If you haven't taken steps to reduce the amount of red bag waste in your facility, you might quite literally be throwing money away.

At our hospital, we used to take an ultra-conservative approach to all disposables that were generated after patients were brought into the OR. We disposed of all of it, including non-contaminated disposables such as packaging of surgical items, in red bag waste containers. We weren't alone in adopting this policy. According to Hospitals for a Healthy Environment (a program developed by the Environmental Protection Agency, the American Hospital Association, the American Nurses Association and Health Care Without Harm), many hospitals throw 50 percent to 70 percent of their trash into the biohazardous waste stream, even though industry guidelines suggest that only between 6 and 15 percent of waste actually belongs in red bag containers.

In 2004, we performed a study that examined the effects of segregating our infectious and non-infectious waste generated by our open-heart surgical cases. We found that, although separating the trash didn't alter the total amount, it helped us greatly reduce the cost of disposal. That's because red bag waste costs us 24 cents per pound to dispose of; non-infectious, or clear bag waste, costs only 4.5 cents per pound.

Our study took place in the cardiovascular operating rooms, where we found that we could save 38 percent on trash removal costs by simply paying closer attention to what went in the red bags. But we feel that any OR team could take the simple steps that we took and realize similar savings.

Too often, disposing of waste is an unconscious process, a lazy habit. While we certainly don't want to compromise efficiency or violate hazardous waste disposal rules, we do want our staff to think more critically about where they're throwing items away. Here are some tips to do just that.

1 Educate your staff
Make sure everyone understands what red bag trash really is. We reviewed AORN guidelines and consulted with colleagues at neighboring hospitals to clarify our own policies and procedures. Then we held meetings to re-educate our staff. One key point that we had to get across: Items stained with dried blood or dried fluids could go in clear bags. Red bag waste included items that were saturated with fluid; in other words, if the item would release liquid if it were squeezed or compressed, it was red bag waste (see "What is Red Bag Waste?").

Just letting people know how much it costs to dispose of red bag waste can have a powerful effect ' many of our staff had no idea that it costs nearly six times as much as non-infectious waste.

2 Place waste containers strategically
The "location, location, location" adage about real estate also holds true when evaluating where to place red bag and clear bag waste containers. Keep red bags close to the source of infectious waste and you'll help ensure that it's properly disposed of and reduce the amount of non-infectious waste that is casually tossed in.

In our ORs, we place red bags next to the clinicians who use them most ' the surgeon and the anesthesia provider. Staff in the periphery of the OR have easy access to two non-infectious waste containers that are on wheels, so we can move them easily while keeping them at least two feet away from the sterile field.

We've also put signs above and on the red bag waste containers to remind everyone what should go in red bags and what shouldn't. The signs are colorful and in large type, so they're noticeable and easy to read.

3 Monitor your waste stream
Our circulating nurse and a member of our housekeeping staff periodically check the contents of the red bags to ensure that waste is being properly disposed of, and they alert the rest of the staff about any problems at regular staff meetings.

We've come a long way from our initial policy of "if it's red, it should be red-bagged." Today, our waste disposal policies allow for common sense and critical thinking, and our bottom line is all the better for it.