What Comes In Must Go Out

By Beth Eckl, Director of Practice Greenhealth's Environmental Purchasing Program on October 21, 2014

Consider these supply chain strategies for reducing solid, regulated medical and hazardous waste

shutterstock_2166070What comes in the front door of health care organizations through the supply chain also goes out the back door as waste—and costs of disposal add up. It’s estimated that U.S. health care organizations spend more than $752 million across the sector each year on waste disposal. But there are ways to eliminate or reduce these costs and provide savings to health care organizations.

The supply chain can play an active role. At a time when cost minimization is a must, savings from waste reduction efforts are not trivial, but it takes a team approach, and many options are available.

While we don’t encourage “dumpster diving,” the first step is to examine or audit what is thrown away. Some hospitals have checked their waste and found surprises. For example, Boulder Community Hospital in Colorado noticed it was throwing away partially used boxes of tissue from patient rooms—a clue that the hospital needed to modify its purchasing and reduce the size of tissue boxes.

Practice Greenhealth suggests several oppor­tunities where a supply chain can further support waste reduction for a health care organization. Here are a few:

Solid Waste Reduction Opportunities

Solid waste typically costs between $0.03 and $0.08 per pound.1

  1. Establish a contract or utilize a group purchasing organization (GPO) contract for recycling services and consider a composting service for food waste and landscaping clippings. (Refer to the EPP Specifications and Resources Guide available at www.PracticeGreenhealth.org for request for proposal questions.) Examples of recycling services include single-stream or commingled recycling services. Consider recycling for the following materials depending on your market: paper, confidential paper, cardboard and boxboard, general plastics (bags, shrink wrap), medical plastics (irrigation bottles, skin prep solution bottles, trays, overwraps, rigid inserts, blue wrap, Tyvek, basins, urinals, bedpans, other admission items and more), metals, precious metals from clinical devices, office supplies (printer/toner cartridges) and batteries.
  2. Add a “Take Back Program” to contracts, making suppliers responsible for taking products back for recycling. This eliminates the need for the hospital to pay for disposal.
  3. Establish a memorandum of understanding with a responsible donation organization for materials, equipment and furniture that ensures the needs of developing countries are met. One resource is the Catholic Health Association guide Assessing and Selecting High Quality Medical Surplus Recovery Organizations, found at www.chausa.org/internationaloutreach/medical-surplus-recovery.
  4. Specify the use of reusable totes or containers for supply delivery to reduce waste and labor for handling. Visit the Use Reusables campaign at www.usereusables.org.
  5. Specify office duplication equipment to standardize double-sided copying when installed.
  6. To measure your success and impact, require vendors to provide spend reports as part of the contract terms. For example, measuring copy paper purchases can show success of paper reduction efforts.

As with the supply chain, a robust waste reduction strategy starts at the front door. Take the first step by putting the right contracts in place with reliable vendors who believe in waste reduction as much as you do.

Regulated Medical Waste Minimization Strategies

Regulated medical waste (RMW) typically costs $0.20–$0.50 per pound and is six to eight times more expensive to dispose of than solid waste or recyclable materials. Examples of RMW include red bag or infectious waste, sharps and some microbiological waste.

  1. Establish or utilize a GPO service contract with a third-party reprocessor for collection of single-use medical devices (SUDs) in patient care areas and the OR, including EP/cath labs. Ask the vendor to provide reports on the type and weight of devices collected.
  2. Purchase reprocessed single-use medical devices from an FDA-approved third-party reprocessor. Specify that they provide reports on the type and weight of devices collected.
  3. Establish or utilize a GPO contract for a reusable sharps container program. This is important because reusable sharps containers can be reused between 400 and 600 times, reducing waste from disposable containers and driving down supply costs.
  4. To accurately report success, specify that vendors must provide the following information on a periodic basis (ideally, at least monthly):
  • Tons of general RMW treated.
  • Tons of sharps treated, but do not include weight of reusable sharps containers if applicable.
  • Tons of RMW incinerated. Split out by non-RCRA (Resource Conservation and Recovery Act) pharmaceuticals and other incinerate-only RMW.
  • Tons of RCRA-hazardous pharmaceutical waste treated.
  • Costs associated with each kind of disposal.

Hazardous Waste Minimization Strategies

Hazardous waste is defined and regulated by the U.S. Environmental Protection Agency (EPA) and is either a “listed” waste or meets the characteristics of a hazardous waste. Individual states might have stricter regulations than the EPA, so management requirements can vary state to state. The costs vary depending on the material, but common RCRA hazardous wastes include hazardous pharmaceuticals, bulk chemotherapeutic agents, mercury, xylene and other solvents, some paints, aerosol cans and more. The typical cost for this waste is about $3.25 per pound.

  1. Establish or utilize a GPO contract for recycling services for electronics-related waste using a certified e-waste service (such as e-Stewards certified). Refer to www.e-stewards.org.
  2. Purchase digital X-ray equipment for radiology to reduce costs of fixer solutions.
  3. When applicable, establish or utilize a GPO contract for recycling services to recycle silver from X-ray films.
  4. Establish or utilize a GPO contract for recycling collection services for proper disposal of fluorescent lamps, thus ensuring mercury is not released into the environment.
  5. Establish or utilize a GPO contract for recycling batteries or require a vendor take-back program to recycle batteries.
  6. When applicable, purchase equipment to recycle, reprocess or distill solvents, alcohols or other chemicals from the lab. Specify that vendors report gallons handled annually.
  7. To measure success with hazardous waste reduction, specify and ensure that service providers for collection of RCRA hazardous waste (including solvents, engine oil, Zenker, B5 stains, lab packs, refrigerants, etc.) periodically report:
  • Tons and/or gallons of RCRA hazardous waste annually.
  • Costs associated with this treatment.

As with the supply chain, a robust waste reduction strategy starts at the front door. Take the first step by putting the right contracts in place with reliable vendors who believe in waste reduction as much as you do. Investing the time and effort in these practices now can keep your disposal costs down at the other end.



1. Practice Greenhealth website, www.practicegreenhealth.org/topics/waste/waste-categories-types.