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.

1. It’s not all rainbows and unicorns…
May 16, 2017 | CleanMed 2017 | Minneapolis, MN

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. 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. 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
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
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
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. 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. 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. 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. 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
For more information
Visit www.hprc.org

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. 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. 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. 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. Average % of waste categories
Solid Waste
Recycling
RMW
Hazardous
Average Percent Total Cost
Solid Waste
Recycling
RMW
Hazardous
Average Percent of Total Waste

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. 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. 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. 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. Recycling Healthcare Plastics
Gundersen Health System

23. Andy Kragness
Environmental Compliance Tech
adkragne@gundersenhealth.org
(608)-775-4211

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. 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. What is waste?
Waste is a resource that is poorly managed.

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. 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. Medical Plastics
 IV Bag Sheath
 Syringe Casing
 All hard plastic kit cases
 Blue wrap
 Irrigation bottles

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. 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. Mapping Sample

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Recycling Healthcare Plastics
Mayo Clinic – Rochester, MN

47. Recycling Healthcare Plastics
Glen Goodsell
Recycling Coordinator
goodsell.glen@mayo.edu
Angie Dalenberg
Education Coordinator
dalenberg.angela@mayo.edu

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. 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.

51. Recycling Healthcare Plastics & More
 Mayo Clinic Rochester Recycling Center
recycled 5,500 tons of material in 2016

52. 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

53. Storage
 Healthcare plastics generated in 1 day

54. 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

55. 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

56. PETE & HDPE Plastics
 Combined with beverage containers

57. Upstairs - Sorting Table Above the Grinder

58. Sorting LDPE, PP, PS & Other
Rigid PP is
ground

59. Rigid PP Flakes

60. Sorting – PP
 Polypropylene (PP) sterile water bottles are
baled separately due to its melting point and
label contaminant

61. Sorting – PP
 Oversized rigid polypropylene items that
don’t fit in the shredder are baled

62. Sorting – PP
 Blue wrap is collected and baled separately

63. Sorting – PS
 White and blue polystyrene (PS) are baled
separately

64. PS Surgical Kit Trays

65. Baled – PETE & HDPE
 Healthcare plastics, pop bottles, water
bottles, milk jugs

66. Baled – LDPE, PP, & PS
LDPE:
shrink wrap
PP: sterile water
bottles & large items
PS: surgical
kit trays

67. Sorting – HIPS and other
 High impact polystyrene (HIPS) and other
items are boxed and sent to a plastic recycler.

68. 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

69. Sorting – EPS
 Expanded polystyrene (EPS)

70. Plastics We Currently Can’t Recycle
 Mixed plastics
• Multiple plastics
combined
• Plastic with metal
 PVC
 Tubing
 Food EPS
 Any contaminated
items

71. 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

72. Feedback to Generators
 Walk through lab /unit
• Including supply and par
stock areas

73. We do well, but it’s not all…

74. 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

75. 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)

76. Recycling Processors & Drivers

77. Environmental Services (EVS)
 Almost all EVS staff take part in recycling
efforts

79. Samantha McKeough
Sustainability Coordinator
Samantha.A.McKeough@HealthPartners.com

80. 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

81. 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.

82. 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

83. 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

84. 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.

85. 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.

86. 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

87. 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

88. 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)

89. 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

90. • Ongoing employee education
• Relationship with Vendors
• Innovative uses for blue wrap in Western,
WI
• Well established donation program
What is going well

91. 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/

92. Interactive Sessions
92
Learn Share Lead

93. HPRC
Introductions
93

94. HPRC
Introductions
94

95. 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?

96. Interactive Sessions
96
B
Infection
Prevention
& Recycling
C
Stakeholder
Engagement &
Recycling
A
Procurement
& Recycling
Learn Share Lead

97. 97
Interactive Sessions
A
Procurement
& Recycling
Holli Alexander Margaret Enos Marc Bandman Susan Williams

98. B
Infection
Prevention
& Recycling
98
Interactive Sessions
Monica Torres Bob Render Janet Howard Katie Wickman

99. C
Stakeholder
Engagement
& Recycling
99
Interactive Sessions
Sarah Hill Katie Velekei Kaeleigh Sheehan Iqbal Mian

100. Interactive Sessions
100
Find your
starting group
Change
groups every
15 min
Timekeeper
Business
Break
Report back

101. Interactive Sessions
101
Infection
Prevention
& Recycling
Stakeholder
Engagement
& Recycling
Procurement
& Recycling
Report Back

102. 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

103. Come by our booth!
Booth #303
Complete a short survey and get a tote bag
made of recycled sterilization wrap!!

104. Lunch
104