Initially the biggest challenge at this facility was improper medical waste segregation. The hospital was looking to move to one vendor for all of their Sharps, biohazardous medical waste, and Chemotherapy waste management, and to launch a new pharmaceutical waste management program. Daniels currently managed the sharps waste, and another vendor managed their Regulated Medical Waste and Chemotherapy Waste. The incumbent vendor had a very status quo program; the medical waste was generated and moved in red bags to the main biohazard/dock area then the driver made pickups five days a week. There was no communication on what was being generated or ways to improve waste segregation, no suggestions to create safer movements of the waste from point of generation to the dock, and no opportunities for cost savings. The team at the hospital had become used to paying a premium to dispose and treat patient and visitor trash that ended up in red kickbuckets - disposed and treated as regulated medical waste.
Current practice was a red bin in every patient room, and each bin constantly filled with left-over lunches, paper towels, newspapers, soda cans, and more. These bags were pulled by housekeeping each day, whether they were full or not and whether the waste was regulated medical waste or not. Tied off bags were disposed of in larger bins in the soiled rooms which contained a lot of air and took up a lot of space, thereby causing more medical waste containers to turn quickly and fill without being truly full. These bags at times ripped causing spills and clean up time, as well as occasionally injuring a housekeeper due to a stray sharp puncturing through the bag when being pulled and transferred to a larger bin.
At a dock level, the main biohazard area/dock has limited space and the incumbent vendor needed to move medical waste containers off site five days a week to maintain a manageable workspace. In addition to high costs of treatment, the hospital team was challenged with the time it took to make multiple trips to move waste and the injuries incurred throughout the multiple touchpoints when transporting the waste.
Our Daniels team completed waste audits of all medical waste bins and backed into estimates of what was truly medical waste and where we could see immediate decreases with proper waste segregation training. We then did a full ward walk and identified locations of each red kickbucket in patient areas and all locations where larger biohazard bins were housed. We shadowed nursing to watch their process of generating the waste and then also shadowed EVS to watch their current process of collection and to identify the number of touches and probability of risk while moving the waste. We were able to make estimates on time it took to service each department and inefficiencies in the current process.
We presented a plan to educate on all medical waste segregation and move the accountability to nursing, to empower them to have a direct impact on the waste generated. We introduced the Daniels Medismart system to create a mobile regulated medical waste solution for nursing to access and thereby remove kickbuckets from patient rooms, (which currently were abused not only by poor segregation clinically but also by patients and visitors). Next we presented a plan to more efficiently move medical waste bins without pulling bags and without having to pull every container, but instead only pulling full medical waste containers; thus eliminating bag related injuries and spills and also giving valuable time back to hospital staff. Once the clinical and EVS teams were on board, we were able to present our waste and injury reduction goals on top of competitive pricing to the purchasing team. Once we were chosen, the real work began.
Nursing would be the group who had the most impact on the reduction of regulated medical waste volumes. We worked with the Infection Prevention team and educators to provide waste segregation training on their internal server where there was testing all of nursing had to complete prior to the rollout of Daniels' premium reusable medical waste containers - the Medismart. Thereafter, myself and our Daniels Field Service Technicians brought in some Medismart containers to introduce the new system to each department and allow them to test and identify the best locations with their current volume and processes in mind. Working with the CNO, we allotted each department the number of Medismarts required for optimum volume and effiency, identified best placement, and coordinated training for each department with the clinical manager. We then trained EVS on the use of our containers and optimized transportation (we had a tech previously servicing our sharps containers).
In addition to the initial training, we helped create new segregation posters with the clinical education team. Initially we were on site for 10 full days to help with process, both on the nursing and EVS sides. We continued to shadow and develop best practices around transport and location of Medismart containers and Accessmart trolleys. We joined huddles at shift changes to address questions or issues staff were facing, and each day checked in with the EVS director who would handle requests received while we were not on site and then we could meet with those departments later that day.
We completed waste audits weekly, then monthly, and now quarterly. We also meet with the clinical managers on a quarterly basis to go over photos from waste audits and discuss where improvements could be made with their own departments. Where additional training is required, we schedule time with that clinical nurses team individually. In addition, we provide average medical waste container weights, monthly turns, audit results, and opportunities for improvement to the EVS Director on a quarterly basis.
The hospital has seen an overall reduction in RMW pounds of 59% (based on the poundage report provided by the previous vendor). This number includes Medismart collectors mainly, but also the few areas generating Pathological waste and still using a traditional bag and bin. The highest monthly reduction seen was 66%.
All areas proved better segregation and significant decrease in waste generated. The ED, which is one of the highest volume ED's in the area, still has a lot of room for improvement, but they have been making steps in the right direction and consistently show improvement. Any transportation sharps injuries have been eliminated. The nursing team needed to get used to not having a container right in the room at first, but understand the impact and like having the medical waste container on wheels to be able to dispose of medical waste at the point of generation.
The system is fully engrained with clinical staff and they even get competitive about who's department is doing better with waste segregation! The number of trips to move waste were greatly reduced. For example, the EVS employee was going to the lab 5-6 times daily to pull containers and now only pulls Daniels Medismart containers once a day. While the previous vendor was coming out 5 days a week to do pickups for just regulated medical waste, Daniels comes out to the facility only three times a week to pick up Sharps, biohazardous medical waste, Chemotherapy, and Pharmaceutical waste. The Hospital have also transitioned our service technician out and began to manage their sharps waste disposal program internally as well. The dynamic has really shifted from EVS just collecting waste to nursing really being responsible and accountable for what is generated. There is great teamwork between both groups!