Challenges and Solutions in Waste Management for Health Care Facilities

Health care waste

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Health care facilities are prolific waste generators due to the nature of their operations, which involve diagnosing, treating, and caring for patients. According to findings from a study published in JAMA, waste within the US health care system amounts to an annual expenditure ranging from $760 billion to $935 billion, representing approximately 25% of total medical spending. Management of this waste can be complex, requiring compliance with strict regulations to mitigate health care risks. Examples of risks to organizations can include infection, pollution, injury, and resource depletion.¹

Challenges in Waste Management

Waste management in health care facilities presents many challenges due to the unique characteristics of the waste generated and the stringent regulatory requirements governing its disposal.¹ Health care facilities produce various types of waste, including hazardous, medical, pharmaceutical, infectious, solid, food, and general waste, as well as recyclables.^2-4 Each waste stream requires specific handling, storage, and disposal methods, adding complexity to waste management processes.5 For example, hazardous waste should be stored in secure areas away from public access and protected from damage or tampering. Infectious waste, on the other hand, such as blood-soaked materials, tissues, and cultures, should be handled with caution and placed in leak-proof, puncture-resistant containers labeled with biohazard symbols.^4,5 Nonhazardous, nonrecyclable waste, such as food waste, paper towels, and wrappers, can be disposed of in regular trash bins.

Health care waste is also subject to stringent federal, state, and local regulations to ensure public health and environmental safety.5 Compliance with regulations such as those of the Resource Conservation and Recovery Act and the Occupational Safety and Health Administration standards requires extensive training, documentation, and resources. It is critical for health care facilities to maintain accurate records as mandated by regulatory authorities, detailing the procedures for waste management, waste collection, and staff training. During health care surveys or inspections, surveyors or auditors can request this documentation,³ and organizations should be prepared to provide it at any given time.

Health care waste can expose people to...

Properly managing health care waste can result in significant costs, including segregation, collection, transportation, treatment, and disposal fees. The expenses associated with compliant waste management can strain health care facility budgets, especially for smaller facilities or those serving underserved communities.⁴ It is also important for health care facilities to remember that failure to comply with waste requirements may result in enforcement actions such as fines and citations, which can add more to costs. These penalties are imposed to ensure compliance with regulations and incentivize health care facilities to prioritize proper waste management practices. Fines for noncompliance can vary depending on the severity of the violation, the extent of harm caused, and the facility’s history of compliance.

Health care waste may contain infectious pathogens, posing risks to health care workers, patients, and the community if improperly handled.² Worldwide, an estimated 5.2 million individuals succumb annually to illnesses resulting from unmanaged medical waste,
4 million of whom are children.⁴ Therefore, implementing stringent infection control measures, such as proper waste segregation, personal protective equipment (PPE), and decontamination protocols, is essential. When handling any health care waste, it is best practice to assume that it may contain an infectious pathogen to protect yourself.

Solutions in Waste Management

Effective waste segregation at the point of generation is crucial for streamlining waste management processes in health care facilities.³ Facilities can implement color-coded bins to facilitate proper segregation of different waste streams. For example, yellow bins can be used for biohazardous materials, brown bins for radioactive materials, and black bins for general waste, according to World Health Organization guidelines.⁴ All bins in the facility and rooms for bin storage should have clear, easy-to-read signage.

Additionally, health care facilities can prioritize waste minimization initiatives by adopting practices such as reducing packaging waste, implementing reusable medical devices and supplies, and optimizing inventory management to minimize overstocking and waste generation.⁴

Comprehensive training and education programs are essential for health care facility staff to ensure adherence to waste management protocols and regulatory requirements.² Regular training sessions on waste segregation, handling procedures, infection control measures, and environmental sustainability foster a culture of accountability and
adherence among health care workers. Moreover, educating staff on the importance of waste reduction, recycling initiatives, and sustainable practices can empower them to actively participate in waste management efforts and contribute to positive outcomes.³

Also, continuous improvement and evaluation are critical components of effective waste management in health care facilities. Regular audits, performance evaluations, and feedback mechanisms enable facilities to identify areas for improvement, address compliance gaps, and implement corrective actions.⁶ Various departments, such as environmental services, infection prevention, risk management, safety and security, and quality can conduct these audits and evaluations.

Collaboration with external stakeholders, including waste management companies, regulatory agencies, and sustainability organizations, can enhance health care facilities’ waste management capabilities. Establishing partnerships for waste collection, treatment, and recycling services ensures compliance with regulatory standards while leveraging external expertise and resources. Personnel from environmental services and infection prevention should be in regular contact with their waste management company and know how to contact them if an issue arises.⁴ It is also imperative to discuss hand hygiene and PPE requirements with contracted waste management personnel. These personnel frequently travel throughout the hospital, and they should be educated on moments for hand hygiene and glove changes to protect patients and staff.

Lastly, this collaboration can include touring waste management companies’ sites to understand waste disposal processes. This touring can take place yearly or as needed.

Importance of Waste Management

The consequences for facilities failing in waste management can be significant and encompass various areas, including legal, financial, reputational, and environmental aspects.⁴ By prioritizing proper waste management practices, facilities can mitigate risks, protect public health and the environment, and uphold their commitment to delivering safe, high-quality health care services.^2,4 To evaluate your waste management program at your organization, consider reviewing current policies regarding waste management, auditing handling, and storage practices, tracking key performance indicators such as recycling rates and occupational injuries related to waste disposal, seeking feedback from health care workers, and participating in a waste management committee with stakeholders. By following these steps, you can identify opportunities for enhancement and drive continuous improvement in waste management practices.

References

1. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-1509. doi:10.1001/jama.2019.13978

2. Health-care waste. World Health Organization. February 8, 2018. Accessed February 19, 2024. https://www.who.int/news-room/fact-sheets/detail/health-care-waste

3. Waste. The Joint Commission. Accessed February 19, 2024. https://www.jointcommission.org/our-priorities/sustainable-healthcare/sustainable-healthcare-resource-center/greenhouse-gas-reduction-strategies/waste/#t=_KeyResourcesTab

4. Janik-Karpinska E, Brancaleoni R, Niemcewicz M, et al. Healthcare waste–a serious problem for global health. Healthcare (Basel). 2023;11(2):242. doi:10.3390/healthcare11020242

5. Background I: regulated medical waste. CDC. Updated November 5, 2015. Accessed February 19, 2024. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/medical-waste.html

6. Instructions on conducting waste assessments. US Environmental Protection Agency. Updated April 4, 2023. Accessed February 19, 2024. https://www.epa.gov/smm/instructions-conducting-waste-assessments