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Healthcare Plastics Recycling: It's Not All Rainbows and Unicorns, CleanMed 2017 Pre-Conference Event

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HPRC and PGH hosted a pre-conference session at CleanMed 2017 focused on the realities of healthcare plastics recycling. The event included an overview of the issue, some of the work PGH and HPRC are doing to help increase healthcare recycling, and then some in-depth advice from the trenches from Mayo Clinic, HealthPartners, and Gundersen Health System. For more information, go to hprc.org.

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Healthcare Plastics Recycling: It's Not All Rainbows and Unicorns, CleanMed 2017 Pre-Conference Event

  1. 1. It’s not all rainbows and unicorns… May 16, 2017 | CleanMed 2017 | Minneapolis, MN
  2. 2. The Business Case Healthcare facilities in the United States generate approximately 14,000 tons of waste per day1, most of which is being disposed of in landfills or by incineration. It is estimated that between 20 and 25 percent of that 14,000 tons can be attributed to plastic packaging and plastic products2. In addition, 85 percent of the hospital waste generated is non-hazardous, meaning free from patient contact and contamination3. 1 Practice Greenhealth, https://practicegreenhealth.org/topics/waste 2 Lee, B., M. Ellenbecker, and R. Moure-Eraso. “Analyses of the Recycling Potential of Medical Plastic Wastes.” Waste Management (2002): 461-470 3 Grogan, Terry. “Solid Waste Reduction in US Hospitals.” Hospital Engineering & Facilities Management (2003): 88‐91.
  3. 3. Recycling one metric tonne of plastic saves: • 16.3 barrels of oil1 • 30 cubic yards of landfill space1 • 5,774 Kwh of energy1, enough to power an average house for 6 months2 REFERENCES 1 http://sanjoaquinvalley.wm.com/recyclingfacts.asp; http://bgm.stanford.edu/pssi_faq_benefit 2 http://205.254.135.7/tools/faqs/faq.cfm?id=97&t=3 HPRC The Potential
  4. 4. In 2012, 2.8 million tons of plastic waste was recovered for recycling, representing1: • Green House Gas benefit of 3.2MMTCO2E2 • 670,000 cars taken off the road2 REFERENCES 1 U.S. Environmental Protection Agency, Office of Resource Conservation and Recovery “Municipal Solid Waste Generation, Recycling, and Disposal in the United States Tables and Figures for 2012” (February 2014). 2 U.S. Environmental Protection Agency “Municipal Solid Waste Generation, Recycling, and Disposal in the United States: Facts and Figures for 2012.” (February 2014) HPRC The Potential
  5. 5. 5 What is HPRC? HPRC is a private, technical coalition of industry peers across healthcare, recycling and waste management industries seeking to improve recyclability of plastic products within healthcare. Vision All healthcare plastics are safely and effectively recycled and widely accepted as a valuable resource
  6. 6. 6 Members Each HPRC member company is a leader in their respective industry with a demonstrated expertise, commitment and passion for shaping the future of plastics recycling and reducing the environmental footprint of not only their own operations but also the operations of their customers. Current Members
  7. 7. 7 Healthcare Facility Advisory Board (HFAB) Established to provide valuable voice of the customer insight to HPRC activities. HFAB members help HPRC: • Understand the plastic recycling barriers that exist within healthcare facilities today • Establish priorities for technical agenda • Develop solutions through access to data, information and resources Current HFAB Members
  8. 8. A Value Chain Approach to Inspire and Enable Recycling of Healthcare Plastics Plastics Sourcing Product & Packaging Design Manufacturing Warehousing Distribution Purchasing & Receiving Product Use Waste Collection & Processing Collection Sorting Processing FEEDBACK LOOP
  9. 9. Flagship Project: Product Design Improving Recyclability and Market Value Work Product: Design Guidelines for Optimal Healthcare Plastics Recycling Looks at product and packaging design features that inhibit post-use recycling potential. Articulates desirable design practices and less desirable design practices. Avoid multiple material types used within one product Avoid paper tapes or labels attached directly to products Avoid metalized plastics and paper/film packaging combinations Allow for the identification and removal of product residue Minimize the use of pigments in products Desirable Design Practice Less Desirable Design Practice
  10. 10. Flagship Project: Product Use A Helping Hand for Hospitals Work Product: HospiCycle “How to” guide and collection of tools for establishing plastics recycling in patient care settings. Looks at economic, regulatory, resourcing and infrastructure considerations Materials accredited for healthcare continuing education credits. Experience the Interactive Prezi at: http://bit.ly/HospiCycle
  11. 11. Flagship Project: Disposal & Recycling Chicago Project Supply, Meet Demand Connects supply with demand - - creating opportunity for hospitals to reduce waste disposal cost and recyclers to access valuable feedstock. Project Partners
  12. 12. 12 For more information Visit www.hprc.org
  13. 13. Less Waste Circle of Excellence  The hospitals in the Less Waste Circle have excelled in waste prevention and material handling, demonstrated through high recycling rates, low regulated medical waste generation and low rates of total waste generated per patient day. These mature programs address all facets of the complex health care waste stream.  Cleveland Clinic Dartmouth Hitchcock Medical Center Gundersen Health System Harborview Medical Center Mayo Clinic Health System - Eau Claire Metro Health Hospital Park Nicollet Methodist Hospital Seattle Children's VHA 07 Ralph H. Johnson VA Medical Center (Charleston, SC) Virginia Mason Hospital & Seattle Medical Center
  14. 14. Benchmark report scope COMPREHENSIVE ANALYSIS Data collected from more than 300 hospitals and organized in 10 topical areas for the 2016 report. SAVING REPORTED Hospitals reported a combined savings of more than $92 million across a range of areas.
  15. 15. LESS WASTE is the recycling rate routinely achieved by leading hospitals—more than double the early EPA goal of 15%—but it is getting harder to surpass the 30% mark. More than 10 Years after EPA began training hospitals on pharmaceutical waste compliance, many hospitals are still challenged by the management costs and training necessary to minimize the impact of this waste stream. 55% of the hospital's waste budget is composed hazardous waste and regulated medical waste (RMW), whereas these two categories represent only 8% of the total waste volume. 30%
  16. 16. LESS WASTE CONCLUSION Hospitals continue to find new and innovative ways to drive down total waste generation while diverting more material from the landfill and ensuring safer disposal for more toxic waste streams. Together, Practice Greenhealth participating hospitals recycled 121,556 tons of material in 2015 and netted nearly $23.7 million dollars in savings through recycling.
  17. 17. Average % of waste categories Solid Waste Recycling RMW Hazardous Average Percent Total Cost Solid Waste Recycling RMW Hazardous Average Percent of Total Waste
  18. 18. Per Ton Median Cost by Waste Type $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 Solid Waste Costs by Stream Solid Waste Recycling Waste RMW Waste Hazardous Waste
  19. 19. Greening the OR Circle of Excellence  The Greening the OR Circle acknowledges leadership in implementation and innovation in the surgical department. A number of practices in the OR were evaluated for this award, including: regulated medical waste segregation and clinical plastic recycling, reformulation of OR kits, single-use device reprocessing, use of reusable sterilization cases, and a range of other programs and associated metrics.  Cleveland Clinic Gundersen Health System Harborview Medical Center Kaiser Permanente Vacaville Medical Center Memorial Sloan Kettering Cancer Center Providence Hood River Memorial Hospital VHA 23 Minneapolis VA Health Care System (Minneapolis, MN) VHA 07 VHA 21 VA Southern Nevada Healthcare System (N. Las Vegas, NV) VHA 23 St. Cloud VA Healthcare System (St. Cloud, MN) Virginia Mason Hospital & Seattle Medical Center
  20. 20. Greening the OR 0 20 40 60 80 100 Irrigation Bottles Blue Wrap Skin Prep Solution Bottles Trays Basins Rigid Inserts Overwraps Tyvek Urinals/bedpans other Types of Recycled Plastic Types of Recycled Plastic
  21. 21. Down in the Weeds with Medical Plastics Recycling  Andy Kragness, Environmental Compliance, Gundersen Health System - collection, signage, segregation  Glen Goodsell, Recycling Coordinator, Angela Dalenberg, Education Coordinator, Mayo Clinic - transport, storage, feedback loop  Samantha McKeough, Sustainability Coordinator, HealthPartners – pick-up, marketing, vendor relationships
  22. 22. Recycling Healthcare Plastics Gundersen Health System
  23. 23. Andy Kragness Environmental Compliance Tech adkragne@gundersenhealth.org (608)-775-4211
  24. 24. Organizational Background  2,588,365 Cleanable ft2  Minnesota, Wisconsin, and Iowa  Mission: We will distinguish ourselves through patient care, education, research and improved health in the communities we serve.  http://www.gundersenenvision.org/envision/
  25. 25. Priorities in Sustainable initiatives  Energy Management • Energy Efficiency • Renewable Energy  Resource Management • Inventory control • Waste reduction • Recycling  Commingled (Plastics 1-7, paper, metal, glass)  Medical Plastics  Sustainable design of new facilities
  26. 26. What is waste? Waste is a resource that is poorly managed.
  27. 27. Our Hierarchy Staff Safety Patient Safety Environment Cost I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
  28. 28. Plastic Recycling  Polyethylene Terephthalate (PETE)  High-density Polyethylene (HDPE)  Polyvinyl Chloride (PVC)  Low-density Polyethylene (LDPE)  Polypropylene (PP)  Polystyrene (PS)  OTHER (PC and PLA)
  29. 29. Medical Plastics  IV Bag Sheath  Syringe Casing  All hard plastic kit cases  Blue wrap  Irrigation bottles
  30. 30. Implementation  First step was to switch to commingled recycling • one container system allowed easy access to recycling for staff, visitors, patients • allowed for better utilization of floor space for further recycling projects
  31. 31. Implementation  To improve recycling capture we needed to know where we were lacking recycling containers • Mapping recycling on every floor was key • Understanding where opportunities were by digging in trash • Reviewing work flow with stakeholders on units and departments
  32. 32. Mapping Sample
  33. 33. Signage  Took a basic design to our in-house interior designer to get approval for new signage  Had a graphic designer create the sign we wanted  Had a local business print the signage on material that would hold up to our cleaning agents
  34. 34. Signage  Needed to keep it simple and to the point  Kept away from using the term Commingled to avoid confusion  Used the opportunity to promote the Think Downstream campaign
  35. 35. Signage  Needed a way to make the result of trashing an item a little more real to people  Wanted to make people take the time to think “I should recycle this”
  36. 36. Roll Out  Sent out 2 cooperate communications notifying people when the roll out would start and what changes were coming  Talked to Clinical Managers as we rolled the new bins out on the floors  Talked to staff that had time when we were on the floors
  37. 37. Collection  At the beginning we received a lot of calls about items  Went to the floors talked about items with all staff  If we questioned the material we went to the manufacture to get the products specs
  38. 38. Collection  Reduce the amount of items purchased that can’t be recycled • Staff bring items to our attention • We work with purchasing to find a product that can be recycled
  39. 39. Collection  Grossly soiled items • Is cleaning an item worth the risk to staff safety? • At what point do we create more of an environmental impact than we negated?  Disinfectant use to clean plastic along with cleaning materials and water.
  40. 40. Collection  Grossly Soiled Items • Is the items worth the time and cost to clean it?  Nurse makes >$25.00/hr  Spends 5 min every hour cleaning a half pound of soiled plastic $2.00/ hr cleaning x 8 hrs = $16.00 a day for 4 lbs of plastic  Receive ≈$0.05 a lb for recycled plastic, 4lbs x $0.05/lb = $0.20 • More importantly we took the nurse away from patient care for 40 minutes this day
  41. 41. Segregation  Limit the amount of sorting by staff  Get as close to a 1 bin system as possible  Currently Blue Wrap is the only plastic item that must remain separate
  42. 42. Continuous Follow-up  Waste Audits • Pulled and sorted randomly selected trash cans from the floors to see what recycled material was being thrown in the trash
  43. 43. Continuous Follow-up  Round with staff • Meet with Patient Care staff departments twice a year • Meet with Environmental Services Staff once a month • Quarterly meetings with recycling centers, waste incinerators, and landfill.
  44. 44. What is going well  Open communication and great employee engagement  Easy for patients, visitors, and staff  Understanding workflow allows for changes to be implemented easier
  45. 45. Pain Points  Communication (New Employees/ constant changes)  Recycling complex plastic items (multiple materials make up an item)  Recycling grossly soiled items  Recycling in patient rooms  “Cost justification” for materials
  46. 46. Recycling Healthcare Plastics Mayo Clinic – Rochester, MN
  47. 47. Recycling Healthcare Plastics Glen Goodsell Recycling Coordinator goodsell.glen@mayo.edu Angie Dalenberg Education Coordinator dalenberg.angela@mayo.edu
  48. 48. Mayo Clinic in Rochester, MN • 3 Campuses  Mayo Clinic (outpatient)  Mayo Clinic Hospital, Saint Marys  Mayo Clinic Hospital, Methodist • Integrated medical center providing comprehensive diagnosis & treatment in virtually every medical & surgical specialty • 36,000 + employees • 21 million square feet
  49. 49. Mayo Clinic  Mission: To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.  Primary Value: The needs of the patient come first.
  50. 50. Recycling Healthcare Plastics & More  Mayo Clinic Rochester Recycling Center recycled 5,500 tons of material in 2016
  51. 51. Transport  50 dock stops per day  2 full-time night drivers  1 full-time day driver  Collection routes are for all recyclables  Expanded polystyrene (EPS) collected on regular routes and on a separate route
  52. 52. Storage  Healthcare plastics generated in 1 day
  53. 53. A glimpse at what we are sorting Today’s 13 plastic categories  PETE & HDPE  LDPE - rigid and film  PP - water bottles  PP - rigid  PP - oversized rigid  PP - blue wrap  PS - blue polystyrene  PS - white polystyrene  HIPS & other  EPS
  54. 54. Pre-sorting the Green Bags  #1 (PETE) & 2 (HDPE) plastics stay downstairs  #4 (LDPE), 5 (PP), 6 (PS) & 7 (other) go upstairs to the sorting table
  55. 55. PETE & HDPE Plastics  Combined with beverage containers
  56. 56. Upstairs - Sorting Table Above the Grinder
  57. 57. Sorting LDPE, PP, PS & Other Rigid PP is ground
  58. 58. Rigid PP Flakes
  59. 59. Sorting – PP  Polypropylene (PP) sterile water bottles are baled separately due to its melting point and label contaminant
  60. 60. Sorting – PP  Oversized rigid polypropylene items that don’t fit in the shredder are baled
  61. 61. Sorting – PP  Blue wrap is collected and baled separately
  62. 62. Sorting – PS  White and blue polystyrene (PS) are baled separately
  63. 63. PS Surgical Kit Trays
  64. 64. Baled – PETE & HDPE  Healthcare plastics, pop bottles, water bottles, milk jugs
  65. 65. Baled – LDPE, PP, & PS LDPE: shrink wrap PP: sterile water bottles & large items PS: surgical kit trays
  66. 66. Sorting – HIPS and other  High impact polystyrene (HIPS) and other items are boxed and sent to a plastic recycler.
  67. 67. Sorting – EPS  Expanded polystyrene (EPS) • Collected separately from high usage areas • Transported on regular routes • Plus a dedicated 40 yard truck (4 days / week) from one location
  68. 68. Sorting – EPS  Expanded polystyrene (EPS)
  69. 69. Plastics We Currently Can’t Recycle  Mixed plastics • Multiple plastics combined • Plastic with metal  PVC  Tubing  Food EPS  Any contaminated items
  70. 70. Feedback to Generators  Start on the right path from the beginning • Meet briefly before start up • Gauge staff compliance  Resources: Program posters, webpage, in-service, Recycling Center tours
  71. 71. Feedback to Generators  Walk through lab /unit • Including supply and par stock areas
  72. 72. We do well, but it’s not all…
  73. 73. Feedback to Generators  Frequently received • Gloves, paper towels, Tyvek packaging • Discuss in pre-collection visit  Infrequently received • Source identification is ideal • Staff are very responsive
  74. 74. Lessons Learned  Pain Points • Space • Patient care areas (workflow / inconvenience) • Moving material efficiently to loading docks • Quality of material (rejected bails, discounted boxes, discounted EPS)  Making Progress • Surgical areas (blue wrap pilot underway)  Successes • Collaboration with Infection Prevention and Control • 78% increase in recycled plastics volume from 2015 to 2016 • EPS volume makes it worthwhile • Relationship with Environmental Services staff • Laboratories • Patient care areas (excited about the program)
  75. 75. Recycling Processors & Drivers
  76. 76. Environmental Services (EVS)  Almost all EVS staff take part in recycling efforts
  77. 77. Samantha McKeough Sustainability Coordinator Samantha.A.McKeough@HealthPartners.com
  78. 78. Who We Are Health Insurance 1.5 million members in Minnesota and surrounding states Care More than 1 million patients 55 Medical Clinics 22 Dental Clinics 7 Hospitals 15 Pharmacies 22,500 Employees Research and Education Insti
  79. 79. Our Culture Mission To improve health and well-being in partnership with our members, patients and community. Vision Health as it could be, affordability as it must be, through relationships built on trust.
  80. 80. Environmental Stewardship Commitment Statement HealthPartners is committed to caring for the places where we live and work so we can provide a healthier and cleaner community for our employees, members, patients and future generations. We will: • Expand the use of sustainable and earth-friendly practices that help us work smarter, be healthier and save money • Encourage employees to participate in and champion or support sustainability practices, both at work and at home • Measure and monitor our progress toward our sustainability goals
  81. 81. Recycling • In 2016, recycled 2,213 tons (37%) of materials at hospitals and larger facilities • Single-stream, comingled recycling program • Accepts all plastics, rigid or soft • Bottles, cans, glass, aluminum, cardboard • Blue Wrap • Shrink Wrap • Batteries • Salvaged Metals • Food waste, organics, and fryer oil • E-waste • Confidential Paper • X-rays • Ink Jet Toner Cartridges HealthPartners standard recycling decal
  82. 82. Plastics Recycling • Single-stream, comingled recycling program through Republic Services • Accepts all plastics, rigid, soft • #1 PETE • #2 HDPE • #3 PVC • #4 LDPE • #5 PP • #6 PS • #7 Others • Packaging, grocery bags, Ziploc bags • Merrick Inc. recycles • Blue Wrap • Shrink wrap Top Left: Single-stream, commingled recycling containers from Emergency Department. Top Right: Shrink wrap recycling container on receiving dock.
  83. 83. Plastics Recycling: Pick-up and Removal Right: Plastics and blue wrap collected in separate recycling containers. Containers are located inside the OR and are removed before the beginning of the case. Left: Full containers are brought to centrally located utility room or soiled linen closet.
  84. 84. Plastics Recycling: Pick-up and Removal • Materials are brought to the waste management area • Plastics in Republic Services Container/Compactor • Blue wrap in separate staging area Partnership Resources, Inc (PRI) employees collecting recycling through out Methodist Hospital Blue wrap staged for pick-up
  85. 85. Merrick Inc. • Collects shrink and blue wrap from locations • Bailed the materials separately • Shrink wrapped sold to Trex • Composite decking • Blue wrap sold to Poly Wrap Recycling, LLC or a vendor that makes plastic shelving • All materials stay in USA Blue wrap and Shrink wrap bales at Merrick, Inc. facilities Merrick, Inc. employees
  86. 86. Republic Services • Two Material Recovery Facilities in the area • 8% residual rate; lowest rate throughout the whole company • Optical Sorters: • #1 PETE • #2 HDPE • #5 PP • Hand sorting/Pick line: • #3 PVC • #4 LDPE • #6 PS • #7 Others • Soft plastics; packaging, grocery bags, Ziploc bags • Materials stay in USA Republic Services Material Recovery Facility (MRF)
  87. 87. Issues • Uncertain commodity markets • Outlet for materials • Local ordinances • Items with two types of plastics • Smaller plastic items • Black plastics Smaller plastic items Overwrap bags from supplies Plastic nitrile gloves PVC tubing
  88. 88. • Ongoing employee education • Relationship with Vendors • Innovative uses for blue wrap in Western, WI • Well established donation program What is going well
  89. 89. Practice Greenhealth Resources Date Title November 6 at 2 eastern How to Conduct a Material and Waste Baseline November 14 at 12:30 eastern Climate and health: using the EPA WARM Tool to communicate environmental benefits associated with material and waste management. November 29 at 12:30 HPRC & PGH Repeat with Gundersen, Mayo and HealthPartners https://academy.practicegreenhealth.org/
  90. 90. Interactive Sessions 92 Learn Share Lead
  91. 91. HPRC Introductions 93
  92. 92. HPRC Introductions 94
  93. 93. Hospital Introductions 95 Raise your hand… 1. If you are tracking your recycling rate? 2. If your current recycling rate is greater than 10%? 3. If you have a recycling goal? 4. If your recycling goal is greater than 10%? 5. If you are currently recycling plastics in clinical areas? 6. If you are planning to recycle plastics in clinical areas?
  94. 94. Interactive Sessions 96 B Infection Prevention & Recycling C Stakeholder Engagement & Recycling A Procurement & Recycling Learn Share Lead
  95. 95. 97 Interactive Sessions A Procurement & Recycling Holli Alexander Margaret Enos Marc Bandman Susan Williams
  96. 96. B Infection Prevention & Recycling 98 Interactive Sessions Monica Torres Bob Render Janet Howard Katie Wickman
  97. 97. C Stakeholder Engagement & Recycling 99 Interactive Sessions Sarah Hill Katie Velekei Kaeleigh Sheehan Iqbal Mian
  98. 98. Interactive Sessions 100 Find your starting group Change groups every 15 min Timekeeper Business Break Report back
  99. 99. Interactive Sessions 101 Infection Prevention & Recycling Stakeholder Engagement & Recycling Procurement & Recycling Report Back
  100. 100. Contact us Janet Howard Director, Member Engagement Practice Greenhealth jhoward@practicegreenhealth.org Peylina Chu, PE HPRC Executive Director www.HPRC.org peylina.chu@anteagroup.com
  101. 101. Come by our booth! Booth #303 Complete a short survey and get a tote bag made of recycled sterilization wrap!!
  102. 102. Lunch 104

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