HACKENSACK — A group of more than 30 residents and Hackensack City Council members came to the Bergen County Freeholders meeting Wednesday to speak out against an application by a Prospect Avenue senior care center’s owner to neutralize medical waste at the site.
In an unusual action, Freeholder Chairwoman Joan Voss allowed the group to have a spokesman address the board at the 4:30 p.m. meeting. Public comments are typically reserved for the later 7:30 p.m. meeting, she told the audience.
Bob Feinberg spoke for the Prospect Preservation Group. Echoing much of what he told the county Solid Waste Advisory Council in November, he said the in-house cold sterilization method proposed by Richard Pineles, head of the Prospect Heights Care Center at 336 Prospect Ave, is ineffective at neutralizing medical waste.
“You don’t process toxic waste in the midst of where people live,” Feinberg said. “It will create a health issue, a safety issue and a horrendous real estate issue.”
The cold sterilization method would use a chemical solution that is both cheaper and requires less equipment than traditional heat-based methods to sanitize medical waste such as syringes and bandages commonly contaminated with bodily fluids including blood.
Feinberg told freeholders that the medical waste should be destroyed at an incinerator, where other such materials are destroyed, to ensure safety and avoid any potential for contamination.
The crowds applauded Feinberg, a Prospect Avenue resident, after his remarks.
City Deputy Mayor Kathleen Canestrino and Councilmen David Sims and Leo Battaglia were present to support the residents in opposing the permit.
Battaglia said that any medical waste disposal should be done in an isolated area, not a residential area.
The item was not on the agenda, Voss reminded the crowd, but she allowed it to be discussed out of courtesy to the large crowd that arrived to be heard on the issue.
Pineles could not be reached for comment. It was not apparent whether he attended the Wednesday meeting.
Prospect Preservation Group members returned for the late meeting and the public comment period Wednesday night.
The county Utilities Authority approved his waste disposal permit application after an October 2013 public hearing. The request then went to the Solid Waste Advisory Council in November. Its next stop is with the freeholders. Voss told Feinberg and the audience that she would closely review all materials submitted related to the permit application but until that happened the board could not take any action.
Pineles is still in a lengthy zoning battle involving his application to the Hackensack Zoning Board to allow him to build the 19-story Bergen-Passaic Long Term acute Care Hospital on 1.15 acres on Summit Avenue that would extend to Prospect Avenue. The board denied the application on quality-of-life grounds in January 2012. Pineles filed a lawsuit and a state Superior Court judge upheld the board’s decision in August 2013. That decision was appealed.
Hackensack city officials at the time also sided with residents, many of the same who oppose the current medical waste disposal permit, in the LTAC application.
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Global Medical Waste Management Market Forecasts 2013-2019
Global Medical Waste Management Market Forecasts: $20.13 billion in 2019
photo credit: www.fearlesswealth.com
As generators of medical waste, healthcare and other medical facilities are required to establish a medical waste management plan in keeping with federal and state laws. Depending on state regulations, generators may be required to employ the use of state regulated treatment, storage, transportation and disposal companies, for small and large-quantity medical waste.
With the health care industry experiencing exponential growth all over the world, so has the need for medical waste management support (medical waste treatment centers, haulers, etc.). This opens the opportunity for the creation of state regulated medical waste disposal companies, which can range from treatment to storage to transportation.
Transparency Market Research recently released a report of forecasts for the global medical waste management market. Looking at a forecast period from 2013 to 2019, with the expected growth rate (CAGR) of 4.8%, the market is valued at $20.13 billion in 2019.
The global medical waste management market has been sub-divided into the following main categories:
Collection: The collection of medical waste from healthcare/medical facilities (generators).
Processing: The treatment, and other processes, of medical waste.
Disposal of medical waste.
Out of the three processes, according to a 2012 report, the collection sub-segment had the largest share of the global medical waste management market (54.5% in 2012) with the processing sub-segment expected to “grow at a faster pace” than the other sub-segments.
In analyzing the market from a geographical perspective, four sub-segments were created: the North American market, European market, Asia-Pacific market, and the Rest of the world (RoW).
From the results, the following was ascertained:
North America and Europe make up the largest markets
The Asia-Pacific region is expected to increase rapidly due to upcoming opportunities in various countries like Japan, Australia and New Zealand.
Not only were the process and geographical aspects of the medical waste management market looked at but the kinds of medical waste often disposed of. The most commonly generated medical waste includes, but is not exclusive to the following:
Human and animal tissue
Sharps e.g. (surgical instruments and scalpels, needles etc.)
Bloods soaked material, including blood-soaked cotton, etc.
These kinds of medical waste, on federal and state levels would be classified as regulated medical waste, including biohazardous waste and would need specialized methods for treatment, storage and disposal.
Overall the report has identified “key players” in the global market medical waste management. These key players contribute significantly to the market. They include Stericyle, Inc., Waste Management, Inc., Republic Services, Inc., Veolia Environment SA, Suez Environment SA, US Ecology, Inc., and Clean Harbors, Inc.
The gist of this report, is not only to analyze which of the various sub-segments are outperforming the others, but to also identify improvements in the methods of medical waste disposal, including the planning and implementing of more eco-friendly methods of medical waste treatment and disposal.
Persons willing to view a full report can do so by visiting the Transparency Market Research, here.
10 Steps to Implementing a Regulated Medical Waste Reduction Plan
Courtesy Greenhealth Magazine
Because Regulated Medical Waste (RMW) or red bag waste can cost five to eight times more than solid waste to dispose, hospitals can save significant amounts of money by improving their waste segregation.
While the primary objective of RMW management is to minimize the risk of disease transmission, every facility has an opportunity to reduce both risk and cost through improved collection and segregation of RMW. Practice Greenhealth’s 2009 Partner for Change Award winning hospitals generated an average of 8% RMW of their total waste stream (with a median of 7%). This article will show you how to calculate and reduce your RMW waste stream. In addition to guidance from the Green Guide for Health Care (www.gghc.org) Version 2.2 Operations Section, Practice Greenhealth recommends the following ten-step process to implement a RMW Reduction Plan.
Step 1: Develop/Review Your Facility’s Definition of Regulated Medical Waste
Keep in mind that RMW is defined by each state but hospitals also must be in compliance with federal OSHA regulations. Once you have gathered your facility and State information defining RMW in your region, work with infection control to review your facility’s policies and procedures. For further information, check out Practice Greenhealth’s RMW Resource Locator Tool at: http://hercenter.org/rmw/rmwlocator.cfm.
Step 2: Define the Problem and Develop a Cost/Benefit Analysis
There are several steps necessary to define the current state of your RMW program. Collecting the following pieces of data is critical to developing an accurate baseline needed to document improved segregation, reduction of red bag waste and associated cost savings.
Step 3: Create a Team, Set Goals, and Develop an Action Plan
With a good understanding of the amount of RMW your facility generates and the total cost of disposal, you are ready to develop your reduction program’s goals and action plan. It is critical that a multi-disciplinary team be established and staff educated thoroughly. If you already have a Green Team, this would be a good project for the team. If not, create a diverse team that includes representatives from Environmental Services, Infection Control, Nursing, Safety, Facilities, Employee Education, Employee Health, Laboratory, and clinicians— particularly those from the OR, ED and critical care areas. Highlight management commitment to the effort. (See Practice Greenhealth’s “Guide to Creating Effective Green Team’s” at: www.practicegreenhealth.org/educate/operations/io). Delegate a leader and review the processes and departments that are generating the most RMW and target them first for education and reduction.
Step 4: Make Waste Segregation Simple
Provide the proper tools for employees to easily implement waste segregation. First, work with department heads and nurse managers in each area to determine the types and volumes of wastes generated. This will help you determine their container, placement and training needs. Work with Communications to develop educational information including posters, receptacle labels, newsletters and employee training.
Step 5: Determine Optimal Container Placement and Use Good Signage
Rule number one-make it easy to do it right! Proper container size, placement and signage are critical to the success of any waste segregation program. For greatest success:
Red bag containers should be as small as possible for a given area and covered to reduce solid waste that is casually tossed in.
Always place a larger, solid waste container beside the regulated waste container.
Signage should be clearly posted above and directly on the lid of the receptacle. Use a large font, color and bullet type format, so they are easy to read and understand at a glance. Keep the signage consistent.
All RMW containers should display the biohazard label.
Remove red bags from underneath sinks, in hallways, restrooms, non-critical care patient rooms and other areas where people are likely to dispose of their solid waste in RMW containers.
Size the container for the appropriate amount of waste generated. The smaller the container, the less likely clinicians will be to throw extraneous items into it. Small, eight gallon containers with step-on lids work well.
Ensure solid waste receptacles are emptied in a timely manner so that overfilled cans don’t result in improper use of the red bag.
Use multiple languages if necessary for optimal communication.
For high use area, consider wheeled receptacles or one waste station per several beds.
Step 6: Train, Educate, Repeat
Training is a critical component in an RMW reduction program. Staff requires clear, consistent information to understand the reasons for proper segregation: regulations, health and safety impacts, cost implications, and environmental leadership.
RMW training must be part of new employee orientation.
Re-train current staff on the newly agreed upon definition of RMW.
Work with your executive team to hold department heads accountable for their RMW generation and associated disposal costs. You must include the OR, which typically generates the most RMW in the entire hospital.
Develop incentives or competitions to get people involved.
Monitor work areas regularly and consider tracking generation rates.
Continue with training on a regular basis, including spot checks, monitoring, reporting, and ongoing training.
Step 7: Review Your Specialty RMW Streams
Sharps Management – Sharps, including needles and scalpel blades, are singled out for special regulatory provisions by many states. Does your facility have a history of problems with needle sticks or sharps injuries due to improper waste handling? The Center for Disease Control estimates that over 800,000 accidental needle sticks occur each year among healthcare workers.
Are you using disposable sharps containers? Reusable sharps containers are normally emptied and returned by a vendor at about 2/3 full, so they can reduce needle sticks. Typically this program saves money, reduces worker exposure and handling, and can significantly improve environmental impacts.
Train staff on the proper use and disposal of sharps, including the imperative to dispose of sharps in the right container.
Safety is the priority. Assess opportunities to maximize container use by optimizing their size and placement.
Consider a reusable sharps container program.
Single Use Device Reprocessing – Reprocessing reduces both the purchase and disposal costs of single use devices (SUDs). Instead of treating these items as disposables, they are cleaned and reassembled for reuse. Many hospitals have started this type of service for just a few types of equipment, but quickly grow the list when they see the savings roll in. The biggest savings come from not having to purchase new equipment, and some health systems are saving millions!
Liquid Waste - Managing fluids in the OR – Liquid medical wastes such as suction canisters present another unique disposal question. Suction canisters can be responsible for up to 40 percent of infectious waste in the OR (see http://mntap.umn.edu/health/91-Canister.html). If you are adding solidifiers, then disposing of it in red bags, you are adding additional chemicals into the mix and could be exposing employees to splashing and spills.
There are now several technologies available to manage fluids in the OR; these systems empty liquid contents of suction canisters directly into the sanitary sewer, reducing transportation and disposal costs and removing canisters from the waste stream. Canister-free vacuum systems are also available. Work with your local POTW and state regulatory officials to determine your best disposal options.
“Trace” Chemotherapy Waste – Ensure trace chemotherapy waste is NOT disposed of in red bag waste containers, as these are often autoclaved or microwaved, potentially exposing waste management employees.
Step 8: Be Ready to Identify and Solve Problems
Even after program implementation and staff training, facilities may still encounter resistance to change and proper segregation.
Develop a good working relationship with anyone handling your organization’s waste."
Develop a written protocol for any segregation issues with waste treatment facilities and landfill operators to have a clear protocol for reporting out on any problems. A response plan is critical, in the event of a contamination or other infraction.
Develop a monitoring form, ongoing rounds and a mechanism to report concerns and appropriate solutions swiftly back to staff.
Step 9: Consider All Your Waste Treatment and Hauling Options
RMW must be “disinfected” before it can be disposed of, meaning that the waste must be treated to destroy or kill infectious micro organisms with a potential to cause disease. Requirements and acceptable treatment methods vary from state to state. RMW treatment technologies rely on two basic approaches to sterilization, excessive heat or chemical agents. Weigh your options and choose wisely.
Step 10: Track Your Progress, Report Successes, and Reward Staff!
A successful, sustainable program needs a strong leader, good tracking and reporting, and sustained vigilance. To realize full benefits:
Track the positive changes in your waste volumes and celebrate these reductions and cost-savings.
Reward staff for their efforts!
Let the community know about your successes.
Inform hospital administrators about any cost-savings.
Write a case study of the project’s results to use in your newsletter and as a performance improvement indicator for the Joint Commission.
Apply for an Environmental Excellence Award with Practice Greenhealth and get recognition for your hard work
By BRADY McCOMBS - Associated Press - Monday, December 1, 2014
Medical waste incinerator agrees to pay $2.3M
SALT LAKE CITY (AP) - A medical waste burning facility cited for toxic emissions has agreed to pay Utah a $2.3 million fine and move its facility to a more rural area, state officials announced Monday.
Stericycle would only pay half of the fine if it moves its plant from North Salt Lake City to Tooele County as planned. It must move within three years of getting necessary permits.
The agreement must be approved by the state air quality board to become final.
The settlement resolves a case opened after state officials found Stericycle exceeded emissions limits over 13 months in 2011-2012, said Bryce Bird, director of the state’s division of air quality.
The fine, the largest ever given out by the division, sends a stern message to other companies that they will pay for violations, Bird said.
Phone and email messages left with Illinois-based Stericycle Inc. were not returned.
The Utah attorney general’s office is still investigating at the request of Gov. Gary Herbert following accusations about the handling of other material.
The Stericycle incinerator processes about 7,000 tons of medical waste each year, according to the Utah Division of Air Quality. The waste includes pharmaceuticals, laboratory tools made of plastic and glass, and human tissue and fluid.
Stericycle plans to build a new facility about 45 miles west of North Salt Lake City in rural Tooele County. Its current facility is located near a residential area. This new location is an industrial area and away from neighborhoods.
The new facility will likely cost tens of millions and be built with much higher emission standards, Bird said.
Alicia Connell, co-founder of Communities for Clean Air, applauded the state division of air quality for imposing the stiffest fine possible and imposing a timeline on the move. She said the new facility will be an improvement but won’t get rid of the problem. Her group would prefer the facility is completely shut down and not allowed to operate anywhere.
“I’m not thrilled with the idea that nobody can watch and see what’s going on,” Connell said. “And it’s still in our air shed.”
Stericycle officials tried to ease worries at a meeting in Tooele in May, saying the plant would be 20 miles from any homes and that a stricter set of incoming emissions standards should quell health concerns.
President Obama signed into law H.R. 7551, which allows for a one-year extension of a package of tax credits that would have expired at the end of 2013. Those who benefit from the extensions now can apply the credits toward their 2014 tax year fillings.
Of these extensions, several directly support the waste and recycling industry, the Washington-based NW&RA said in a news release.
“Many of our members will benefit from these tax extensions as they prepare to file their 2014 returns,” said Sharon Kneiss, president and CEO of NW&RA. “We are particularly pleased with the renewable energy and work opportunity credits that not only reward our industry’s forward-thinking efforts but they also promote the good work of the private waste and recycling sector that American families depend on.”
One major result of H.R. 7551 was a restructuring and extension of the Section 45 production tax credit, which offers credits for incentives for the development of renewable energy facilities, including landfill gas operations. With the extension, any facility whose construction began before Jan. 1, 2015, is now eligible for the credit.
“The association is proud to have championed these issues through our work with members of Congress and their staffs, urging them to keep the incentives in place,” Kneiss said.
Another provision extended excise tax credits for use of alternative fuels, as well as for property dedicated to refueling alternative fuel vehicles. “The renewable and alternative energy extensions afforded by H.R. 7551 empower our industry to continue pushing innovation and improvement in the way we do business,” Kneiss said.
Also affecting the industry was the extension of the Work Opportunity Tax Credit for hiring individuals from a number of groups, including veterans, the long-term unemployed and workers on government assistance, and the extension of a bonus depreciation allowance on certain business property.
Emergency Medical Services (EMS) systems and 9-1-1 public safety answering points (PSAPs) play an important role in the pre-hospital identification, management and transport of suspected or confirmed patients with Ebola. The Centers for Disease Control and Prevention (CDC) offers resources to help support EMS and PSAP providers in the fight against Ebola:
Few issues have garnered the attention, or generated the much concern among the general public, as the Ebola patients in the United States. When the first Ebola patient showed up at the hospital in Texas, reaction was extreme. And, every aspect of the disease has received magnified scrutiny, including its waste. If not handled properly, waste generated in the course of treatment for an Ebola patient may pose a risk to workers. This article outlines the critical controls and procedures used by hospitals and the healthcare waste companies to manage that risk.
According to the Centers for Disease Control and Prevention (CDC), the Ebola virus is transmitted through direct contact with blood or other bodily fluids of a person who is ill (exhibiting symptoms) with the Ebola virus disease. The Ebola virus can be present in aerosolized particles (liquid droplets sprayed into the air) of the bodily fluids mentioned. But there is no scientific evidence that the Ebola virus is an airborne infectious disease, meaning that the virus does not remain suspended in the air for an extended period of time or persist in a dry environment.
Protection from the Ebola virus starts with following the Occupational Safety & Health Administration’s (OSHA) Bloodborne Pathogen Standard, using Universal Precaustions and following Regulated Medical Waste (RMW) Regulations, all of which have been in place for decades. Under Universal Precautions, all blood and other potentially infectious material (OPIM) are considered infectious. According to the OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030, appropriate Engineering Controls, Administrative Controls and Personal Protective Equipment (PPE) should be utilized to reduce or eliminate exposure to employees reasonably expected to come in contact with blood or OPIM in the course of their work. Training to the OSHA standards, company protocols and applicable regulatory permits is required. Protocols and procedures should be reviewed regularly to ensure accuracy and effectiveness.
Employees can be vulnerable to some of the same fear exhibited by the general public. Educating employees on appropriate protocols and reviewing procedures prior to ever handling Ebola contaminated waste will instill confidence and trust.
Waste Characterization and Standard Infection Control
The Department of Transportation (DOT) regulates the movement of regulated medical waste. Some regulated medical waste that is potentially fatal, such as Ebola, is classified as Category A waste, which requires more robust packaging than normal regulated medical waste. If Ebola contaminated waste is to be transported from the hospital to an off-site treatment facility, it must be packaged as Category A waste according to the DOT’s guidelines.
Other recommendations for infection control include:
Limit the number of workers who handle the waste to a minimum.
Keep Category A waste separated from other Regulated Medical Waste.
Understand and practice proper donning (putting on) and doffing (taking off) of required PPE.
Notify your supervisor immediately in the event you may have been exposed to blood or other potentially infectious material.
It is important to develop a plan. Part of that plan should be to: Identify the complete custody chain for waste handling, collection, transportation and disposal before the waste is generated. Create back-up plans at each step in the process and ensure that the process is sustainable over time. The volume of waste generated will likely be more than can be anticipated. Emory University and the University of Nebraska experienced 15 to16 95-gallon containers of waste per day for each patient. According to the transportation requirements, the waste should be double bagged with the exterior of each bag disinfected after sealing. The bags should be put into a rigid, leak-proof outer container and labelled appropriately.
If practical, consider on-site autoclaving of waste using an appropriate autoclave to reduce the risk prior to packing, transportation and disposal. If an on-site autoclave is utilized, the Ebola virus will have been inactivated meaning that the waste material is generally not regulated as medical waste any longer.
Collection and Transportation
Appropriately packaged Ebola contaminated waste is not considered to pose a significantly higher risk of exposure than any other potentially infectious RMW.
Do not use forklifts or other equipment capable of damaging the waste containers.
Place waste sealed containers as low as possible on hand trucks, dollies, carts and in trucks to reduce the risk of tipping or falling. Secure containers within trucks and trailers to prevent damage in transit.
Never handle leaking containers or containers visibly contaminated with blood or other potentially infectious materials without proper protection, possibly including enhanced Personal Protective Equipment (PPE).
Waste Treatment and Processing
Depending on their job tasks, workers involved with processing appropriately packaged Ebola contaminated waste are not considered to be at a significantly higher risk of exposure to the Ebola virus than any other potentially infectious material they would handle on a daily basis.
Workers exposed to waste prior to it being completely treated and decontaminated (e.g, workers opening waste containers or loading autoclaves or incinerators), are at a higher risk for exposure than workers handling treated waste products (e.g., Incinerator ash, autoclaved material, point of origin autoclave waste).
Conduct a risk assessment to determine potential points of exposure and appropriate controls.
Do not shred contaminated waste. Shredding can create bio-aerosols capable of spreading the virus.
Avoid using pressurized water or air for cleaning. High pressure sprays can create bio-aerosols capable of spreading the virus.
Final Disposal of Treated Waste
Ebola contaminated waste that has been properly disinfected using autoclaving, incineration, a combination of these or other general accepted methods employed for other infectious RMW is not considered to be infectious. As such, treated waste can be disposed of following the normal protocols used by a permitted facility under the jurisdiction of the state where it is located.
The Regulated Medical Waste industry in the United States has, for many years, worked daily with infectious substances in a professional and responsible manner. Ebola presents a new challenge, but one the industry is prepared to meet. NW&RA staff members continue to coordinate Ebola-waste handling, transportation and treatment issues with our Healthcare Waste Institute members and representatives from government agencies to ensure that industry input is being heard as important protocols are being developed and implemented. For more information, we have developed an Ebola resource page on our website (http://wasterecycling.org/ebola).
John Haudenshield is the safety director for the National Waste & Recycling Association and may be reached at (540) 589-2975(540) 589-2975 or JHaudenshield@wasterecycling.org.
Anne Germain is director of waste and recycling technology for the National Waste & Recycling Association and may be reached at (202) 364-3724(202) 364-3724 or AGermain@wasterecycling.org.