W r i t i n g a W a s t e R e d u c t i o n P l a n f o r H e a l t h C a r e O r g a n i z a t i o n s 1 Writing a Waste Reduction Plan for Health Care Organizations Sponsored by: Tennessee Hospital Association Tennessee Valley Authority The University of Tennessee Center for Industrial Services In cooperation with Tennessee Department of Environment and
Conservation U T C e n t e r f o r I n d u s t r i a l S e r v i c e s 2 About This Handbook This handbook will help your hospital comply with the Tennessee
Hazardous Waste Reduction Act of 1990, the Resource Conservation
and Recovery Act (RCRA), and the Joint Commission requirement
for a management plan to consider hazardous wastes. In it, you will find information to help you identify and assess
pollution prevention/waste reduction options. You will also find
answers to questions such as: How do I identify RCRA hazardous wastes? What are the rules for hazardous waste generators? How do I write a plan to reduce wastes? How do I conduct a waste reduction assessment? How do I implement waste reduction practices? Because individual hospital circumstances and needs vary widely,
you should modify the waste reduction opportunities to meet your
own unique requirements. W r i t i n g a W a s t e R e d u c t i o n P l a n f o r H e a l t h C a r e O r g a n i z a t i o n s 3 Contents ABOUT THIS HANDBOOK ....................................................................... 2 WHY DO WE NEED A WRITTEN PLAN? ................................................ 6 FOUR COMMON QUESTIONS ................................................................. 8 CHAPTER 1 HAZARDOUS WASTE....................................................... 10 LISTING YOUR HAZARDOUS WASTE .............................................................................................. 12 TABLE 1 WASTE REDUCTION STATUS .......................................................................................... 13 TABLE 2 WASTE VOLUME AND COST TARGETING ..................................................................... 14 TABLE 3 HAZARDOUS WASTE REGULATIONS ............................................................................. 15 WRITING A WASTE REDUCTION PLAN ........................................................................................... 20 CHAPTER 2 REDUCTION OPPORTUNITIES ........................................ 24 PURCHASING ...................................................................................................................................... 25 INVENTORY CONTROL ...................................................................................................................... 26 XYLENE ............................................................................................................................................... 27 FORMALDEHYDE ............................................................................................................................... 30 MERCURY ............................................................................................................................................ 32 FLOURESCENT LIGHTS .................................................................................................................... 33 SILVER ................................................................................................................................................. 34 PHARMACY ......................................................................................................................................... 35 TABLE 4 CHARACTERISTIC WASTES ............................................................................................. 36 TABLE 5 LISTED WASTES ................................................................................................................ 37 CLEANING CHEMICALS .................................................................................................................... 37 CHAPTER 3 MAINTENANCE WASTES................................................. 38 BATTERIES ......................................................................................................................................... 37 PARTS WASHING ............................................................................................................................... 40 PAINTS ................................................................................................................................................. 41 AEROSOLS .......................................................................................................................................... 42 PESTICIDES ........................................................................................................................................ 43 LAUNDRY CHEMICALS ..................................................................................................................... 43 USED OIL ............................................................................................................................................. 44 DRUMS ................................................................................................................................................. 46 HAZARDOUS WASTE STORAGE ..................................................................................................... 48 U T C e n t e r f o r I n d u s t r i a l S e r v i c e s 4 CHAPTER 4 SAMPLE HOSPITAL PLAN ............................................ 51 WASTE REDUCTION POLICY STATEMENT .................................................................................... 53 SCOPE AND OBJECTIVES ................................................................................................................ 54 WASTE REDUCTION PLAN ADMINISTRATION .............................................................................. 54 BARRIERS TO WASTE REDUCTION ................................................................................................ 56 WASTE REDUCTION OPPORTUNITIES ........................................................................................... 56 CHAPTER 5 HAZARDOUS MATERIALS TRAINING ............................ 58 MSDSs AND WASTE REDUCTION .................................................................................................... 59 CHAPTER 6 SOLID WASTE ................................................................... 61 ESTIMATING YOUR CARDBOARD GENERATION .......................................................................... 63 ESTIMATING YOUR PAPER GENERATION ..................................................................................... 65 ESTIMATING YOUR PLASTIC GENERATION .................................................................................. 66 FOOTNOTES ........................................................................................... 68 APPENDICES .......................................................................................... 69 A ........................................................................................................................................................... 69 B ........................................................................................................................................................... 70 C ........................................................................................................................................................... 71 D ........................................................................................................................................................... 72 E ............................................................................................................................................................ 73 F ............................................................................................................................................................ 74 G ........................................................................................................................................................... 75 H ........................................................................................................................................................... 76 I ............................................................................................................................................................. 77 J ............................................................................................................................................................ 78 K ........................................................................................................................................................... 79 L ............................................................................................................................................................ 80 M ........................................................................................................................................................... 81 N ........................................................................................................................................................... 82 Solid Waste Markets .......................................................................................................................... 83 W r i t i n g a W a s t e R e d u c t i o n P l a n f o r H e a l t h C a r e O r g a n i z a t i o n s 5 ABOUT THE SPONSORS Tennessee Hospital Association, established in 1938 as a not-for- profit membership association, serves as an advocate for hospitals
and the patients they serve, provides education and information for
its members, and informs the public about hospitals and health care
issues at the state and national levels. The Tennessee Department of Environment and Conservations
Division of Pollution Prevention and Environmental Awareness
and Division of Solid Waste Assistance exist to help industries and counties implement voluntary pollution prevention measures. Tennessee Valley Authority is a resource development arm of the federal government committed to environmental leadership
supporting creative solutions to environmental problems. Through
public and private partnerships, TVA promotes sustainable
economic development by educating corporate America on the
value of waste reduction. The University of Tennessee Center for Industrial Services is Tennessees statewide industrial extension program. CIS provides
technical and management assistance to Tennessee industry and
hospitals to help them prosper. CIS was created in 1963 by the
Tennessee General Assembly to render service to the industries in
this state by providing information, data, and materials relating to
the needs and problems of industry. U T C e n t e r f o r I n d u s t r i a l S e r v i c e s 6 Why Do We Need A Written
Plan? The first answer to this question is that The Joint Commission 1995
Accreditation Manual for Hospitals standard on Management of
the Environment of Care requires that health care organizations
have a documented management plan(s) for the environment of
care that considers... hazardous materials and wastes. 1 Secondly, the Hazardous Waste Reduction Act of 1990 2 requires a plan to reduce RCRA hazardous waste from all large and small
quantity generators in Tennessee. The Act provides for civil
penalties of up to $10,000 per day for failure to file, refusal to
comply, or knowingly giving false information. In addition, every time you dispose of your hazardous wastes with a
disposal company, you prepare and sign the EPA-required manifest.
Above your signature is a certification statement that states I [you]
certify that you are making your best efforts to reduce hazardous
waste generation. Having this written plan and making annual progress reports documents that certification of having a program-
in-place. Additional reasons include: A plan may help you lower your waste disposal cost and other less obvious expenditures. These costs make your operation less
profitable. The plan may also help you justify capital expenditures
to upper management for waste reduction investments. Remember, the true cost of wastes include: Management or oversight costs (administrative record keeping costs, regulatory reporting and compliance cost,
environmental training cost, spill and emergency response
costs, and monitoring costs) Waste disposal costs (on-site labor, safe and legal storage space, laboratory analysis costs, value of raw materials
lost, and off-site disposal cost), and Potential liability costs (cleanup cost, long-term employee health care cost, legal fees, and bad public image impact). W r i t i n g a W a s t e R e d u c t i o n P l a n f o r H e a l t h C a r e O r g a n i z a t i o n s 7 A plan may help you reduce your cradle to grave liabilities. When your organization generates hazardous wastes, it assumes
perpetual liability for any future impacts those wastes may have on
the environment because of storage, treatment, or disposal
practices. A plan will identify waste reduction opportunities. The procedure involved in writing an effective waste reduction plan
requires that you and a team carefully examine all operations and
practice, including procurement. Close observation of processes and
procedures by a team of people with different expertise is likely to
result in improvements in productivity, quality, safety, and waste
reduction. A plan is good for employees. Reducing the facility hazardous waste generation rate reduces
employee exposure to materials that may harm their health. It also
involves them as stakeholders in the waste reduction program. A plan can be inexpensive and easily implemented. Much of the waste may be generated unnecessarily and is easily
eliminated with minimal efforts, modest changes in procedures, and
waste awareness training. These better operating procedures can
improve profitability without significant expenditure. U T C e n t e r f o r I n d u s t r i a l S e r v i c e s 8 Four Commonly Asked
Questions 1. Is our plan a public record and available to anyone who wants
to see it? No. Your plan and annual updates remain on your premises. The
plan and updates must be available for on-site inspection by the
Tennessee Department of Environment and Conservation (TDEC).
You are not required to file them with the Solid Waste Control
Board or any other state agency. You report progress to TDEC in
your Annual Hazardous Waste Activities Report. 2. Am I required to reduce my hazardous waste by 25 percent? No. The 25 percent reduction before June 30, 1995 is a statewide
reduction goal. Individual generators have no limits. However,
generators are expected to set goals that support Tennessees policy
that states, wherever economically and technically feasible, the
generation of hazardous waste is to be prevented or reduced as
expeditiously as possible. 3 3. Does the Solid Waste Management Act of 1991 require us to
reduce solid waste generated and hauled to the landfill? No. It does require Solid Waste Planning Regions (counties or
groups of counties) and municipalities to reduce the amount of
solid waste landfilled and incinerated by 25 percent before
December 31, 1995. This means that industrial, commercial, and
institutional generators will eventually find disposal costs
increasing. So, solid waste reduction will make greater economic
sense as the years progress. For this reason, you should consider
writing a waste reduction plan to include solid waste reduction.
Many generators of hazardous waste will find greater economic
benefits for reducing solid waste than for hazardous waste. W r i t i n g a W a s t e R e d u c t i o n P l a n f o r H e a l t h C a r e O r g a n i z a t i o n s 9 4. How do we get started on a waste reduction plan? In order to plan waste reduction, it is first necessary to identify your
wastes. You must at least know what your wastes are and how
much is generated. To do this you must conduct a waste reduction
assessment. Most companies that have a plan believe the team approach will
include a cause champion, or team leader. The cause champion will
have ideas, broad-based talents and insights. Other cause
champions may include the environmental or safety director for the
hospital or a laboratory technician who knows instrumentation and
may easily observe wasteful equipment performance. Purchasing
department personnel and lab managers who oversee test quality
can help identify wasteful practices and propose corrective action.
The assessment team should have members from different
disciplines such as safety and environment, facility maintenance,
laboratory services, infection control, and housekeeping.
Independent consultants from university-based programs or private
companies can be of great benefit because they can more easily
observe and objectively question traditional ways of doing things. During an assessment, identify, quantify, and profile each waste
stream. The profile must include a description of the operation or
process that causes generation and factors impacting generation and
quantities. Once the wastes are profiled, the opportunities for waste
reduction are easily identified. Remember, every waste stream is a
waste reduction opportunity. U T C e n t e r f o r I n d u s t r i a l S e r v i c e s 10 Chapter 1 Hazardous Waste The first responsibility for a hazardous waste generator is to identify
all RCRA hazardous wastes generated. A waste is hazardous if it
appears on one of EPAs hazardous waste lists or if it exhibits a
hazardous characteristic. EPA has four hazardous waste lists. These lists are found in 40 CFR
261. Any RCRA waste that appears on these lists is hazardous and
has a designated waste code. The first list is for nonspecific sources
and is called the F list. An example of an F listed material is
spent xylene found in histology laboratories and the sludge
generated from distilling xylene. The waste has an F003 hazardous
waste code. The K list is for wastes from specific sources. The lists typically
include waste water sludge and probably will not apply to hospitals. The P and U lists contain chemical products, off-spec materials,
container residues and spill residues. The P list contains acutely
toxic wastes and if 1kg (2.2 lbs) of a P listed waste is generated,
the facility is a Large Quantity Generator (LQG). Mercury is a
typical U listed waste. If a waste exhibits a hazardous characteristic, then it is a hazardous
waste. The four characteristics are: IGNITABLE (D001) means the waste has a flash point < 140