With cost savings of over $1,000,000 per year system-wide, New York City’s Beth Israel Medical Center has shown that good waste management is also good business. The nation’s hospitals generate approximately 6,600 tons of waste per day. Add to that the waste from 180,000 physician offices and 98,000 dental practices. That’s a lot of medical waste, and a lot of potential savings!

It’s time to think about your garbage. How much waste do you generate in a day? Where does it go? And how much do you pay to get it there? In this column I will explore ways to reduce waste volume and toxicity in your medical practice. The result is cost savings and a “greener” practice. Let’s start by making a “Garbage Survey.”

Begin with the red bags. At the end of the day, walk through your office and look in the red bags. The definition of red bag waste, or Regulated Medical Waste (RMW), varies state-to-state, but typically includes blood-soaked materials, human tissues and cultures, and stocks of infectious agents.

Red bags are not for exam table covers, non-bloody gloves, packaging, diapers, non-bloody paper towels, pizza boxes, newspapers, or soda cans. Yet, this stuff often ends up in the red bags. Guess who pays for it? RMW haulage rates vary, but it is safe to say you pay five times more to haul red bags than for Non Regulated Medical Waste (NRMW). Your hauler doesn’t mind a bit if you red-bag your NRMW, but you’re throwing dollars away if you do.

Place a clear-lined container next to each red bag receptacle, eliminate red bag containers where RMW is not generated, and instruct staff in correct use of red bags; then, just count the savings! You may be able to cut RMW volume by up to 50%! This may not reduce overall waste volume, but it is the fastest way to save money. Now, look at your clear bags. Do they contain newspapers, magazines and office paper? Paper recyclables can usually be hauled at no cost, or at least at reduced rates, so you save if you recycle (more on recycling in a future column).

Beyond the sheer volume of trash, the big environmental impact of medical waste is plastics and mercury. Health care garbage, due to wide use of disposables, has more than double the PVC and other plastics of a municipal waste stream. PVCs form dioxins when incinerated. According to the Environmental Protection Agency, medical waste incinerators are major sources of both mercury and dioxin in the environment. Future installments of Greening Your Practice will focus on reducing plastic, mercury, and toxic chemicals. For now, just take a look at your waste stream; you might be surprised at what you see.

The bottom line on health care environmentalism is that it reduces costs, and it is fun. How often do you have the chance to do the right thing, save money, and feel good at the same time? But if you’re still unsure, here are a few things to think about:

1. Cost Savings: At Beth Israel we save roughly $1 million annually, mostly due to reducing red bags, increasing recycling, monitoring haulers, and switching to reusable sharps containers. Your practice won’t save quite that much, but the truth is, small practices pay more for haulage due to their relatively small volumes and infrequent pick-ups.
2. Environmental Impact: Medical incinerators are major sources of both mercury and dioxin. Many hospitals and practices are firmly committed to reducing their share, and new environmentally conscious purchasing and disposal options are emerging. To learn more about medicine’s environmental impact and what can be done, visit Health Care Without Harm at: www.noharm.org.
3. Ethical Responsibility: Most health care facilities have stated commitments to compassion and concern for the communities they serve. If you believe in those principles, then it only makes sense to do whatever you can to make sure you are practicing environmentally-responsible medicine.
4. Community Relations: You may not realize it, but your neighbors may fear your trash and consider your office a health hazard! By showing environmental commitment, you win community support and goodwill.
5. Employee Morale and Safety: Conscientious waste management demonstrates respect for your patients, community, and staff. And respect boosts morale across the board. You also reduce the odds of accidents, injuries, and occupational exposure to toxins or infections.

I hope this column will foster your interest in health care environmental issues. I look forward to sharing with you what we have learned at Beth Israel, and I welcome any questions you may have. Send them to: jbrown@bethisraelny.org.

Janet Brown is the medical Waste Manager for Beth Israel Medical Center, New York City. Beth Israel is firmly committed to reducing the volume and toxicity of its waste stream. Many of the strategies that work for Beth Israel can also work for you.