SAMPLE WASTE MINIMIZATION PLAN
One of the purposes of this Manual is to provide practical, "user-friendly" guidelines for use in waste management plans. Following is a sample waste minimization plan that can serve as a guideline for healthcare facilities' use.

The "Yes," "No," columns can be checked to indicate whether or not the goals are/will be achieved, or the practices are done/will be done. Some may be checked "No" to indicate that they cannot be done but may be done in the future. Other goals and actions may be added to this sample list.

An analysis of this checklist should/will:

• Provide a basis for waste minimization plans and practices
• Be a guideline or "compass" for further actions
• Lead to a discussion of "expected outcomes" for the overall plan
• Serve as a summary of present plans and a template for future actions
• Serve as a "report card" for the status of the facility's progress in waste management

The reader is also encouraged to use the examples of waste minimization contained in Appendix A.

Now for the example: Your hospital is organizing a facility-wide waste management plan. The most significant portion of this strategy is the waste minimization action plan. The following pages offer a sample plan:

Sample goals:

Yes	No	1. To establish a balanced waste minimization program that considers: patient and personnel safety infection control/prevention principles state-of-the-art technologies ease of use; convenience effectiveness and reasonable cost education and tracking required degree of change involved, ability of staff to integrate changes into work- load mission of hospital
		2. To minimize the generation of waste throughout the facility by:     reducing     reusing     recycling
		3. To reduce (by 10%) the total hospital waste stream in one year.
		4. To properly segregate infectious (RMW) from noninfectious waste at the point of generation so that the amount of RMW is reduced 10% in one year.
		5. To choose single-use versus reusable draping and gowning systems, based on established guidelines and criteria.

Waste reduction can include:

Yes	No	Working with supply and device manufacturing companies to consider specific ways of reducing packaging, when appropriate and not compromising integrity (or sterility) of products; requesting that they take back packaging materials; considering this information in making purchasing decisions
		Obtaining information from medical products companies regarding corporate environmental initiatives and outcomes; using 800 telephone numbers
		Whenever possible, purchasing products with the largest percentage of post-consumer recycled content, such as in:    Paper products    copier paper    business cards, letterheads, envelopes    tissues, towels, toilet paper    promotional pieces    Business equipment    refilled toner cartridges for copiers and printers    remanufactured copiers, printers, and computers    rebuilt or recovered furniture, desks, and cabinets    building and construction materials
		Renting, rather than disposing of or storing, infrequently used equipment
		Donating, or reselling books    furniture    appliances    equipment    unused, clean nonwoven wrappers, surgical and isolation gowns, towels; sterile supply plastic trays; gloves (to Third World countries, veterinary clinics, day care centers, schools)
		Reducing    Paper usage    copying and printing documents on both sides    posting or circulating memos rather than making copies    using e-mail and voice mail to eliminate paper memos    editing documents on screen instead of printing    printing only the quantity of documents, copies and promotional pieces necessary     distributing in-house newsletters and memos electronically    keeping mailing lists current to avoid duplication    Unsolicited mail    Wasteful lunches with excessive packaging, plates, cups, disposable utensils

Waste reduction can include:(continued)

Yes	No	Reusing    dishware, utensils, drinking glasses and mugs    batteries by recharging    notebook binders and folders    patient water containers and cups    patient slippers    kidney and wash basins    scissors    linen incontinence pads    eggcrate mattresses    pillows    bedpans and urinals    dressing trays
		Saving bubble wrap and foam peanuts for shipping of packages
		Returning shipping containers to suppliers
		Placing magazines and journals in central location (library) for multi-use
		Placing containers at point-of-use locations as much as possible; avoid placing "red bags" in locations where they can easily be used for extraneous wastes
		Offering incentives to employees to develop new ways to reduce hospital waste

Examples of RMW (for segregation): (Note: Each State has a definition of RMW that must be used by hospitals in segregation policies. The following list contains examples only.)

Yes	No	Used and unused discarded sharps (needles, syringes with needles, scalpels, electrosurgical tips, pins, broken glass, pipettes, capillary tubes, glass slides, cover slips)
		Items so grossly contaminated with blood and tissue that they would produce dripping upon compression (only saturated sponges, dressings, drapes)
		Items substantially stained with dried blood
		Bulk blood and blood products; blood and body fluids (usually > 50 cc) in individual containers (pleurovacs, hemovacs, suction canisters)
		Bags and tubings used to transfuse blood and blood products
		Microbiological waste (cultures and stocks of infectious agents, discarded live or attenuated vaccines, culture dishes)
		Tissues, organs, body parts removed during surgery and autopsy
		Contaminated carcasses, body parts, excrement, and bedding of animals inoculated with infectious agents
		Waste contaminated with excretion, exudate or secretions from humans who are required to be isolated in the hospital (to protect others from highly communicable diseases)

Identification of waste that is not RMW (can usually be disposed of as solid municipal waste):

Yes	No	Paper cups; food containers
		Packaging materials; cardboard
		Paper towels; tissues
		Drapes, gowns, towels, gloves, or other articles with none or minimal amounts of blood/body fluids
		Prep sets used in clinical areas, such as ER, ICU, OR IV fluid bags and tubing
		Urine, feces, saliva, sputum, nasal secretions, sweat, tears and vomitus, unless they contain fluid, visible blood

Following is a listing of possibilities for recycling:

Yes	No	Packing materials (solid foam, bubble wrap)
		Aluminum cans, crushed
		Corrugated cardboard (two-layered cardboard, kraft paper bags, boxes, sheets)
		Glass (bottles and jars)
		Newspapers
		Office and computer paper
		Magazines and catalogs
		Grocery and newspaper bags
		Plastics, usually #1 and #2
		Tin (steel) cans
		Toner cartridges
		Fluorescent light bulbs
		Videotapes
		Appliances
		Tyvek¨ envelopes
		Styrofoam (cups, cartons, trays)
		CDs, tapes, records
		Computer disks
		Computers
		Copy and fax machines
		Clothing
		Scrap metals (copper, aluminum, brass)

Single-use versus reusable drape and gown systems. (Some questions apply when considering either system; other questions are only applicable to the one system which is being evaluated.)

For any system:

Yes	No	Consistency of materials and products?
		Compatibility with infection control mandates and practices? (barrier qualities; staff and patient protection, effectiveness in preventing occupational exposures to blood and body fluids; meet professional standards; aseptic handling; clinical studies from manufacturer)?
		Good drapability?
		Time in opening packages/packs?
		Number of individual packages to open?
		Adherence to aseptic technique by opening the least amount of items possible?
		Comfortable?
		Meet needs of surgeons and nurses?
		Convenience and ease of usage?
		Heavy? Lightweight? Small or large packs, packages?
		Consideration of alternate delivery systems, such as customized procedure packs?
		Opportunities for reduction in total waste by use of custom packs?
		Design features that enhance product usage (e.g., built-in fluid pouches, fasteners that hold tubings in place)?
		Meet requirements of different procedures? (amount of blood loss expected, length of procedure, resistance to abrasion)?
		Presence of stitching that could allow penetration of micro-organisms or liquids?
		Quality control of production and sterilization by manufacturers that is consistent with requirements for performance?
		Quality variations over time?
		Costs over time? Purchase costs?
		Amortization over time?
		Loss and damage rates?

For reusables only:

Yes	No	Costs of laundry, energy, chemicals and detergents, labor, sterilization?
		Amount of water, detergents, and other chemicals used in laundering?
		Environmental effects?
		Amount of energy (electricity, gas) expended?
		Verifiable laundry standards?
		Cost of human labor used in sorting, inspecting, delinting, reprocessing, laundering, and finishing?
		Chance of "wear and tear" defects in materials?
		Resterilization process verified by quality assurance standards?
		Potential for presence of pyrogens in resterilized materials; particles trapped in interstices; detrimental effects on barrier qualities by mangling or other procedures used in laundering?
		Consistency in performance over the product's lifetime?
		Accurate method of calculating numbers of launderings?
		Able to use in custom kits and packs?
		Amounts needed to provide a consistent supply?
		Storage space?
		Reliable JIT (just in time) deliveries?

Contribution of laundry wastes to the water supply and environmental issues of pollution?

SUMMARY
Waste minimization is an integral part of the facility's overall waste management plan. It is truly a form of resource conservation. The plan for minimization tactics must be balanced for cost-effectiveness, time and safety for patients and personnel.

Waste minimization techniques must demonstrate value and tangible, positive results to employees. Protocols must be convenient and sensible. Outcomes, progress notes, recognitions and cost effects must be communicated, in the form of visible and meaningful ways to reinforce positive behaviors.