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Hospital Waste in County Monaghan

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					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

                          7
Kg of waste per bed day




                          6
                          5
                          4                                                      Risk Waste
                          3                                                      Non-Risk Waste

                          2

                          1
                          0
                               Acute      Maternity   Community    Psychiatric
                              Hospitals   Hospitals    Hospitals    Hospitals
             Composition of non-risk waste in one acute hospital



                                              Healthcare Textiles
                        Other Non-Packaging          6%
                                7%
                                                     Protective equipment
                     Cardboard                           (e.g gowns)
                       16%                                    8%


                                                           Paper towels, etc
                                                                 16%
          Newspapers and
            Magazines
               8%
              Office Paper
                   6%
                                                      Food Waste
                  Glass Packaging                        15%
                        7%
48% recyclables
                           Other Packaging
                                 11%
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
Waste Management Practices Monaghan Hospitals
                                St. Marys Hospital
                                St. Marys Hospital




                                     Landfill,
                                      100%
                                       Landfill,
                                        100%



                                                                 St. Davnets
    Monaghan General Hospital



                    Recycling                        Recycling
                                                       30%
                      20%




                                                                               Landfill
                                                                                70%
       Landfill
        80%
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.
                                                                                            woodvale
                                                                                            Ward 8
                                                                                            Ward 4
Landfill wieghts weekday (Wednesday-Thursday)




                                                                                            St. Judes
                                                                                            Regional Disability Services
                                                                                            Oriel House
                                                                                            Local Health Service




                                                                                                                           area
                                                                                            Laundry
                                                                                            Kitchen
                                                                                            Houses on main avenue
                                                                                            Disability Training Workshop
                                                                                            Day Activation Unit
                                                                                            Community Stores
                                                                                            Carpenters workshop




                                                                                        0
                                                80
                                                     70
                                                          60
                                                               50
                                                                    40
                                                                         30
                                                                              20
                                                                                   10
                                                               weights
                       Total Recycling by area
                         woodvale   Care for the elderly
                           8%               1%               Community Stores
                                                                 11%

                                                                         Day Activation Unit
            Ward 8                                                              4%
             15%
                                                                                  Disability Training
                                                                                     Workshop
                                                                                          7%

   Ward 4
    4%

Ward 15
 1%
St. Judes                                                                          Kitchen
   3%                                                                               14%

Regional Disability
    Services
       5%
            Oriel House                                                  Laundry
                  4%                                                       3%
                     Office Area                           Local Health Service
                          7%                                      13%
                                                         weight
                C
                  om
               D mu
          H a y ni
           ou         Ac ty S
              se
                                                                       100
                                                                             120




                                               0
                                                   20
                                                        40
                                                             60
                                                                  80
                 s tiva tore
                   on ti                  s
                       m on
                           ai Un
                              n
                                 av it
                                    en
             Lo                 K ue
                                  itc
                 ca                   h
                    l H L en
       R               ea a u
        eg
          io                lth nd
            na                  S ry
               l D O er
                  is rie vic
                     ab         l         e
                        ili Ho
                           ty         u
                              Se se
                                   rv



area
                             S ic e
                               t.         s
                                  Ju
                                      d
                              W es
                                  ar
                                     d
                                        1
                                W 6
                                    ar
                                       d
                                W 4
                                    ar
                                                                                   Landfill weights weekend and bankholiday




                              w d8
                                oo
                                    dv
                                        al
                                           e
                                              Kg




                                    0
                                        100
                                                   200
                                                         300
                       Pa
                         pe
                           r

                     O
                      rg
                         an
                           ic
                  Ca
                     rd
                       bo
                          ar
                            d

                      Pl
                           as
                             t ic


                       M
                            et


Waste Material
                               al


                       G
                        la
                          ss
                                                               Recycling Waste Survey




                       O
                        th
                          er
                 Co
                    m
                     po
                       sit
                           es
         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

2000


1500


1000


500


  0
       cardboard        organic   landfill
                                  10.0%
                                  15.0%
                                  20.0%
                                  25.0%
                                  30.0%
                                  35.0%




                                   0.0%
                                   5.0%
                    Pa
                           pe
        C                     r
              ar
                 d   bo
                       ar
                             d
                     G
                      la
                            ss
                    Pl
                      as
                            tic

                     M
                      et
                             al
               O
                rg
                       an
                                          ward waste




                         ic
                Te
                      xt
                        ile
                              s
                     W
       C              oo
            om               d
Sp               po
     ec               sit
        i   al
                            es
              /ir
                    re
                       g   ul
                             ar
                                        10.0%
                                                15.0%
                                                        20.0%
                                                                25.0%
                                                                        30.0%
                                                                                35.0%




                          0.0%
                                 5.0%
             Pa
                 pe
        Ca            r
           rd
             bo
                  ar
                     d
             G
                la
                  ss
            Pl
               as
                  t ic

              M
                  et
                     al
           O
            rg
               an
                                                                                        Shop waste




                  ic
           Te
             xt
               ile
                   s
              W
               oo
   Co            d
        m
Sp         po
  ec           sit
     ia            es
       l/ir
            re
              gu
                   la
                      r
                            0.0%
                            5.0%
                           10.0%
                           15.0%
                           20.0%
                           25.0%
                           30.0%
                           35.0%
              Pa
                pe
        Ca        r
           rd
             bo
                ar
                  d
              G
               la
                 ss
             Pl
                  as
                    t ic

              M
                   et
                      al
           O
            rg
               an
                  ic
                                   Kitchen Waste




           Te
             xt
               ile
                   s
              W
               oo
   Co            d
        m
Sp         po
  ec           sit
     ia            es
       l/ir
            re
              gu
                   la
                      r
   Energy Management
Energy Benchmarking (Carbon   Typical   Good   St.
Trust)                                         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

1000

800

600
                                                        Series1
400

200

  0
       Cardboard   Food Waste   Landfill    Recycling
                 Recycling Overall


                    Composites
                       3%

        Other
        28%                              Paper
                                          39%

Glass
 3%


    Metal
     3%
                Plastic          Cardboard
                 13%               11%
Overall compostition of landfill bins
                            Paper
                     Wood    7%
                      1%
                                Organic Cardboard
                                  1%       8%

                                       Plastic
                                         5%
                                                 Metal
                                                  3%




          landfill
           75%
      Landfill Male Medical


                     Paper
                     11%

                              Cardboard
                                 8%
                                  Plastic
                                    5%
                                    Metal
                                     1% Composites
                                           1%




landfill
 74%
Main Kitchen Landfill

           Cardboard
              15%
                       Plastic
                         1%

                       Metal
                        1%
                                 Composites
                                    2%




Landfill
 81%
        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

				
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