Hospital Waste in County Monaghan

Nial O’Connor

LAPD Project

Monaghan Co. Co.

Hospital waste in Ireland

• Report by Comptroller and Auditor General into value for money and waste management in hospitals

• Summary of findings– Two types of waste risk and non risk waste– Cost of handing waste is significant – especially risk

waste– Level of recycling poor in comparison to other

countries– Different levels of waste in different types of hospitals

Average waste output per bed per day used

0

1

2

3

4

5

6

7

AcuteHospitals

MaternityHospitals

CommunityHospitals

PsychiatricHospitals

Kg

of

wa

ste

pe

r b

ed

da

y

Risk Waste

Non-Risk Waste

Composition of non-risk waste in one acute hospital

Healthcare Textiles6%

Protective equipment (e.g gowns)

8%

Paper towels, etc16%

Food Waste15%

Other Packaging 11%

Glass Packaging7%

Office Paper6%

Newspapers and Magazines

8%

Cardboard16%

Other Non-Packaging7%

48% recyclables

International comparison

Background to Prevention Project in County Monaghan.

• Currently working with 3 hospitals

• Did not have agreement with hospitals before submission to EPA

• Considerable effort required from LAPD team to get projects up and running.

Background

• Level of environmental management different in each hospital ranging from poor to medium

• Must go through the waste management hierarchy first. In developing Prevention Plans – recycling still a key element – walk before you run

Monaghan General Hospital

Landfill80%

Recycling20%

St. Marys Hospital

Landfill, 100%

Waste Management Practices Monaghan Hospitals

St. Davnets

Landfill70%

Recycling30%

St. Marys Hospital

Landfill, 100%

St Davnets

St. Davnets

• St. Davnitts Hospital– Mental Health service along with other services e.g.

disability etc. spread out over a number of different buildings. Mostly 9-5 now.

• Environmental improvements being undertaken include waste, energy use and water use.

• Finance a driver for change but also some staff are motivated by environmental considerations

St. Davnets Phase 1.

• Established working committee – admin and maintenance

• Sub committee of nurses aides then established. They deal with the waste!

• Benchmarking completed – waste characterisation study and desktop analysis of energy and water use.

• Walk around survey with CTC

Waste in St. Davnitts

• Total landfill weight for 2006 was 101554 kg. figure from waste contractor

• BDU = 100 beds* 365 = 36500 bdu• 101554/36500 = 2.78 kg per bed day unit

Benchmarking

• Water 2.34m3/sq. metre floor area/annum

• Small acute or long stay hospital with personal laundry facility – 1.56 m3/sq. metre floor area/annum

• Heating 635kwh/m2/year (excluding pool) 22% above typical (carbon trust)

• Electricity 75 kWh/m2/yr – compare with offices circa 50 kWh/m2/yr

Waste management

• Waste management currently done on an ad hoc basis costing metal health circa €50,000 a year. (non risk only + 6k for risk waste)

• Standard weekly charge• Other services also paying for collection• 70% of waste being landfilled• Some recycling talking place on an ad hoc basis• Different levels of recycling talking place in

different areas of hospital• Not enough receptacles for recycling in hospital• No management policy on waste

Waste Characterisation study

– Difficult to undertake – incontinence wear, food waste, no central location foe bins

– Weighed landfill waste– Characterised recycled waste – Bank Holiday week– Data not great– learnt from our mistakes.

Landfill wieghts weekday (Wednesday-Thursday)

0

10

20

30

40

50

60

70

80

Carpenters w

orkshop

Com

munity S

tores

Day A

ctivation Unit

Disability T

raining Workshop

Houses on m

ain avenue

Kitchen

Laundry

Local Health S

ervice

Oriel H

ouse

Regional D

isability Services

St. Judes

Ward 4

Ward 8

woodvale

area

wei

gh

ts

Total Recycling by areaCare for the elderly

1% Community Stores11%

Day Activation Unit4%

Disability Training Workshop

7%

Kitchen14%

Office Area7%

Oriel House4%

Regional Disability Services

5%

Ward 815%

St. Judes3%

Ward 151%

Ward 44%

woodvale8%

Local Health Service13%

Laundry3%

Landfill weights weekend and bankholiday

0

20

40

60

80

100

120

area

weig

ht

Recycling Waste Survey

0

100

200

300

Waste Material

Kg

Energy and Water

• Significant cost associated with Energy

• 1,035,480 litres of 3500 sec fuel oil costing over €380,000 per annum

• Additional costs – labour, insurance, chemicals, etc

• Electricity costs are €172,958

• Water circa €40,000 p.a. (water in only)

Phase 2

• Prevention Plan given to management from that the following tasks where identified– Review current waste collection service– Improve levels of recycling and diversion away from landfill– Awareness for staff on waste related issues– Monitoring of waste, water and energy– Prevention opportunities in waste management especially on

wards and kitchen - accounts for roughly ½ landfill 1/3 recyclables

– Water and energy use in swimming pool and kitchen– Training on risk waste– Good housekeeping in water and energy management

St. Mary’s Phase 1

• Community Hospital “care of elderly”• Working more with management than

committee• Pre intervention everything being landfilled• Benchmarking complete in energy and

water• Waste characterisation study complete –

incontinence wear!• Prevention Plan given to management

Waste in St. Mary’s

• Landfill in 2006 137.14 tonne

• 2.6 kg per bdu

• Costs €23971 (€174 p/t)

• Risk waste 2.2 tonne costing €2384 in total (€1083 p/t)

• Risk waste accounts for 1.5% of overall waste but 10% of the overall cost

Waste study

• Asked for food waste to be Segragted

• Incontinence wear!

Total waste

0

500

1000

1500

2000

cardboard organic landfill

ward waste

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%

Paper

Cardb

oard

Glass

Plastic

Met

al

Organ

ic

Textile

s

Woo

d

Compo

sites

Specia

l/irre

gular

Shop waste

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Paper

Cardbo

ard

Glass

Plastic

Met

al

Organ

ic

Textile

s

Wood

Composite

s

Specia

l/irre

gular

Kitchen Waste

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%

Paper

Cardbo

ard

Glass

Plastic

Met

al

Organ

ic

Textile

s

Wood

Composite

s

Specia

l/irre

gular

Energy Management

Energy Benchmarking (Carbon Trust)

Typical Good St. Mary’s

Heating KWH/M2 332 252 550

Electricity KWH/m2 71.8 48.4 105

Total cost of energy 2006 =€188,278.40

Electricity = €59878

Oil = €128,399.58

Water Management

• Using 60m3 per day (equivalent of 100 houses)

• €41,829 per year

St. Mary’s Phase 2

• Awareness with all staff poster, fliers etc

• New waste collector hired wheelie bins – saving €8,000 – 10,000 p.a.

• Recycling scheme introduced on wards

• New measures for ordering dinners from wards introduced – prevention of food waste

St. Mary’s Phase 2

• Water flow logged – leak detection

• Energy monitoring in kitchen and laundry

• Moving through the waste management hierarchy

• Review meeting with management on regular basis

Monaghan General

Monaghan General Hospital

• Working with management to improve environmental performance which is currently good

• Good segregation of waste but could be improved

• Level of recyclables going to landfill still considerable

Waste in Monaghan General

• 122. 697 in 2006 tonne non risk waste

• = 3.4 kg non risk waste/bdu (below benchmark)

• .5 kg risk waste/bdu

• Recycling 20% of non risk waste – more can be achieved

Total KG for waste characterisation study

0

200

400

600

800

1000

Cardboard Food Waste Landfill Recycling

Series1

Recycling Overall

Paper39%

Cardboard11%

Plastic13%

Other28%

Composites3%

Glass3%

Metal3%

Overall compostition of landfill bins

Paper7%

Organic1%

Plastic5%

Wood1%

landfill75%

Cardboard8%

Metal3%

Landfill Male Medical

Paper11%

landfill74%

Cardboard8%

Composites1%

Metal1%

Plastic5%

Main Kitchen Landfill

Plastic1%

Metal1%

Landfill81%

Composites2%

Cardboard15%

Monaghan General

• Prevention Plan given to management

• Some tasks undertaken by Hospital Administrator

• Awaiting the establishment of committee

Observations

• Central Procurement– Buy the cheapest – does not always represent the

best value for money

• Disposable nature of a lot of products– Gloves, medical products, hand wipes, latex gloves

• Nature of waste – incontinence wear!• Infection control• Training for risk waste for staff needed• Prevention possible in some areas through

better housekeeping

Challenges

• Need to Keep momentum going

• Getting access to key personnel

• Moving from Recycling to Prevention

• Budgets and time constraints in health sector

• Awareness vs. motivation for staff