If hazardous waste disposal is a big expense at your facility, like it was at ours, it could be because OR staff routinely fill red bags that are labeled as medical waste with harmless trash that could be disposed of more cheaply. Take surgical gloves, for example. Where do they wind up after a case? Probably right in the red bag waste, tossed there by surgeons and staff conditioned to think that that's the right thing to do. But if those gloves are free of blood and bodily fluids, they could — and should — go in the regular trash.

That was just one of the many pleasant surprises and positive outcomes from our infectious waste reduction project. There were other surprises, too. IV bags, IV tubing, unsaturated sponges, unbroken glass vials, alcohol swabs, emptied suction canisters, emptied syringes — none of these items need to be placed in red bag trash, according to Pennsylvania Department of Health regulations.

Is that truly medical waste?
We set out a few years ago to reduce our red bag waste at our 2-OR, 2-procedure room surgical center. Most of the staff at our 5-year-old facility made their bones in hospitals, where they were conditioned to believe that everything from bottles to Band Aids goes in red bag waste. As you set out on your red bag reduction project, realize that you may have to recondition staff to stop and think before they toss something in the trash.

Segregating operating room waste before you dispose of it is a critical step in reducing your waste disposal costs. The amount of medical waste U.S. hospitals produce could be reduced by more than 30% solely by proper waste separation, according to recent study led by Martin A. Makary, MD, an associate professor of surgery at the Johns Hopkins University School of Medicine, in the February issue of Archives of Surgery.

Also realize that old habits die hard. Your staff won't be resistant to the idea of reducing waste, but you'll need to recondition them. Constantly remind, gently nudge and sometimes challenge staff to think about what they're throwing away and whether it's truly medical waste. When you observe someone throwing something into the inappropriate bin, challenge her: "Does that really need to go there?" A great reminder that's worked well for us are sheets of paper (see photo to the left) attached to each waste bin that delineate which items in your facility belong in red waste and which can go in regular trash. One caveat: Be sure you research and understand your state department of health and local municipality trash disposal regulations. What you can dispose of in regular trash might not hold true for a facility in the next town over.

Speaking of bins, make sure they're readily available, highly visible and placed in accessible areas. You want them to be as close to the action as possible. You don't want your staff walking clear to the other side of the room to dispose of a needle. We have 1 red box in each procedure room, 2 in each OR (1 is designated for anesthesia) and 1 in our decontamination area.

Obviously, the goal of implementing environmentally friendly practices is to reduce healthcare costs without compromising patient safety. But if staff questions whether an item belongs in regular trash (a bloody dressing, for example), instruct them that it's OK to err on the side of safety. It's not worth putting a bloody item in the regular trash.

Ongoing education and observation
When we started our infectious waste reduction project in 2007, we were generating around 144 boxes of red bag waste per year with an annual cost of $1,587. After implementing the trash disposal strategies, we reduced the red bag waste by around 56 boxes for an annual reduction of $576, while our case volume had increased by 32%. Put another way: Our trash contractor was removing 10 to 12 boxes of infectious waste per month in 2007. Now we're down to 4 boxes per month. By continuing to diligently maintain the proper trash separation, we kept our annual costs for 2009 and 2010 at the same levels.

We also implemented a third-party reprocessing program that let us place some of those items that would have gone into red bag waste into a separate container that is sent off for reprocessing. Ex-amples include arthroscopy trocars, shavers, drill bits, K-wires, GI and ENT snares, and GI biopsy forceps and snares.

We collect arthroscopy fluid in suction canisters. If the canister is grossly contaminated, we leave it intact and put it in red bag waste. Otherwise, we pop the top off and throw it in the hopper.

Remember, from the beginning we were taught that surgical waste (all of it!) goes in red bag waste. Your biggest challenge lies in changing your staff's mindset.