Brisbane’s major hospital has saved $450,000 per annum by taking a clinical approach to waste disposal, writes Garth Lamb.

An organisation with 12,000 people on-site during an average workday will always demand a busy waste management team. And when that site is a hospital – disposing of body parts, blood-soaked bandages and contaminated materials on top of the standard beverage containers and boxes – controlling waste is clearly a complicated operation. However, the Royal Brisbane and Women’s Hospital has come up with some simple solutions that have sliced more than $450,000 from the annual waste costs. And it has flagged more big changes in the near future.

In the past two years, clinical waste volumes have come down 15 per cent, thanks in large measure to an increased number of segregation containers beneath hand basins and, according to waste operations manager Christian Pattison, a “fair bit of education”. There’s a strong incentive to properly separate material, with clinical waste disposal costing the hospital about $650/tonne, compared with $40/tonne for general waste, and the EPA slapping on penalties if hazardous contamination is found mixed with the general waste.

The hospital recently changed its electronic waste tracking system so that it can better identify areas where signage may be lacking, bin placement is off or more staff education is needed. While the hospital’s total waste volumes have been tracked using barcodes for some time, the information can now be traced back to one of the nine main building floors. It’s early days for the program, but Pattison observed an interesting trend within the first month – “a steady increase” in waste on theatre floors five and six as the hospital received extra State funding that allowed for extra shifts.

The barcode stickers are currently being scanned with a handheld unit before the bins leave each floor, a system the staff has picked up quite easily. However, Pattison says it does take up a bit of time – both in scanning and then downloading the information – and he would like to see it become more automated down the track. While there are still issues to work out around system implementation, the hospital is confident that tracking will improve its waste performance.

“I think we’ve [already] seen a couple of floors not perform as well, and that’s simply due to them probably not taking into account the segregation as well as they could,” he said.

These floors are the prime targets for extra staff education programs, such as the online questionnaire on clinical waste being developed with KDL Products. Staff will be able to undertake the survey in their own time, answering 20 multiple choice questions such as “Which bin does a nappy from an infectious patient go in”? At the end, a detailed description will explain why they were right or wrong.

Separation and safety
While the economics of separation is key, OH&S issues surrounding clinical waste handling are another big challenge. Pattison said the hospital recently started emptying the under-sink bins into 660 L bins “so that we could get away from lifting 240s on top of one another”. While the bigger bins each cost an extra $10/load to transport, the hospital believes the OH&S benefits are worth it. When it goes to tender on its waste contract at the end of the year, it is contemplating further reform to collection and transport.

“The other thing we’re looking at is radio-chipping our bins and coming up with a totally new, innovative way of carrying clinical waste off-site, which will halve the transport costs,” said Pattison.

It wants the clinical waste removed without any on-site handling. This could mean locking and stacking the 35-50 L under-sink bins into trolleys and having them emptied, washed and returned. It could also go down the internationally popular path of introducing disposable cardboard bins that are conveyed directly into a collection vehicle. Pattison said they didn’t want to get too specific in their tender documents to encourage creative solutions, simply stating the less handling the better.

The hospital will also push for the winning contractor to be more proactive in taking the onus for improving waste streams. The clinical and general waste contractors can help reduce volumes while the recyclers help to drive higher collection. Pattison envisages a number of ways they might be able to achieve this, such as “providing education, sponsoring various waste days – things that get the information out there to the staff”.

He would also like to see other staff members – particularly nurses, who generate most of the waste – able to take on-site tours of waste facilities, something that is often reserved just for the hospital’s waste hierarchy.

Big changes afoot
While drink containers and cardboard boxes seem a little dull compared to body fluids, they’ve been the big money savers for the hospital. Some 72 tonnes of general waste a month goes into a new
30 m3 compactor that has seen collections drop from 2-3 times a day to just 1-2 a week, cutting about $205,000 from annual waste costs.

The hospital also has a new cardboard compactor, saving a further $200,000/year. At some 25 tonnes/month, the hospital lays claim to being the eastern seaboard’s biggest cardboard recycler. Not only do most medical supplies come in boxes, but there is also a kitchen catering for about 1,000 people three times a day, with a lot of the meals prepared in single serve, pre-packaged quantities off-site and delivered to the hospital for reheating.

“One of the big things during the past year has been the step up of co-mixed recycling in the ward kitchens. We’re now recapturing most of the recyclables... which is something a lot of hospitals have trouble doing, simply because of space and placement of bins,” said Pattison.

“We came up with 120 [L] white wheelie bins – we were using white lidded prior to that for our co-mixed – and went for the totally white bin to identify it a bit easier, and it’s just ramped it up” he said.
The Australian Council on Health Standards has awarded the hospital its highest rating – OA – for its waste history. With the further improvements planned, that rating scale may need an extra level.