Infectious Waste Management

As a healthcare administrator, the task of making sure your hospital is effectively managing your infectious medical waste can be daunting. Because of the highly regulated nature of this waste stream, it is important to understand both the composition of what defines “infectious medical waste” and cost-effective strategies for properly managing this material. Definitions of this material will vary depending upon each state.

Many healthcare executives have little to no direct day-to-day involvement in how their infectious medical waste is managed – that is, until a problem occurs. For several reasons, it is suggested that all senior administrators should familiarize themselves on how their hospitals manage this material along with identifying potential weaknesses of current programs.

Although the topic of medical waste may not be on the minds of most healthcare executives, one can argue that no other factor within a hospital can provide as much opportunity to reduce costs, reduce legal scrutiny and ready organizations for outbreaks and pandemics.

To better understand your current practice, we need to examine how infectious medical waste was managed as little as 20 years ago. Up until the 1990s, many hospitals managed this material on-site with an incinerator. Because of the environmental and human health issues associated with incineration, some hospitals transitioned to non-combustion technologies such as autoclaving. Another approach hospitals selected was to outsource the management of their infectious medical waste to an off-site hauler as a temporary solution. What began as a short-term “fix” became permanent for a majority of these hospitals. Administrators quickly lost visibility as soon as this responsibility transitioned to facilities and housekeeping’s operating budget.

With a weakened economy and new healthcare laws intended to reduce costs, the practice of outsourcing infectious medical waste disposal may be considered a luxury service many hospitals can no longer afford. I recently completed a study for a hospital operated by a Southern California municipality and concluded that the amortized cost of an in-house program to manage the infectious medical waste was significantly less than the outsourcing to a medical waste hauler for this particular hospital. Increasing fuel prices and industry consolidation have made future outsourcing costs unpredictable, unlike the cost stabilization of managing infectious medical waste on-site. These costs are primarily predicated by the life of the equipment. I have been told by facilities personnel that many of these treatment systems have been in place for more than 20 years.

In March of this year, a government study was submitted to Congress, which demonstrated that on-site programs to manage infectious medical waste are less than half the cost of outsourcing. The report went on to document how these on-site programs also have significantly reduced carbon emissions for these hospitals.

As our healthcare industry strives for efficiency, we must consider the threats that could cause hospitals to be vulnerable. Hospitals are perhaps the only healthcare facilities the public expects to stay open and operational during a crisis. A crisis can be defined as a natural/man-made disaster or an epidemic outbreak/pandemic. Even experts are warning of a robust bird flu outbreak (Scientific American, June 2012, “Is Bird Flu Waiting to Explode?”). This ongoing threat is headlined as I write this article. In early August, there was a new outbreak of Ebola in Africa and a new strain of influenza in the United States, H3N8, that have scientists concerned.

The consequences regarding infectious medical waste management are multiplied during an outbreak. We now know from scientific studies (Infection Control and Hospital Epidemiology, May 2006, “Hospital Waste Generation During An Outbreak of Severe Acute Respiratory Syndrome In Taiwan”) that infectious medical waste volumes surge by as much as 500 percent during an outbreak because of the increased number of patients, as well as an over-classification of what is deemed infectious to protect the healthcare provider and public. Medical waste haulers lack the trucks, manpower and treatment capacity to accommodate this demand, especially if a large percentage of their employees are ill and/or refuse to service hospitals. To guard against this vulnerability, some hospitals have sized their treatment equipment to manage surge capacity.

In order to determine the best strategy of managing your infectious medical waste for your hospital and community, I recommend the following:

  • Factor lifecycle cost of the equipment, not equipment price, to accurately assess and compare the true overall cost and potential savings of managing the infectious medical waste on-site. Considerations should include the capital investment, labor, utility consumption, infection control concerns, consumables, maintenance and disposal of the treated material.
  • Examine the reliability or up-time of the equipment by talking to multiple end-users and even visiting multiple sites.
  • Only partner with well-established organizations that can provide the long-term assurance that they will be around to support your needs. Unfortunately, many  companies exit this industry as quickly as they entered, leaving the hospital with no after-sales service support.
  • Fully understand the infectious medical waste implications to your hospital and community if/when an outbreak occurs.

A successful program will be one that ultimately allows your hospital to be more operationally and financially independent.

James McNally is a principal at ENVIRON International Corp., which helps clients resolve their environmental and human health issues. He has more than 32 years of experience in hazardous waste management, medical waste management, and environmental compliance in hospitals.

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