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checkReduce Regulated Medical Waste (RMW) Generation

All PIM content was independently developed and reviewed to be vendor-, product-, and service provider-neutral.

Description

  • Regulated medical waste (RMW) is a highly regulated, expensive waste stream to treat, manage and properly dispose of. RMW requires the development and implementation of policies and operational procedures to ensure compliance. With effective planning and education, a hospital can reduce the volume of RMW generated, decreasing cost and enhancing staff and patient safety.  
  • Project Talking Points

    • Many hospitals routinely throw from 50-70% of their waste into the RMW stream (in your state RMW may be referred to as infectious or biomedical waste) and the disposal rates are often up to 10 times as much to dispose of RMW versus solid waste.
    • Case studies prove that with comprehensive education, hospitals can realistically aim to decrease RMW waste to a mere 6-10% of their waste stream and the Centers for Disease Control (CDC) suggests that only 3-5% of hospital waste truly needs to be disposed of as RMW.
    • Typically, a facility can realize significant improvements in their RMW generation rate by simply implementing an education and training program focused on proper segregation. RMW reduction programs demand that staff follow procedures by making decisions about where to put the waste.  Asking staff to pay attention to these details can also result in safety related improvements – fewer needle sticks and blood borne pathogen exposures. 
    • Other RMW reduction opportunities include reprocessing single use devices, switching to re-usable sharps containers and using a fluid management system (for suction canister reduction).
  • Triple Bottom Line Benefits

    • Cost savings –– A comprehensive RMW program can reduce waste stream expenses via proper segregation and the implementation of single use device reprocessing, re-usable sharps containers and fluid management systems.
    • Environmental benefits – Decreasing the quantity of RMW reduces the demand and frequency for treatment of this kind of waste, thereby reducing consumption of various resources and energy for treatment. This strategy also reduces the final volume of waste entering landfills after appropriate treatment.  Consequently, the decomposition of the potentially dangerous or toxic constituents present in medical waste, and the associated emissions, are avoided.   
    • Health and safety – Staff and patient exposure to needle sticks and blood borne pathogen exposures are reduced.
    • Quality and outcomes - Metrics are in development. If you have suggestions, please  contact us or participate in the discussion below.

  • Purchasing Considerations

    Ensure language is integrated into RMW contracts that requires:
    1. Detailed reporting on RMW volumes and costs. Determine the level of detail the vendor can provide regarding tracking RMW generation to the department level. Ensure incinerated waste costs are well defined and delineated from non-incinerated medical waste costs. Also, ensure energy, fuel, pickups costs, etc. are detailed out.
    2. Documentation of where you’re RMW is processed along the entire cradle to grave continuum.
    3. Pickups/containers are maximized to reduce transportation related emissions and associated costs. See Maximize waste equipment utilization and hauling efficiencies PIM for more information.
    4. The latest regulatory updates and RMW technology advancements are provided to your organization within an agreed upon timeframe.
    5. Education, training and staff engagement support, i.e., DOT training.
    6. Resources, tools and support are provided for waste audits and other improvement initiatives.
    7. Hosting in partnership with your organization, community collection days where community/staff members can drop off their sharps free of charge at a collection site.
  • How-To

    1. Review state and federal regulations for specifics on RMW and the types of waste designated as RMW. Ensure infection control is part of this discussion/research. Defining RMW can be complicating as definitions vary state to state. For example, a health and safety agency may use a different definition than an environmental agency, even within the same state. To help clarify this situation, see the HERC RMW state locator. Understanding the RMW waste definition applicable to your state will help you reduce the amount of waste your facility generates and maintain compliance. For additional information regarding RMW regulations and defining RMW check out the HERC Regulated Medical Waste Overview page.
    2. Determine the facility’s current percentage of waste stream make-up, specifically the current RMW rate. This can be accomplished by partnering with your waste stream vendors to conduct an invoice review. Once determined, this will provide you with a baseline from which goals and actions plans can be developed. For additional information see conduct a waste assessment PIM.  
    3. Determine a tracking and reporting tool that can be utilized to establish the facility’s waste stream baseline and measure progress. Track RMW generation by department and hold department heads accountable for their RMW generation and disposal costs. See Establish baseline for current waste generation and program for ongoing waste metrics reporting PIM for additional information.
    4. Set basic, intermediate, and advanced goals for reducing RMW. Respectively, aim to reduce the RMW rate to 15, 9, and 5 percent of the total waste stream. Determine costs savings and RMW volume reduction associated with obtaining these reduction goals.
    5. Communicate your RMW reduction goals with your vendor and identify how they can be leveraged to achieve the identified goals. See the contracting specification above for additional information on how to maximize your program through vendor leveraging.
    6. Conduct a facility walkthrough for a visual inspection of waste disposal practices and process. During the walkthrough:
    • Determine the needs of each department for segregation and reduction efforts.
    • Ensure red bag containers are place appropriately with corresponding signage.
    • Document the removal of unnecessary red bag containers.  
    • Educate employees regarding the upcoming RMW reduction program.  
    • Identify champions along the way that could act as ambassadors once the program is launched.

    For additional information on conducting a facility walkthrough see conduct a waste assessment PIM.

    7. Determine facility contacts, such as department managers and decision makers that can assist with education, communication and staff engagement.

    8. Develop an education, training and communication plan that includes approaches such as train the trainer, departmental presentations, friendly competitions amongst departments, emails, newsletters, posters, etc. It is best to utilize the facility’s existing communication vehicles and then develop creative approaches to further reach your intended audiences.

    9. Launch the RMW reduction program in conjunction with the education, training and communication efforts. The following items should be addressed:  

      1. Appropriately place RMW containers to maximize compliance with segregation goals (not in highly accessible areas, areas not generating RMW, non-accessible areas, etc.). Involve employees in the determination of container placement. Make sure trash containers are available wherever there are RMW containers.
      2. Optimize the size of containers to adequately meet the needs of the volume of RMW generated in that area. For example, smaller containers will help prevent general trash from entering the RMW stream.
      3. Ensure containers are color coded and well-labeled.
      4. Cover red bag containers to reduce solid waste that is casually tossed in.
      5. Remove red bags from areas where RMW generation is unlikely or small.  
      6. Provide personnel with clear and coherent information to understand the reasons for proper segregation of medical waste.
      7. Educate staff on RMW reduction program and logistics such as the definition of RMW, reduction goals, proper waste management, handling procedures, etc.
      8. Poste educational “know where to throw” posters/guides throughout the facility in areas such as break rooms, utility rooms, etc. Outline what types of waste are to be disposed of as RMW and use multiple languages, if necessary, for optimal communication.
      9. Reduce disposal of RMW packagin.
        1. A significant percentage of the RMW sent off-site for disposal is packaging (e.g., bags, sharps containers); including local collection containers and additional containers used for off-site shipment; the entire weight of which counts as RMW. To reduce the quantity of packaging material disposed of, consider the following:
          1. Size red bags and sharps containers according to need at specific locations (i.e., smaller bags/containers for areas with low RMW generation rates).
          2. Maximize container use by optimizing when they are replaced (i.e., don't unnecessarily remove half full or less containers).
          3. Ship RMW off-site in reusable containers. These may be available from your RMW waste services provider and/or disposal facility

    10. Switch to a reusable sharps container system. A reusable sharps container program can significantly reduce RMW volume and sharps container purchase costs. See switch to reusable sharps containers PIM for more information

    11. Implement a single use device (SUD) reprocessing program. The reprocessing and reuse of SUDs is an optional healthcare facility cost-cutting practice (40 to 60% less than new devices) that also reduces the volume of regulated medical waste disposed of. The majority of SUDs reprocessed are products made from rigid, hard metals or durable polymers and plastics that can be reused between two and five times, depending on the device. Reprocessing has been regulated by the U.S. Food & Drug Administration (FDA) since 2000. See reprocess approved single use devicesPIM for more information

    1. Reprocessing of single use medical devices has evolved over the past 20 to 30 years. Initially, reprocessing was performed by healthcare facilities themselves. When hospitals desired reprocessing of complex products, complicated decontamination and sterilization procedures were needed. As a result, an industry of third-party reprocessors developed.
    2. Before medical devices can be reprocessed and reused, a third-party or hospital reprocessor must comply with the same requirements that apply to original equipment manufacturers, including pre-market submission requirements, plus they must meet supplementary rules, including submission of validation data (see Medical Device Special Report by ECRI Institute.)

    12. Utilize fluid management systems to reduce suction canister usage. Most systems on the market offer fluid waste management and smoke evacuation all in one unit. The system collects surgical waste fluid within a totally enclosed system, then disposes of it with little human intervention, reducing operator exposure. Addition advantages include:

    1. Protects staff from splash exposure
    2. Minimizes the need for canisters and red bags
    3. Reduces waste disposal costs
    4. Uses powerful, consistent, controllable suction
    5. Allows for faster turnover times and is
    6. Cleared for case to case

    13. Develop a continuous improvement process that includes:

    1.Conducting regular rounds/audits.

             2. Educating and training staff when appropriate. Reinforce waste segregation as part of annual training requirements under OSHA or other routine training.

             3. Developing a feedback process with Environmental Services to continually identify improvement opportunities.

             4. Creating a reporting process to track changes in waste generation volumes and associated cost savings. Publicize results to facility personnel and the surrounding communities on the successes and positive effects of the reduction program.

    For further RMW reduction ideas, see the Healthcare Environmental Resource Center.

  • Tools

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

  • Case Studies

  • Regulations, Codes and Standards, Policies

    • Review state and federal regulations for specifics on RMW and the types of waste designated as RMW. Ensure infection control is part of this discussion/research. Defining RMW can be complicating as definitions vary state to state. For example, a health and safety agency may use a different definition than an environmental agency, even within the same state. To help clarify this situation, see the HERC RMW state locator. Understanding the RMW waste definition applicable to your state will help you reduce the amount of waste your facility generates and maintain compliance. For additional information regarding RMW regulations and defining RMW check out the HERC Regulated Medical Waste Overview page.
  • Cross References: LEED

    LEED 2009 For Existing Buildings: Operations & Maintenance

    • Materials & Resources Credit 6: Solid Waste Management: Waste Stream Audit
  • Cross References: GGHC

    GGHC Operations

    1. Waste Management Credit 2.1: Regulated Medical Waste Reduction: <10%
    2. Waste Management Credit 2.2: Regulated Medical Waste Reduction: Minimize Incineration
  • PIM Synergies

  • Education Resources

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

  • More Resources

  • PIM Descriptors

    Supply Chain, Waste

    Level: Beginner

    Category List:

    • Regulated Medical Waste

    PIM Attributes:

    • Optimize Operations

    Improvement Type:

    • Waste Minimization

    Department:

    • Environmental Services
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