Healthcare Risk Waste (HCRW) is any waste that poses a risk due to its potential infectious nature and includes items contaminated with blood or body fluids, contaminated waste from patients with transmissible infectious diseases and other healthcare infectious waste. Dealing with healthcare risk waste correctly is an important task for every hospital. However, the Green Healthcare programme has found that only 66% of the waste in the yellow bags is actually healthcare risk waste. As healthcare risk waste is the most expensive waste to dispose of, this is an ongoing issue that needs to be addressed.
1The problem
In order to better understand what materials are being disposed of as healthcare risk waste, the Green Healthcare programme carried out waste surveys in over 50% of the acute hospitals in Ireland. The surveys observed that, on average, only 66% of the healthcare risk waste was contaminated materials, with 19% clean packaging and the remaining 15% being clean non-contaminated materials that may not be risk waste.
2Why is it important?
There is a large cost difference between the different disposal options for wastes generated in hospitals. For example, there is €700 difference between the disposal of a tonne of non-hazardous residual waste and healthcare risk waste. This means that there is real potential to make cost savings by ensuring that only material that is healthcare risk waste is disposed of in this costly waste stream.
Based on waste survey work conducted by Green Healthcare, savings of between €800,000 and €1,300,000 per annum could be made in national acute hospitals, by ensuring that only healthcare risk waste is put into the healthcare risk waste stream.
3What to do about Healthcare Risk Waste?
To reduce the quantity of non-risk waste that is incorrectly disposed of in the healthcare risk waste stream, there are a few steps that need to be followed.
In conjunction with infection control, consider reviewing what your facility classifies as healthcare risk waste. Examples of materials that are often automatically classified as healthcare risk waste include incontinence wear, clean gloves and clean table or stand covers. This may not always be the case.
This is particularly the case for waste generated in isolation rooms which can lead to unnecessary waste if not managed properly.
It might sound obvious, but ensure that staff are made aware of what should be disposed of as healthcare risk waste.
Regular training is essential to keep staff up-to-date with any changes to the classification of healthcare risk waste. Training of new staff on segregation policies is essential, and should include important information, such as the large cost difference between disposing of waste as healthcare risk waste and non hazardous residual waste.
The Green Healthcare programme developed a number of resources, including best practice guidance, an information poster and a training game.
In the main, patients and visitors are not aware of the difference between healthcare risk waste and non-hazardous residual waste – particularly in terms of the significant disposal cost differential. Consequently, they may incorrectly dispose of waste in the risk waste bin. This has been observed in surveys undertaken in healthcare facilities. Also, as the general public do not deal with risk waste they do not require access to these types of bins.
Removing healthcare risk waste bins from the public areas of wards (with the exception of isolation rooms) and confining them to utility rooms, eliminates the potential for misuse, and also limits the number of areas where healthcare risk waste is stored.
The Green Healthcare programme has produced benchmarks for the amount of healthcare risk waste generated in Irish hospitals. A waste benchmark expresses the average quantity of waste generated (usually in kgs) per in-patient bed day. In acute hospitals the average benchmark for healthcare risk waste is 1.9 kg per in-patient bed day, while in community hospitals it is 0.2 kg per in-patient bed day.
The benchmarks calculated by Green Healthcare allow any hospital to identify if they produce more or less waste than the average. If a hospital exceeds these average benchmarks, it may need to consider the reasons for this, and implement improvement options.
Based on comparing actual volumes measured against best practice, there is the potential to reduce healthcare risk waste costs in acute hospitals by between €15,000 and €27,000 per annum. This can be achieved by diverting ‘non-risk’ and ‘potentially may not be risk’ materials from the healthcare risk waste stream.
Though community hospitals produce much lower levels of healthcare risk waste, the average savings could still be in the region of €2,000 – €6,000 per annum in each facility.
4Health Care Risk Waste Best Practice
Simply put, your facility can reduce the quantity of healthcare risk waste it generates, by avoiding non-risk waste being incorrectly placed in the healthcare risk waste stream.
The following should be considered:
If little or no healthcare risk waste is generated in an area, then consider not providing a HCRW bin (yellow bin). Try not to consider ‘just in case’ scenarios. A dedicated HCRW bin is probably not required in these areas. Any healthcare risk waste that is generated ‘only every so often’ can be disposed of in a HCRW bin in a nearby area.
Where a HCRW bin is needed, but only small quantities are generated, then a smaller bin (e.g. 20 litres) may be sufficient instead of the standard 70 litre bin.
Cleaning procedures require bins to be emptied on a regular basis, regardless of how full the bags are. Due to hygiene and visual reasons, staff are unlikely to over fill bins, and are more likely to place bulky non-risk packaging in another bin, rather than filling up a small HCRW bin.
Believe it or not, the positioning of the HCRW bin in the room, in relation to other bins, can make a big difference in terms of good segregation. Through studying the impacts of bin placement on waste, Green Healthcare noted the following:
Place the HCRW bin next to a non hazardous residual waste or recycling bin. Staff have to make a decision on which bin to use. Make sure to place a non hazardous residual or recycling bin closer to the main source of waste generation.
Do not place the HCRW bin:
The work undertaken by CUH theatre staff results in a significant quantity of recyclables being segregated. A survey by GHCP showed that 40% of the total waste generated in the CUH theatre department (general, healthcare risk waste and recycling) is being segregated for recycling. This is compared to an average value of 11% in theatres in other GHCP acute facilities. If CUH’s recycling level was as low as the average value, their waste disposal costs for the theatre would increase by a minimum of €5,000 per annum.
SVPH produced 1 kg less clinical waste per bed day than the average acute facility in the Green Healthcare Programme. The good practices result in savings of €58,000per annum for SVPH, compared to the average acute facility.
The healthcare risk waste bags surveyed from the theatre contained 22% less non-risk waste than the average for other acute hospitals in the GHCP. This shows a higher level of segregation of non-risk waste in the hospital.
Midlands Tullamore produces 0.5 kg less healthcare risk waste per bed day than the average GHCP facility. This equates to saving in the region of €26,000 per annum, compared to the average acute facility.
A significant reduction of 8% of annual HCRW generated, which equated to 27 toness less per annum.
These waste reduction measures have resulted in notable cost savings for the hospital. The hospital continues to work on measures to reduce the quantity of waste it produces even further.
Between 2010 and 2012, the quantity of HCRW generated reduced from 2.49 to 2.29 kg per in-patient bed day, an 8% reduction. Based on the 2012 activity, this corresponds to a reduction of 6 tonnes per annum and savings of €4,000 per annum (excl. VAT).
This factsheet provides an outline of the healthcare risk waste generated in Irish acute hospitals – where healthcare risk waste is generated, what is in healthcare risk waste, and what savings can be made through better management of healthcare risk waste. The information within this factsheet is based on the results of waste surveys carried out in over 50% of acute hospitals in Ireland.
Best Practices Guide outlines actions to reduce the quantity of non-risk waste disposed of as healthcare risk waste. The Green Healthcare Programme has developed three best practices guides.