharmaceutical waste program designed by corporate. The program centers on multiple colored bins that are used to dispose of different types of drug waste and packaging, says Chris Saboura, R.Ph., MBA, director of pharmacy at Redmond.
“In the hospital setting, we have blue, black and yellow bins that allow us to sort waste more carefully and efficiently,” he says.
Each bin is used for a certain category of medications based on its properties: red for biohazardous waste, black for hazardous pharmaceutical waste as defined by the EPA, blue for non-hazardous pharmaceutical waste, and yellow for trace chemotherapy waste. The contents of each bin are disposed of in a different way, based on guidelines for proper handling of pharmaceuticals that meet those definitions.
To implement the program, Redmond leaders identified people in various departments who would serve as champions of the change and held numerous training sessions throughout the hospital.
“You need key stakeholders from pharmacy, nursing and infection control to successfully launch a program like this,” Saboura says. “We educated these stakeholders on the value of implementation, and that raised awareness throughout the hospital. When we got them engaged, they were instrumental in helping us launch it properly.”
Although employees were trained on the program, they needed reminders. Leaders placed laminated cards above the bins to help nurses understand which medications to put in each. They also programmed the automated medication dispensing machines to show messages to nurses about where medicines should be placed. And for the first six months, leaders audited the material placed in the bins and the results guided ongoing educational efforts.
The hospital discovered that proper disposal of pharmaceuticals was financially advantageous. By sorting pharmaceutical waste into both hazardous and non-hazardous bins, they kept the cost of the highest waste stream collected in the black hazardous waste bins to a minimum. In some cases, the actual bins can be reused and only the waste medications are sent for incineration. The goal is to keep the great majority of pharmaceutical waste out of the water supply.
“When people put waste in the right containers, the hospital saves money,” Saboura says. Such segregation also helps educate staff about the EPA’s Resource Conservation and Recovery Act and steps his facility is taking to help the environment.
For Redmond, implementing a responsible pharmaceutical waste program was not only about a financial return on investment—it was also about doing the right thing.
“Proper disposal of waste is required so we’re in compliance with regulatory agencies, but it’s also what we need to do for the environment,” Saboura says.
Waste Management Sustainability Services (WMSS), PharmEcology Services, which provides pharmaceutical waste categorizations and inventory analysis, has found that the cost of managing all medication waste as hazardous waste in the black bins is about 76 percent higher than segregating waste into hazardous and non-hazardous pharmaceutical waste, says Charlotte Smith, R.Ph., senior regulatory advisor for WMSS PharmEcology Services.
In addition to cutting costs on waste disposal, a responsible pharmaceutical waste program also allows hospitals to avoid the costs associated with non-compliant management of pharmaceutical waste.
“The most obvious ROI would be the elimination of the risk of substantial fines and negative publicity associated with an enforcement action at the state or federal level,” Smith says. “These fines have been considerable, into the hundreds of thousands of dollars.”
New EPA rules for managing hazardous waste pharmaceuticals are expected to be published in 2017, and will offer some relief from the current, more onerous requirements, such as the rule to manage empty warfarin and nicotine packaging as hazardous waste pharmaceuticals. (For more on how the proposed regulations differ from the current regulations, visit: www.epa.gov/hwgenerators/frequent-questions-about-management-standards-hazardous-waste-pharmaceuticals-proposed#q9.)
“We believe that when this rule becomes final, the EPA will continue to expect healthcare facilities to comply and that enforcement at the state and federal level can be expected to increase,” Smith says. “By taking steps now to comply with current regulations and embracing best practices, hospitals can get ahead of the curve, publicize these positive sustainable efforts and avoid the potential monetary costs of non-compliance.”
Safer Cleaning Chemicals
The selection of cleaning products and practices used in hospitals can help facilitate positive impacts on human health and the environment. For instance, alternatives are sought for cleaning products brought into a facility to sterilize equipment and prevent the spread of infection that often contain chemicals that can be potentially harmful, especially to healthcare staff who constantly breathe them in.
According to OSHA, in 2010, the healthcare industry reported more than 650,000 employee illnesses—the highest of any private industry. OSHA also estimates that 11 million workers in a wide range of industries and occupations, including healthcare, are exposed to at least one of the numerous agents known to be associated with occupational asthma. The National Heart, Lung and Blood Institute says that more than 250 substances are known or believed to cause or exacerbate work-related asthma, including some used in healthcare settings, such as chemicals used in manufacturing products common to a hospital like paints, cleaners and latex gloves, as well as dust from flour used in hospital kitchens.
Growing numbers of hospitals are incorporating the use of green cleaning products that are safer for patients, employees and the environment. These products still keep the healthcare environment clean and sterile. Specialty Hospital of Jacksonville, Florida, recently switched to a new contract for cleaning products. Diversey, the new supplier, provides almost all green products, says Tammy Fitch, director of environmental services.
“We don’t really capture the ROI, but changing products has made an impression,” Fitch says. “People understand we’re trying to be more environmentally cautious and protect where we work and the people in our facilities.”
At Alaska Regional Hospital in Anchorage, Alaska, a recent Joint Commission audit questioned the use of a corrosive toilet bowl cleaner that required cleaning staff to wear personal protective equipment.
“To mitigate risk to the employee, the facility reviewed alternative chemicals that were safer,” says Diane Landry, operations support manager for Waste Management Sustainability Services at Alaska Regional. “We were happy to see that HealthTrust already had contracts in place for environmentally preferable products that are safer for cleaning and/or Green Seal certified. We simply switched to a new supplier.”
DeAnn Oryall, hospitality services manager at Mountain View Hospital in Payson, Utah, is also very aware of how commercially produced cleaning products affect more than the environment. Oryall’s team of housekeepers is attentive to patients’ rooms and areas everyone in the facility could access on a daily basis, such as sinks, water fountains and drink machines.
For Oryall, selecting cleaning products is not about saving money; it’s about promoting human health and a safer world.
“I want my grandkids to experience a world like the one I enjoy,” she says. “If we don’t do something to make a difference, they may not have the same opportunities.”
Energy Reduction and Efficiency
As energy costs rise and regulations on carbon emissions tighten, healthcare providers are becoming increasingly interested in renewable energy sources, such as solar and wind power. According to the U.S. Department of Energy, hospitals consume about two and one-half times the amount of energy as an average commercial building. As a result, they can realize above-average energy and cost savings by utilizing energy from naturally renewing sources.
Improved funding, incentives and new technologies have made renewable energy sources more accessible and affordable than ever. Forging the way—meeting 100 percent of their energy needs with renewable energy—are healthcare organizations such as Oregon’s Providence Newberg Medical Center and Gundersen Health System in LaCrosse, Wisconsin. But just incorporating some renewable energy can help cut costs, enhance a hospital’s reputation and lead to better community health.
For instance, after rising fuel costs hit Partners HealthCare in Boston with an unexpected $20 million expense in 2008, leaders committed to reducing the
hospital system’s dependency on fossil fuels. By late 2014, the system was deriving more than a quarter of its energy from renewable sources.
Through a partnership between two universities to purchase energy from 243,000 solar panels, George Washington University Hospital in Washington, D.C., now obtains more than one-third of its energy from renewable sources. And the hospital and its partners pay less for the solar energy than they previously paid for power from fossil fuels.
HealthTrust members can take advantage of similar contracts to conserve energy. For instance, HealthTrust recently completed a contract for a member that replaces 100 percent of the facility’s electricity energy usage with green energy and is currently working with a large healthcare group in Texas to do the same, says Bill Miller, director of strategic accounts, inSight Advisory–Energy.
For members interested in pursuing energy efficiency projects, HealthTrust can provide analysis, look for rebates and incentives, choose the right contractor to take on the project, verify the savings and, in some cases, help provide financing.
“We can assist any member that wants to incorporate renewable energy in a variety of ways,” Miller says. “We can help them purchase it on the market or help in the evaluation of green project installation at their facility.”
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