WASTE MANAGEMENT PLAN
Components of a waste management plan are as follows:

• Goals, objectives, approaches (hospital-wide), for different departments; need not include new goals for each waste stream (from EPA Rule)
  • Review of policies
  • Assessment of wastes generated - amount, weight, cost
  • Classification of wastes: Hazardous (e.g., radioactive waste, solvents, batteries, mercury); Regulated medical (RMW)/infectious (e.g., microbiological agents; used and unused sharps); Recyclable (e.g., paper, cardboard, glass, plastics, packaging materials); Solid waste (e.g., food containers, paper, nonwoven drapes and gowns)
  • Evaluation of current waste practices, generation rates, methods of disposal, external factors affecting choices, costs; new goals needed?
  • Defining the handling, containment, storage, and disposal of each type of waste
• New, additional waste measures (taking into account the effectiveness of waste management measures already in place, costs of additional measures, emission reductions expected to be achieved, and other environmental or energy impacts) - from EPA Rule
  • Comprehensive waste management measures and goals, categorized into:
    • Waste minimization (See Chapter 3):
      • Waste reduction
      • Segregation
      • Recycling
      • Assessment of reusables vs. disposables that leads to wise use, and safety and protection of personnel and patients
    • Resources, time and staff needed to operationalize the plan.
• Overview of plan
  • Revised objectives? ("In one year, reduce waste generated by 10%.")
  • Coordinated throughout hospital?
  • Consistent among departments?
  • Cost-effective? Data to show?
  • Supported by key leaders/administration?
  • Supported by clinicians?
  • Managed effectively?
  • Changes in staffing, disposal policies, to meet new goals?
  • Meet all regulatory requirements?
  • Sufficient, periodic and ongoing education and training of all staff?
  • Visual reminders and reinforcements of practices (posters, in-service education sessions).
  • Relationship to quality improvement programs?
  • Contingency plans?
  • Future plan projections?

SAMPLE WASTE APPROACHES
An example of a successful hospital waste management plan, called the CURE Waste Approach (CURE for "Center-wide Uniform REduction, Reuse and Recycle") is in place at Albany Medical Center (AMC), New York.

Strong "cultural" goals integrated into the plan are: environmental quality, economic value, quality management and community service. Figure 1 is the methodology for process improvement (quality management) used in each step of waste management at AMC.

Effective multi-disciplinary teamwork, well-specified goals and objectives, and effective measurement tools all contribute to the continued success of the AMC program. In the first few years of the plan's implementation, at least $1.2 million in reduced and avoided costs was realized. To date, since 1991, over $10.8 million has been saved through the various efforts of AMC.

Key components of the AMC plan are chemical reclamation/recycling of hazardous chemical wastes; source separation of recyclables, solid waste, and RMW; recycling of more than the "conventional" items; and overall reduction of the patient care waste stream. Achievement factors include strong management commitment, a "can do" attitude, and coalitions and partnerships (with local government and community leaders, waste service companies and manufacturers of healthcare products used in the hospital). The partnerships have proven to be a highly beneficial piece of the total strategy.

Figure 2 shows the comprehensive, workable Waste Assessment Process at AMC, and Figure 3 addresses the issues that must be considered if a waste reduction program will be successful in a patient care or clinical setting.

AMC's RMW amount continues to decrease; in 1997, it was 3.6 lbs./patient/day, down from a high of 4 lbs./patient/day. (Three to fifteen lbs./patient/day is typical; any amount over 4 lbs./patient/day can be corrected).

AMC continues to make strides with aggressive yearly objectives, strong administrative support, a self-motivated CURE Waste team and committed leadership.

Appendix A contains excerpts from AMC's model waste management plan, including mission, goals and overall strategies that can serve as helpful guides to those who are developing hospital-wide plans for waste handling and treatment.

SUMMARY
The JCAHO requires hospitals to have a documented management plan for hazardous materials and waste. Regardless of outside requirements, hospitals should have waste management plans in place that cover all wastes generated. The plan must include all hospital departments, be coordinated under an umbrella of two or three hospital-wide goals, and have "buy-in" from all involved.