Sustainability Roadmap for Hospitals

• Hospitals generate approximately 26.8 pounds of waste per staffed bed per day. As an example, Practice Greenhealth award-winning facilities, on average, segregate 9% of that waste as potentially infectious material, or regulated medical waste. A subset of this 9% is sharps waste – that is, anything that can cut or puncture the skin.
• Disposal of sharps waste is highly regulated. Changes to a facility disposal system are examined and assessed by the Occupational Health & Safety Administration (OSHA). Containers used for sharps disposal are regulated by the Food and Drug Administration (FDA).
• Sharps management is a regulatory, safety, infection control, and environmental issue. Whether using disposable, recyclable, or reusable sharps containers, hospitals benefit from close scrutiny of this process to improve efficiency, safety and associated costs.  
• Each sharps container that is cleaned, disinfected, and reused reduces the environmental impact. 
• Collection protocol with a reusable sharps program may require access to sensitive patient care areas. Adjustments need to be made in collection and handling processes by educating employees and vendor collection agents.

Health and safety benefits – a reusable sharps program reduces the risk of needle sticks for healthcare system employees and allows  staff to focus hours back into patient care and customer satisfaction rather than traveling throughout the hospital exchanging sharps containers. This type of global and long term program is visible evidence of a culture of sustainable safety and environmental consciousness.

Consider the following contract specifications:   

• Specify pick-up logistics, frequency, adequate storage between pick-ups. Can they help with a back-up plan for servicing boxes that become full between pick-ups, and for onsite emergency inventory.
• Understand the conversion and installation process from disposable to re-usable sharps. Room by room listing of current vs reusable by container size, location and mounting type. How will the existing sharps cabinets be disposed of? Are there additional hidden costs? How long will the process take? How will the vendor handle problem areas during installation? How will the material be transported throughout the hospital? How long will vendor be on site during installation? What
• Understand the process of servicing rooms that are in use.
• What educational, training and staff engagement support is provided (i.e., staff training, handler and DOT training) during installation, annually and/or as needed? Can they provide sample signage?
• Does the vendor provide detailed reporting on volumes and costs to tracking sharps generation and avoided landfill volumes? If you have a preference for treatment technologies, (incineration vs. autoclave), specify and understand how that will be reported regularly.
• Does vendor provide environmental metrics like green house gas emissions, landfill waste avoidance?
• Does the vendor provide documentation of where you’re sharps are processed along the entire cradle to grave continuum, including how the sharps waste treated and disposed of, and documentation of the number of times the re-usable containers have been re-used before required destruction/disposal.
• Does vendor participate in transportation efficiency programs to reduce transportation related emissions and associated costs. See Maximize waste equipmentutilization and hauling efficiencies PIM for more information.
• Does the vendor automatically provide the latest regulatory updates and technology advancements within an agreed upon timeframe.
• Are there resources, tools and support provided for waste audits and other waste reductioninitiatives?
• Is there a minimum order charge? What are costs for additional emergency pick-ups?
• Will the vendor co-host in partnership with your organization, community collection days where community/staff members can drop off their sharps free of charge at a collection site?

1. Determine who’s on the team and convene your contracting and implementation task force. Clearly stakeholders include Nursing and clinicians, Infection Control, Phlebotomy, medical director (or leadership), Operating Room managers, Lab, Pharmacy, Environmental Services, Facilities, Supply Chain and others. Considerations for contracting/RFP management are quite different than operational and processing requirements. Stakeholders must represent both aspects of the program.
2. Identify and contract with a sharps collection vendor that provides sharps disposal management as part of its regulated materials service offerings.
3. The RFP requirements should include a cost-benefit analysis for single use disposable versus reusable sharps containers, sharps injury reduction data, in addition to other potential specifications found in the “purchasing considerations” section of this PIM.
4. Evaluation vendor training and educational materials. Not only at initial installation but annual and ongoing training. Review container signage and training posters for utility rooms.
5. Consider an onsite assessment of processing plant. Confirm all regulatory criteria are being met.
6. Review your organizational requirements and preferences for sharps container management. For example:
   1. Preference for horizontal or vertical drop
   2. Identification of full-containers
   3. Does vendor pick up containers even when they are not full.
   4. Storage cart requirements
   5. Container closure preferences
   6. Labeling requirements and preferences. Bilingual options
   7. Container size and options for container mounts, brackets and floor models
   8. Tamper resistance
   9. One-handed disposal
7. Does the vendor provide pharmaceutical containers collection, and any training and education around sharps with potentially hazardous pharmaceuticals?
8. Confirm container retirement processes. Confirm process when container replacement must occur between scheduled vendor pickups.
9. Confirm problem resolution strategies.
10. Work with the vendor to determine pick-up and replacement rates. While most hospitals choose the full-service plan, some prefer limited service. Work with vendor to review criteria and operational considerations.
11. Confirm Post implementation, track waste and cost avoidance.
12. Work with vendor to develop action plan for trouble shooting and regular reporting of environmental improvements. If vendor provides greenhouse gas emissions reductions, work with them on how to use the data.

Carbon emissions calcualtor tool to estimate your facility’s carbon savings. (provided by Stericycle). Others may also have them available.

An contracting and implementation checklist covering all clinical and regulatory requirements. (provided by Daniels Sharpsmart). Others may also have checklists available.

If you have an ROI tool, calculator, or similar resources to share, please contact us or participate in the discussion below.

• Methodist Medical Center improves worker, environmental safety with reusable sharps containers (Premier Inc)

• Harvard Medical School reusable sharps container pilot (aashe.org – 2010)

• Northwestern Memorial Hospital greenhouse gas emission reduction with reusable sharps containers (Waste Management & Research 2012.  Impact on carbon footprint: a life cycle assessment of disposable versus reusable sharps containers in a large US hospital – requires subscription)

• Reusables Give Northwestern Memorial a Sharp Edge on Safety and Sustainability- Medical Tourism Magazine (January 17, 2012)

• Hospitals Partner with Stericycle to Keep 100 Million Disposable Sharps Containers Out of Landfills - Infection Control Today (June 24, 2011)

• Hospitals Switch to Reusable Sharps Containers - NurseZone.com (2008)

• Multi-centre US study showing sharps injury reduction with reusable containment system - (American Journal of Infection Control, 2009)

Ensure containers have received 510K clearances from the FDA and also meet OSHA requirements under the Blood-borne Pathogen Standard. Some vendors offer end of life recycling options furthering the environmental benefit of reusable versus single use containers

LEED 2009 for Healthcare, New Construction & Major Renovations, Materials and Products, Prerequisite 1, Storage and Collection of Recyclables

LEED 2009 for Healthcare, New Construction & Major Renovations, Materials and Products, Credit 3, Sustainability Sourced Materials and Products, 1-4 points

GGHC Version 2.2 2008 Revision, Waste Management, Credit 2.2, Regulated Medical Waste Reduction: Minimize incineration

Reduces worker exposure and handling, incineration and landfill costs and keeps several toxins out of the air and soil. Track reductions in amount of products purchased. Report on cost reduction and plastics elimination.

WASTE: Set waste management goals and track and report progress.

WASTE: Assess waste-handling and management systems and operations.

Vendors should provide adequate training and educational materials for training of all staff handling sharps.

 If you have any information or resources to contribute, please contact us or participate in the discussion below.

Coalition for Safe Community Needle Disposal is a collaboration of businesses, community groups, non-profit organizations and government that promotes public awareness and solutions for safe disposal of needles, syringes, and other sharps in the community. The site offers comprehensive information on needle disposal and can be parsed by state.

Guidance document from the CDC National Institute on Safety & Health (NIOSH) on Selecting, Evaluating, and Using Sharps Disposal Containers.

Guidance from OSHA for Handling Sharps