While hospitals have been champions of recycling for decades, efforts largely have focused on food service and administrative functions. The challenge hospitals now face is successfully integrating recycling practices into a patient care setting, and understanding the economic, regulatory, resourcing and infrastructure nuances that come with it.

Nowhere is the potential upside bigger than in recycling medical plastics.

Health care facilities in the United States generate approximately 6,600 tons of waste per day, according to a 1999 paper by the American Plastics Council called "Hospital Plastics Characterization and Recycling Feasibility Study." Moreover, a 2002 Korean study, "Analyses of the Recycling Potential of Medical Plastic Wastes," estimated that between 20 and 25 percent of such waste could be attributed to plastic packaging and products.

In addition, 85 percent of the plastic waste generated is nonhazardous, meaning free from patient contact and contamination, according to an article called "Solid Waste Reduction in U.S. Hospitals — Case Studies" published in association with the International Federation of Hospital Engineering.

Navigating the process

The Healthcare Plastics Recycling Council (HPRC) is developing a guide with supporting tools to help hospitals navigate the process of initiating a plastics recycling program in a patient care setting from initial planning and business decisions through program implementation and improvement considerations. It is based on data and lessons learned from plastic waste pilot study work and valuable insight provided by Stanford (Calif.) University Medical Center and Kaiser Permanente, Oakland, Calif., which serve in an advisory role to HPRC.

Among these insights, several should be considered before a hospital begins implementing a health care plastics recycling program.

First and foremost, plastics recycling in a patient care setting is an advanced recycling option, so the hospital's commitment to sustainability should be considered carefully. A plastics recycling program will struggle without senior management buy-in. Moreover, it will be much easier to add a new plastics waste stream to an existing recycling program that has an established infrastructure and process. It also may help the hospital meet its recycling objectives and goals.

Financial considerations also should be evaluated. A health care facilities professional can have all the commitment and passion in the world, but a health care plastics recycling program also must be financially viable for the hospital. Assuming the hospital already has a robust recycling program, facilities professionals must evaluate the incremental costs associated with adding a new plastics waste stream to the existing program. They may need to make some assumptions and should be prepared for a cost-neutral result or even a small cost initially. Again, they must find out whether this will be acceptable to senior management.

Lastly, many critical infrastructure components should be considered. Does the hospital have adequate dock space to manage the plastic waste and dock-out processes? Additionally, certain equipment and supplies, such as balers, compactors and carts, can be extremely useful for handling and transport of the captured plastics as they make their way to a recycling facility. Does the hospital have access to these resources through existing recycling programs?

Getting started

Once a facilities professional has confirmed the hospital's commitment to sustainability, and evaluated economic and infrastructure aspects, it's time to develop a health care plastics recycling program tailored to the organization. The program must be focused on clean health care plastic wastes, free from patient contact, to prevent contamination and potential health risks.

Most would agree that it's not prudent to begin a recycling program before first understanding the waste stream. In the waste characterization process, facilities professionals should identify types and quantities of plastic waste generated from an activity or area and map it from the point of generation to the dock-out location where the waste is hauled off-site. This includes identifying who moves the waste, the path it travels within the hospital, how it is handled and how the waste hauler receives it. Facilities professionals also should identify and understand any federal, state and local regulations that apply to recycling health care plastics.

Professionals then will need to select a recycling partner that can provide invaluable insight into running an effective recycling program. A good place to start is to initiate dialogue with the hospital's waste hauler or recycler to determine if it will accept clean health care plastics. Health facilities professionals should have an open, honest conversation about their expectations and discuss such critical topics as what plastic materials the recycler can accept.

Some questions include: Are all the plastics from the waste characterization accepted? What are considered nonconforming materials and how will they be managed? In what form can the recycler accept the material (e.g., bales, gaylords, truckloads) and what will the dock-out process be? What will be the final disposition of the plastics? Can the recycler provide statements that its operations are in compliance with applicable federal, state and local regulations? It is strongly recommended that facilities professionals invite recycler representatives to tour the hospital so they fully understand health care recycling operations, the plastic waste that will be recycled and the measures that will be in place to prevent contamination.

Implementation and improvement

When implementing a health care plastics recycling program, facilities professionals should consider a strategy that either targets limited products or selected areas.

If facilities professionals choose to target limited products, they should pick one or two that are easily identifiable, generated in high volumes according to the waste characterization and accepted by the recycling partner. Once collection and recycling of these products have been implemented across multiple areas, other products can be added incrementally. Good candidates for this strategy include irrigation bottles, rigid plastic trays and basins, plastic nonwoven sterilization wrap and flexible clear packaging.

If professionals choose to target a selected area, they should pick one that is sterile with a small footprint, large volumes of patient processing and repetitive low-pressure activities (e.g., nontrauma areas). Within this selected area, all plastic products that the recycling partner will accept should be collected and recycled. Areas appropriate for this strategy include catheterization labs, pharmacies, radiology and anesthesia areas. Once success has been achieved in a limited area, additional areas can be incorporated into the program.

The next step in getting the program up and running is to ensure that the infrastructure requirements set out in the initial planning stage (e.g., dock space and equipment) are in place and that the right resources to drive the program have been identified and engaged.

Even more important is getting personnel up-to-speed. A well-defined training program is an essential component to running the program and will help to ensure that important safety protocols are maintained throughout the process. Training programs should be tailored to reflect a facility's specific recycling program with respect to affected personnel, departments and plastics to be included.

Training continues during implementation. For instance, visual indicator tools like posters and colored bags, containers or bins that will help to simplify the collecting and sorting of plastics for personnel are highly recommended. Additionally, facilities professionals should hold periodic refresher training at regular intervals.

Metrics to measure the success of a health care plastics recycling program are key to its effective long-term management. There are many types of information that can be gathered easily within a facility as well as through the recycling partner. Data including total plastic waste generated by the facility, total plastic collected for recycling and percentage of contamination or nonconforming materials can help determine key performance indicators such as total recycling percentage, plastics recycled per square foot and plastics recycled per occupied bed.

Facilities professionals should make sure they communicate initial successes with the entire recycling team, so everybody sees the results of their hard work during implementation.

Once the recycling program has been running for a while, it's a good idea for facilities professionals to revisit the economic proforma tool and replace initial assumptions with actual data to determine the program's financial impact. This may provide opportunities to amend the program to include new plastics or additional areas for recycling. Another useful tool to improve program effectiveness is a communication plan that seeks to share program results and successes internally, with partners and other key stakeholders, ensuring continued program buy-in and excitement.

Lastly, it is imperative to regularly audit the health care plastics recycling program both within the hospital and at the recycling partner operations. Audits should include samples of materials being collected and should identify nonconforming items and types of contamination (e.g., paper, cardboard, unacceptable plastics and infectious waste). Audit results should be shared with personnel involved in the program through photos, do's and don'ts lists, lessons learned and other appropriate communication channels.

To drive improvement of audit results, facilities professionals should consider incentive programs as encouragement for key stakeholders. Within the hospital, competitions between different areas based on percentage increase in recycled plastics or percentage decrease in contamination levels will motivate personnel. Incentive options for increasing plastic quantities and decreasing contamination levels should be discussed with the recycling partner as well.

Complex recipe

Implementing a health care plastics recycling program is an advanced sustainability effort that involves a complex recipe for success including strong commitment and support from hospital management, key infrastructure components, understanding the facility's plastic waste stream, partnering with a trusted recycling firm, comprehensive training and established metrics to maintain effectiveness.

Facilities professionals are encouraged to seek help from HPRC and other industry sources to help with the inevitable questions and challenges that will arise.

Tod D. Christenson is director of the Healthcare Plastics Recycling Council. He can be contacted at tod.christenson@anteagroup.com.

Sidebar - Common recyclable plastics

There is an almost endless supply of disposable plastic materials in a typical health care facility. However, some of the most common recyclable medical plastics include the following:

• Tyvek, made from high-density polyethylene, is a common material used in sterile barrier packaging, typically as part of a Chevron peel pouch or lid on a rigid tray. It can be recycled with other No. 2 plastics.

• Sterilization wrap, often referred to as blue wrap, is a sterile material made from polypropylene (PP) that protects surgical instruments and other items from contamination. It can be recycled with other No. 5 plastics.

• Saline bottles are a common operating room product, typically made from PP, and when easy to drain, can be recycled with other No. 5 plastics.

• Water pitchers, basins and trays are common patient care products, typically made from polyethylene terephthalate that can be recycled with other No. 1 plastics.
Sidebar - Coalition seeks to improve plastics recycling

Founded in 2012, the Healthcare Plastics Re–cycling Council (HPRC) is a private technical coalition of industry peers across the health care, recycling and waste management industries seeking to improve recyclability of plastic products within health care.

It is unique in its focus on identification of plastics recycling barriers and solution development along the entire value chain. HPRC is seeking to affect plastics recycling from health care product design and manufacturing through product use, disposal and recycling.

HPRC is made up of 12 brand-leading and globally recognized members, including Baxter, BD, Cardinal Health, Covidien, DuPont, Eastman Chemical Co., Engineered Plastics LLC, Johnson & Johnson, Kimberly-Clark, Philips, SABIC and Waste Management. To provide "voice of the customer" insight to HPRC activities and help set priorities for the technical agenda, the council established a health care facility advisory board. Current advisory board members include Kaiser Permanente and Stanford University Medical Center.

The council convenes biannually at meetings hosted by an HPRC member that include facility tours to further learning and knowledge-sharing opportunities through firsthand demonstration of best practices in sustainable product and packaging design and recycling processes.

For more information, go to www.hprc.org.