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Cleveland Clinic’s Office for a Healthy Environment was founded in 2007 to take on the issue of sustainability across the organization, including the responsible management of medical waste.

That process starts with the organization’s 52,000 caregivers, a title given to everyone who works at the organization whether they’re directly involved with patient care or not. To help achieve its mission, the Cleveland Clinic also has “eco caregivers,” a dedicated group of surgeons, nurses and physicians who are responsible for education and ensuring materials of all types are put where they need to be for proper handling and disposal.

“We deliver these world-class healthcare services, but we require a lot of materials to do that,” says Jon Utech, the senior director of Cleveland Clinic’s Office for a Healthy Environment. “In the area of waste, the issue is what we do with all of these materials we use. The most engaging thing we do with our caregivers is around recycling and waste.”

Nationwide, hospitals generate an estimated 6,000 tons of waste per day, according to Cleveland Clinic. While it’s true that hospitals generate much of the same material as any other business, including food waste and recyclables, Cleveland Clinic is also faced with managing medical waste, including regulated and unregulated pharmaceutical waste and sharps, which are any devices with sharp points or edges that can puncture or cut skin. In all, Cleveland Clinic manages 37 different waste material streams.

In 2018, about 27,000 tons of material went through the organization’s system, Utech says. Of that, regulated medical waste made up about 5 percent of Cleveland Clinic’s total waste stream.

“We handle materials that [are different from] most organizations in the U.S.,” Utech says. “Regulated medical waste is the most important element in our waste stream.”

A color-coded approach

"Colors are really important to how we manage those waste streams.” –Jon Utech, senior director of Cleveland Clinic’s Office for a Healthy Environment.

Cleveland Clinic is a large organization with operations in northeast Ohio; Florida; Las Vegas; Toronto; and Abu Dhabi, United Arab Emirates. The organization is also building a hospital in London.

“From one hospital on the corner of Euclid Ave. [in Cleveland], we’ve expanded, but we try to do so in a fashion where we’re constantly vigilant and compliant in handling those specialty materials that are part of our delivery of healthcare,” Utech says.

The organization’s largest sites include Cleveland Clinic in Cleveland; Hillcrest Hospital in Mayfield Heights, Ohio; and Akron General in Akron, Ohio. Ranked the world’s second-best hospital system by Newsweek in 2019, Cleveland Clinic’s main campus in Cleveland features 80 operating rooms, procedure rooms, clinical labs and test and research labs, which are the primary generators of medical waste across the organization.

At its main campus, an underground tunnel system is an integral part of how Cleveland Clinic manages different waste streams across multiple buildings and complexes. Waste is separated into different colored bags and put into carts, which are dropped into the underground system and delivered to automated guided vehicles (AGVs). About 100 programmed units work to deliver materials in and out of the hospital to help deal with the large volumes of material coming and going from main campus. The robots take the outgoing carts through the tunnels to either an on-site autoclave, where medical waste is weighed and sterilized, or to a dock where unregulated waste and recyclables are then picked up by Phoenix-based Republic Services.

Red bags carry regulated medical waste, yellow bags contain pathological waste, orange bags are used to collect plastics (which make up 10 to 15 percent of the organization’s waste stream), blue bags are for commingled recyclables, purple bags are used for clinical plastics, and clear bags are used for unregulated waste.

“Colors are really important to how we manage those waste streams,” Utech says. “The regulated medical waste comes down all on its own separate cart.”

At the main campus, Cleveland Clinic manages medical waste on-site using an autoclave that uses natural gas and water that’s heated up to 500 degrees to sterilize waste before it is disposed of at the landfill.

“You run it for an hour with a large volume of material inside, and it gets the material hot enough for long enough that anything that’s in there that could be potentially harmful is sterilized,” Utech explains. “At those three facilities, we process waste on-site, and we’re able by Ohio Environmental Protection Agency (EPA) regulation to dispose of that material at the landfill.”

Sharps, on the other hand, are collected in thousands of containers located in hospital rooms and off-site treatment centers throughout the facilities. These containers are then picked up by a centralized vendor and taken to an off-site autoclave where they are sterilized and disposed of.

“The vendor gives us documentation, which verifies the volume of material that was picked up and properly disposed of,” Utech says.

While main campus is the only site that relies on an underground tunnel system and AGVs to manage waste, Cleveland Clinic has worked over the past dozen years to standardize waste management practices across its healthcare system.

“My work in sustainability is made much easier based on the fact that we have that philosophy,” Utech says. “There’re benefits to standardizing your practice. There are other healthcare systems that don’t have that approach. They can do the same work, it’s just a little more complicated.”

Integrity at its core

One of the biggest challenges for healthcare organizations managing medical waste is ensuring compliance.

“There are notable examples of companies that aren’t doing what they’re supposed to do, so the biggest challenge for a healthcare organization is ensuring you’re in compliance and you’re doing everything properly,” Utech says.

Cleveland Clinic overcomes these challenges by using language in its waste management contract that outlines its requirements to properly manage and dispose of medical waste as well as to conduct site visits with its service provider.

“It’s one thing to take somebody for their word, and it’s another thing to go and check and see and ensure it’s done in a valid way,” Utech says of the site visits. “If these products end up in landfills without proper treatment, that’s a health hazard for people living in that community.”

Education around waste and recycling is also a challenge in healthcare settings, which is why Cleveland Clinic has a “Know Where To Throw” education campaign.

“There’s a lot of waste in an operating room,” Utech says. “We need to educate our teams on what goes in regulated waste [streams] and what doesn’t because when in doubt, people just put everything in that container because they want to do the right thing.”

While sustainability is at the core of Cleveland Clinic’s operations, it also can be very expensive, so the organization works to be as efficient and cost-effective as possible when managing medical waste.

“We have committed caregivers who want to do the right thing,” Utech says. “We found in some instances that people put things in containers that don’t need to be there, which increases the costs and makes us less efficient, so we have a Green the Operating Room Committee, which is comprised of a number of physicians as well as nurses and surgeons that are engaged in sustainability and are big supporters of this work.”

Moving forward, the organization is looking to identify best collection practices for operating rooms to continue its push to be more efficient in how it collects medical waste.

Cleveland Clinic has also taken a cue from the municipal sector, placing a renewed emphasis on diverting waste from landfill. Recently, the hospital launched a single-use plastics recycling program to help the organization reach a 50 percent diversion goal.

The author is the digital editor for the Recycling Today Media Group and can be contacted at kmaile@gie.net.