Yes, a soiled utility room can be exciting—that is, if you oversee a facility’s materials and waste program. Ask any healthcare sustainability lead about their challenges, and space will certainly be on the list. With the increased complexity of healthcare waste and best management practices, the configuration of the soiled utility room and back door storage areas can improve or impair a program.
Sustainability leads “make it work” with a given space, where it’s likely multiple material segregation was not a reality during its design.
How can designers plan for smoother waste material operations and make the case for equal time to back door management? How does a designer or facility manager demonstrate the return on investment of smoother operations? After all, hospitals are generating more than 26 pounds of waste material per bed per day, according to the Practice Greenhealth 2011 Sustainability Benchmark Report, so they need an exit strategy.
Designers will benefit from access to sector benchmarks on materials and wastes. And while sustainability leads may have a good understanding of the types and amounts of materials generated, collaboration with the design team can help identify healthier and more efficient solutions.
At the HEALTHCARE DESIGN.11 Conference in Nashville, this topic was discussed in the roundtable session titled “Designing for Sustainable Operations.” The integrated team included Ignatius Tsang, AIA, NCARB, director of facilities planning, national facilities services, Kaiser Permanente; Breeze Glazer, M.Arch, LEED AP BD+C, research knowledge manager, healthcare sustainability, Perkins+Will; and myself as director, sustainable operations, for Practice Greenhealth, a membership-based not-for-profit that works with healthcare and businesses to improve the environmental performance of the sector.
The group provided some background to get the discussion underway by sharing material and waste facts, defining various material streams, reporting volumes and costs per unit of each, and describing some strategies underway at Kaiser Permanente.
Designers benefit from having knowledge of healthcare materials and wastes, including understanding:
- The types of materials generated;
- The volume of materials—how much of each type;
- The varying costs per unit for proper removal; and
- The best approach for each material stream.
Location, location, location
The soiled utility room is a very important staging area for materials and wastes. Gone are the days of two or three waste streams. Hospitals are now relying on multiple bin types, including regulated medical waste (RMW), battery collection, hazardous pharmaceutical waste, chemotherapy, nonhazardous pharmaceuticals, single-stream recycling, and many more. To prepare for the session, various bin sizes were gathered and Perkins+Will mocked-up what a soiled utility room could look like for today’s waste segregation and storage requirements.
This is important as some unit configurations are creating pods with more but smaller soiled utility rooms, a real challenge for managing the various types of materials.
Regardless of facility size, focus is required at the back door. Inching out a bit more room for compactors (the equipment that compacts the waste and then is switched out by the hauler), balers (like the one you see in grocery stores that compacts boxes or other materials into cubes), compost storage, pharmaceutical waste collection, and other carts/bins can help with compliance and ease pickup and efficiency.
Fewer pickups mean lower operational costs—it’s that simple. The move results in fewer trucks, fewer emissions, and less noise, congestion, and stress associated with service. The only way to have fewer pickups is to design for a way to hold onto the material for longer. No room for a recycling compactor? Then a baler is a must. A baler can be used to compact various types of recyclables, which can then be stacked to accumulate a quantity that offers value to the recycler. Too-frequent pickups are a challenge to recyclers and their own potential to see value from the contract.
In addition to identifying proper storage containers for material recycling and waste, proper placement must also be determined. When a waste and material transporter brings materials down to a dock, the segregation of corrugated boxes and other recyclables from regular waste must be convenient. The best case scenario is that two compactors next to each other are clearly identified—one for mixed recycling and one for waste. If the recycling compactor is at the other end of the yard, there could be trouble, as those trying to save time may dump recyclables in the regular trash compactor. Simplicity and ease of use are keys to success.
Look, learn, and listen
Waste is evidence of inefficiency. Scrutiny of wasted material can identify cost-saving and waste prevention opportunities that require a change in procurement, process, or program. Through its minimization, facilities can address safety, health, and cost issues associated with that material. Understanding the true cost of the wasted products can help communicate the value of a closer look.
Corrugated boxes are a good example. Through reusable toters, boxes can be eliminated from patient floors altogether, reducing labor associated with their flattening and transport to recycling storage. Some hospitals still discard corrugated in waste compactors. Because it compacts so poorly and is a commodity, this is like throwing dollars in the garbage. Bulky boxes in a compactor increase pickups and associated costs. Paper and corrugated recycling alone (and prevention) can reduce total waste by more than 10%.
At an average cost of $126 per ton, anything that can be done to reduce pickups is worth it. Often, hospitals are charged by the “pull” of the compactor, so filling it with light cardboard is inefficient.
Another lesson comes from scrutinizing hazardous pharmaceutical waste. Because this is, by far, the most expensive waste stream by unit cost (see Table), prevention offers a big return. Thanks to a U.S. Environmental Protection Agency grant, Albany Medical Center undertook an investigation of its pharmaceutical waste stream to develop a best management approach.
A typical hospital formulary may contain approximately 2,700 medications, about 4.4% of which are hazardous (by law) and about 5% are controlled substances (addictive, harmful). The hospital found a way to cease the sewering of all pharmaceuticals—serving as an early adopter and providing something to watch in the sector. One pearl of wisdom was the finding of Propofol, an injectable anesthetic, as a hazardous pharmaceutical waste material.
Through working with the pharmacy, Albany Medical Center changed its unit dose from 50 and 100 mL vials to 20 mL. The result was a savings of $100,000 per year.
There are many more stories—stories about regulated medical waste, gowns, narcotics, sharps waste, recycling, composting, and electronics. But we all have to take the time to listen and recognize the impact on waste.
Designers bring big-picture thinking to the table when asking for details about the types and amounts of wastes that are generated in the process of providing care in a particular area, department, or unit. By taking steps to improve the efficiency through p
revention or programming, the new space will not only be designed to ease the flow of materials, but input can help transition to a more efficient, more responsible, and lower cost model in the new healing space.
This conversation is ongoing and includes chutes for materials and wastes, reusable bed pans, suctioning, alternative “destruction” of wasted narcotics to avoid disposal in the sewer, alternate methods of material containment and removal, digesters, pneumatic tubes for material transport, and much more. For those interested in being part of the conversation, a series of calls will be convened to continue the conversation.
Send me an email and we’ll add you to our call list: email@example.com. HCD
Janet Brown is Director, Sustainable Operations, for Practice Greenhealth. For more information, please visit www.practicegreenhealth.org.