pollution prevention works for iowa: health care case...

POLLUTION PREVENTION WORKS FOR IOWA:

HEALTH CARE CASE SUMMARIES

Iowa Department of Natural Resources Larry J. Wilson, Director

January 1996

POLLUTION PREVENTION WORKS FOR IOWA:

HEALTH CARE CASE SUMMARIES

Prepared by: Julie A. Nelson Larry A. Gibson WRAP Sr. Team

Waste Management Assistance Division

January 1996

Iowa Department of Natural Resources Larry J. Wilson, Director

HEALTH CARE CASE SUMMARIES (January 1996)

TABLE OF CONTENTS

Introduction To Case Summaries

CASE NO.

95-1

95-2

94-3

95-4

95-5

95-6

95-7

95-8

95-9

95-10

95-1 1

FACILITY

VA Medical Center - Iowa City



VA Medical Center - Knoxville

Story County Hospital


Pleasant View Care Center



Des Moines General Hospital

Des Moines General Hospital

SUBJECT

Replacing Ethylene Oxide/CFC Sterilization

Hazardous & Other Waste Reduction In Clinical Laboratory

Sharing Equipment Between Facilities

Food Waste Reduction Through Recipe Automation

Reducing Cleaning Chemicals By Consolidation & Dispensing

Reducing Waste Through Commodity Standardization

Reducing Laundry & Cleaning Chemicals Through Inputs Changes, Dispensing & Alternative Linens

Effective Commodity Recycling

Energy Efficiency Through Phased Programming

Implementation of Overall Facility-wide Pollution Prevention Plan Using In-house Committee

Reducing Oxygen Cost Through Facility Revisions

HEALTH CARE CASE SUMMARIES (January 1996)

The Environmental Protection Agency - Region VII granted the Iowa Department of Natural Resources’ Waste Reduction Assistance Program (WRAP) a set-aside grant to work with Iowa’s health care industries. The Waste Reduction Assistance Program utilizes senior industry professionals, consultants, and engineers to conduct on-site waste reduction opportunity assessments.

A group of advisors from the Iowa Hospital Association, the Iowa Society of Hospital Engineers, the Iowa Medical Society, the Iowa Department of Public Health, the Iowa Waste Reduction Center, the Waste Management Assistance Division of Iowa Department of Natural Resources, and the Environmental Protection Agency provided guidance for all phases of this project in the form of sponsorship and promotion of the project.

A total of seven health care facilities had on-site opportunity assessments conducted by the WRAP team. The following case summaries represent some of the exemplary projects health care facilities are doing to prevent pollution and save money. Together they document an annual savings of at least $261,000 and one time capital savings of at least $700,000 in addition to the following benefits:

Significant reductions in solid waste to landfill and hazardous wastes to

Reductions in the use of toxic and hazardous materials. Improved efficiency in resource utilization and facility maintenance. Enhanced employee involvement and patient feedback.

treatment/disposal. (Many cannot be rigorously documented, but are no doubt occurring.)

If you would like additional information please contact the Waste Reduction Assistance Program, Des Moines, Iowa at 515/281-4367.

Any questions about WRAP and pollution prevention should be directed to:

Julie Nelson, WRAP Environmental Specialist, Waste Management Assistance Division, Iowa Department of Natural Resources, 515/281-8499, or to Brent Laning, Assistant to Bureau Chief - Waste Management Assistance Division, Iowa Department of Natural Resources, 515/281-8489.

900 East Grand Avenue P h: 515/281 -8927 Des Moines, IA 50319-0034 Fx: 515/281 -8895 The Iowa Waste Reduction Assistance Program is a non-regulatory technical assistance program offered by the Waste Management Assistance Division of the Iowa Department of Natural Resources.

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CASE SUMMARY COMPANY VA Medical Center

LOCATION Iowa City Frank Lower Johnson County 319/338-0581 x7863

PRODUCTANDUSTRY Veteran Patient Care And Services SIC Code 8062

WASTE STREAM Ethylene Oxide (ETO) and FreonTM

MODIFICATIONS Replacing ETO/CFC sterilization system with Abtox™ system using Peracetic Acid.

BENEFITS Eliminate use of Ethylene Oxide, a hazardous material, and Freon, an ozone depleter.

Opportunity Ethylene Oxide (ETO) is widely used by health care institutions as a sterilant because of its potency in destroying pathogens. A few facilities use pure ETO, the vast majority employ a “12/88” mixture of ETO and Chlorofluorocarbons (CFC).

VAMC has an exemplary re-sterilization operation. Reusable plastic utensils and products are re-sterilized wherever practical, in addition to traditional surgical and clinical instruments. Examples of reusable items are bedpans, wash basins, metal instruments, scissors, forceps and knives. “Terminal Sterilization” is defined as “free of all micro-organisms” after sterilizations, and is currently achieved through two processes:

1. Steam Sterilization 2. Ethylene Oxide (ETO)

The ETO process is used for materials that would melt at hot water or steam temperatures. Examples are cystology scopes, arthroscopy scopes, Doppler scopes, cauteries, and electrical or fiber optic materials.

In the past the VAMC has used a “12/88” mixture of ET0 and Chlorofluorocarbon (CFC). New methods of sterilization are being examined because of the 1995 phase-out of CFCs and in light of associated regulatory concerns. ET0 is flammable and explosive, it is a probable human carcinogen, it is a toxic air contaminant, and the CFC is an ozone depleting substance. Operators exposed to ET0 are required to be monitored for exposure.

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900 East Grand Avenue Ph: 515/281-8927 Des Moines, IA 50319-0034 Fx: 515/281 -8895

The Iowa Waste Reduction Assistance Program is a non-regulatory technical assistance program offered by the Waste Management Assistance Division of the Iowa Department of Natural Resources.

Case Study Med95-1 Printed On Recycled Paper

Case Study Med95-1 Page 2

VAMC is actively pursuing an alternative to this gas mixture. 100% ETO is currently being used in two small sterilizing systems in conjunction with two trial systems. Switching from 12/88 to pure ETO would permit continued usage of this chemical, but would greatly increase the safety hazard. Alternative methods of sterilization are available but lack the wide material compatibility of ETO. Some of the alternate treatments are steam, ozone, radiation, vapor- phase hydrogen peroxide, plasma, and microwave radiation.

Change Two other large alternate systems are being investigated both of which use plasma excitation of a chemical as follows: plasma is a cloud of ions, electrons, and free radicals. The free radicals react with cell membranes, enzymes and nucleic acids to destroy microorganisms. Neither system is considered hazardous because they are closed systems.

1. STERRAD- made by Johnson & Johnson- uses H202. Typical cycle time for this unit is 1.5 hours.

2. ABTOX- made by the ABTOX Company- uses Peracetic Acid. Cycle time for this unit is typically four hours.

There are no harmful emissions with these two processes but products containing cellulosics like linen and paper can not go through the system. The cycle and aeration time for the . ETO/Freon system is typically 17 hours.

The major advantage of the ABTOX system over the STERRAD system is the compatibility of the old ETO Packaging system with that of the ABTOX system. The injection system also appears superior.

The University of Iowa Hospitals and Clinics has two of the STERRAD units, but VAMC has started procurement procedures for one ABTOX system.

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Savings/Other Benefits VAMC estimates that 30 instrument and single packaged supplies are re-sterilized to manufacturers specifications on a daily basis.

VAMC has initiated an investigation for the replacement of the current EtO/Freon system with an ABTOX system. The financial justification analysis has not been finalized but the following documents some initial analysis:

* Chemical costs for the ABTOX system will depend on the number of cycles that will be required (yet to be established) to accommodate the same sterilization quantities. VAMC is confident that these costs are likely to be less than the current system; however, even if they are slightly higher, the change will be justified by the other benefits.

This project was identified by the VAMC and shared with WRAP during an on-site opportunity assessment. WRAP recommended that the current EtO/Freon system be discontinued to eliminate hazardous materials.

CASE SUMMARY COMPANY VA Medical Center

LOCATION Iowa City Johnson County

Frank Lower 319/338-0581 x7863

PRODUCT/INDUSTRY Veteran Patient Care And Services SIC 8062

WASTE STREAM Clinical Laboratory Wastes - Hazardous & Non-Hazardous

MODIFICATIONS Source Reduction: Microscaling equipment and procedures, changing reagent supply, upgrading radiological equipment.

BENEFITS Reduced operating costs and waste disposal costs.

Opportunity The VAMC clinical laboratory conducts testing procedures for blood, tissue, urine, spinal fluid, and other body fluids for the medical center with an inpatient average of 150 patients/day and a clinical patient load of approximately 300/day. The clinical and research labs are responsible for the generation of 2 1% of the overall facility waste stream and represent almost 100% of the total hazardous waste generated by the facility.

Change The clinical laboratory was upgraded less than five years ago to utilize “micro-scale” volumes of both samples and reagents (1 milliliter is typical).

Most reagents are now purchased rather than formulated in the lab. This keeps chemical purchase, storage, and disposal at a minimum.

Xylene has been replaced for the most part by a product called Clear RightTM.

The hazardous waste generated in the lab now consists primarily of alcohol and very small quantities of xylene and heavy metals which are low in concentration and volume. Waste alcohol constitutes approximately 1,500 gallons per year and accounts for nearly all the hazardous waste generated by VAMC.

Radioactive wastes that used to be generated primarily from research work (radioisotopes used with X-Ray film for gamma counts) have been eliminated by upgrading testing equipment; testing dependent on radiation has been completely eliminated.

Radioactive waste in the Clinical Laboratory has been nearly eliminated by use of new equipment and methods that do not employ radioisotopes.

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900 East Grand Avenue Ph: 515/281-8927 Des Moines, IA 50319-0034 Fx: 515/281-8895 The Iowa Waste Reduction Assistance Program is a non-regulatory technical assistance program offered by the Waste Management Assistance Division of the Iowa Department of Natural Resources.


Savings/Other Benefits Information was not available to quantify the hazardous waste reduction that micro-scaling lab equipment has attributed but the quantity is substantial. Present costs for disposal of hazardous waste from both clinical and research labs is approximately $19,000 per year.

Eliminating radiation-dependent testing has eliminated 20.67 tons/year of radioactive waste and the annual disposal cost of $24,958.

WRAP recommends all laboratory operations utilize “micro-scale” and other source reduction techniques to minimize use of toxic materials and the generation of hazardous waste. Many labs have been able to become RCRA Conditionally Exempt Small Quantity Generators which decreases the complexity of regulatory compliance in addition to reducing waste related costs.

CASE SUMMARY COMPANY Veteran Affairs Medical Center

LOCATION Iowa City Frank Lower Johnson County 319/338-058 1 x7863


WASTE STREAM Equipment Expenditure - Capital and Utilities

MODIFICATIONS Source Reduction: Sharing equipment.

BENEFITS $700,000 savings, improved utilization of tax dollars and operating costs.

Opportunity The amortization and utilization of major diagnostic and therapeutic medical equipment is a challenge to most medical facilities-how to offer accessibility at a reasonable cost.

The VA Medical Center, which has an inpatient population of 150 and outpatient population of 300/day has an outstanding relationship with the University of Iowa Hospitals and Clinics. This relationship has fostered the sharing of equipment costs (including maintenance) between the two institutions which are within walking distance of one another.

Sharing has also been implemented with another hospital in Iowa City, Mercy Hospital, located approximately two miles from VAMC.

Change VAMC purchased a Scanning Electron Microscope (SEM) which cost in excess of $200,000 in 1980. This piece of equipment is shared with the University of Iowa Hospitals and Clinics.

Other examples include the heavily used machine, VITEK (used for the electronic identification of bacteria), as well as operating room instrumentation.

The VAMC purchased a Magnetic Resonance Imaging (MRI) machine which was installed at the Mercy Hospital. The Mercy Hospital provided space and installation costs and VAMC provided the purchase cost which was in the range of $500,000.

Where duplicate equipment exists, an agreement is in place to share it in the event of equipment malfunction. The procurement of customized equipment reagents is also a joint activity.





Savings/Other Benefits Sharing these two major pieces of equipment has saved the expenditure of $700,000 in equipment purchase costs, reduced the need for space, and reduced the maintenance costs associated with the upkeep of delicate equipment. Opening the door to possibilities such as these will also open the door to future potential equipment sharing relationships.


LOCATION Knoxville Sharon Ethell Marion County 515/842-3 10 1 x6365

PRODUCTANDUSTRY Veteran Patient Psychiatric Care And Services SIC 8062

WASTE STREAM Food Waste

MODIFICATIONS Source Reduction: Methods Changes. Automation of recipe adjustment to minimize waste.

BENEFITS $33,000/year cost reduction, including reduced purchasing costs and 10% reduction in food waste.

Opportunity Large hospitals operate some very large restaurants/cafeterias. Many serve 500 to 600 meals/day in the dietetics sections (which serve the patient population). Most also operate “Canteens” or “Kitchens” catering to staff and patient visitors many of which serve 400 to 500 meals/day. These two types of establishments are operated either separately or jointly, and are managed either by the same entity or by totally different businesses and staff.

Whether they be kitchens, canteens, buffets, or dietary establishments, they are a very large area of opportunity for waste reduction efforts at health care institutions. Some typical issues are:

Use of disposable serviceware, Containerized single serving items (milk cartons, butter, jelly, puddings), Reduction of food wasted, Potential to recycle food waste which might be presently sent down garbage disposal or contained for solid waste disposal, and Use of re-usable napkins and cleaning rags.

WRAP performed on-site opportunity assessments at seven medical facilities as part of a special Medical Facilities Project. One program was observed that is of special note.

The Dietetics section at the Knoxville VAMC has an inpatient population of 600 and serves 15,000 to 16,000 meals each day to inpatients, outpatients, and staff. An annual budget of $770,000 is allocated solely for the purchase of food. Of this budget, $500,000 is for actual food purchases and $270,000 is spent on meal supplements, tube feedings, and liquid beverages. The average cost of a meal ranges between $1.29 and $1.40 each. There are over 50 diet types prepared each meal and over 1,400 ingredients are used in 800 to 900 recipes to fulfill a four week menu cycle.





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Change Over six years ago, a food management computer program was initiated at four of the 177 VAMCs across the U . S . on a trial basis. This food management program is operated through the V.A.’s “Decentralized Hospital Computer Program” (DHCP). The program is designed to track actual consumption and to calculate the future need of food products. It calculates the weight of food required to serve a pre-determined number of meals and integrates the quantities into the basic recipe. The program also gives the potential to input patient likes and dislikes; an alternate main course, vegetable, drink, or dessert is substituted.

Patient numbers are monitored closely. Trips and recreational activities are input on a regular basis to help improve accuracy. Patients are approached on a monthly basis and asked for input to update the program. These numbers are determined in advance of meal preparation. Waste is monitored on a continuous basis to improve the input.

All recipes are written within the boundaries of FDA and other regulations. For example, Hazard Analysis Critical Control Point, which is a time/temperature relationship, is incorporated into each recipe.

Savings/Other Benefits This program has been successfully fully implemented for the past three years. The cost savings are as follows:

Reduced Purchase Costs $15,000/year 10% Reduced Waste undetermined Elimination Of One Full-Time Employee Position $18,000/Year

TOTAL $33,000/year

The 10% reduction is derived from cuts made in over-production and its attendant food waste generation. It is substantial but has not been fully documented. The facility had good controls in place initially before this program and was very pleased to realize another 10% reduction. A facility with very high percentages of food waste would benefit most from a program like this.

By reducing food waste by about 10% more money became available to purchase meals with higher amounts of fruits, vegetables, and meats (which considerably improves patient satisfaction). This evolutionary program implementation was successful because management was supportive and willing to initiate, implement, and continuously monitor improvement.


VAMC will next investigate the “add-ons” on the meal trays for similar cost reductions. This includes milk, juice, fruit cups, and puddings. A study will be conducted to help reduce the work load for dietary staff. This “task-oriented” approach will reduce these hard to handle waste streams listed above.

CASE SUMMARY COMPANY Story County Hospital

LOCATION Nevada Tony Champ story county 5 15/382-2 111

PRODUCT/INDUSTRY County Hospital and Care Facility SIC 8000

WASTE STREAM Housekeeping Chemicals

MODIFICATIONS Source Reduction: Input & Methods Changes. Reduced the number of chemicals used and installed dispensers.

BENEFITS Saved 40% in cost of chemicals, reduced waste, and reduced storage space.

Opportunity This 100 inpatient population facility was using numerous chemicals to perform various cleaning functions. It appeared that many of these chemicals were of similar makeup and differed only in concentration. This discovery allowed the maintenance supervision staff to explore the possibility of buying fewer basic chemicals and adjusting the concentration in house.

Change Initially, the number of housekeeping chemicals was reduced to four. Upon further investigation, the number was reduced to two. To facilitate this change, a dispensing system was purchased that allows the worker to dial in the cleaning function to be done. The dispensing system dispenses the amount of chemical required in the proper concentration.

Savings/Other Benefits Reducing the number of housekeeping chemicals used saved 40% of the cost of housekeeping chemicals, some $200 per month or $2,400 per year.

An unanticipated side benefit was the reduction in the amount of Storage space required for the storage of these chemicals. This is because of purchasing the material in bulk, resulting in fewer containers, better scheduling of purchases, and having less materials on hand.

This also reduced or eliminated disposal problems. Currently, nothing has to be disposed of as a hazardous chemical or out-of-date product.

WRAP recommends consolidation and simplification of chemicals and chemicals management wherever feasible.

900 East Grand Avenue Ph: 515/281-8927 Des Moines, IA 50319-0034 Fx: 51 5/281 -8895




LOCATION Iowa City Barb Aldeman Johnson County 319/338-0581 x7451


WASTE STREAM Commodities

MODIFICATIONS Source Reduction: Methods Changes. Commodity Standardization Committee reviews commodities to eliminate duplications, improve quality, and reduce waste.

BENEFITS Saved $159,000 in commodity costs in five years. Reduced associated wastes.

Opportunity The VAMC, a 150 inpatient and 300/outpatient/day facility was using numerous commodities of a similar nature, in quality, size, types and grades. This resulted in increased costs and required more storage area than was believed to be necessary.

Change A Commodity Standards Review Committee was established to review all commodities to develop purchasing and packaging standards. The committee recommended changes to reduce and eliminate duplications in sizes, kinds, types and grades. Consideration was given to improving overall quality and reducing packaging and other wastes.

Savings/Other Benefits These reviews had the effect of increasing some costs and reducing others; however, the net savings and benefits have been decidedly positive. Savings have been about four times higher than increased costs. The facility provided the following project analysis:

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900 East Grand Avenue Ph: 515/281-8927 Des Moines, IA 50319-0034 Fx: 515/281-8895 The Iowa Waste Reduction Assistance Program is a non-regulatory technical assistance program offered by the Waste Management Assistance Division of the Iowa Department of Natural Resources.



In the past year, savings were realized in such diverse elements as:

WRAP recommends consolidation of materials, purchasing review and standardization wherever possible to reduce supply costs and minimize associated wastes.

CASE SUMMARY COMPANY

LOCATION

PRODUCT/ INDUSTRY

WASTE STREAM

MODIFICATIONS

BENEFITS

Pleasant View Care Center

Whiting Byron Thelander Monona County 712/458-2417

Community Care Center SIC 8000

Housekeeping Chemicals

Source Reduction: Inputs & Methods Changes. Replaced packaged chemicals with metered chemicals for laundry and housekeeping. Implemented alternative linen system.

Reduced laundry chemical costs by over 90% and housekeeping chemical costs by 88%- overall savings of over $13,000/year. Minimized overuse of harsh and toxic chemicals.

Opportunity In 1990 this 99 bed health care facility was buying a wide variety of packaged housekeeping chemicals at a cost of some $10,000 per year. It was decided to change product in an attempt to reduce consumption.

Change The first step was to change from powdered laundry detergent to liquid laundry detergent, in 1992. The liquid products cost more per unit than powdered but measurement was easier. Because so many different people were adding the laundry detergent, and the general belief was that more soap meant cleaner clothes, monitoring product usage had been next to impossible. Although the liquid costs more, consistent measurement enabled the facility so save money; the liquid product system allows consistently less product use.

The second step, completed in 1995, was to install a metering dispensing system for the liquid laundry detergent. At the same time, the facility purchased a new linen program called CON/SEPTM. The new system reduces linen poundage by 30-40% compared to standard linen systems, thus allowing more pieces per wash load. Reduced laundry chemicals use comes from lower weight and improved fabric soil release characteristics. The metering system allowed the facility to further reduce the amount of liquid laundry detergent required.

The same metering technology was applied to housekeeping chemicals. This reduced the number of chemicals used to four-one each for floors, glass, air freshener and all-purpose.

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900 East Grand Avenue Ph: 515/281 -8927 Des Moines, IA 50319-0034 Fx: 515/281 -8895




Each chemical is dispensed from a metered reservoir in the proper amount and concentration. A typical unit has eight 3-gallon plastic containers set against the wall in a rack arrangement, each connected to a pumping system that is also connected to the water lines in the sink. The pumping system has several selections which the cleaning staff can set to get pre-mixed measured cleaning chemicals. They can select; glass cleaner, floor cleaner, furniture cleaner, etc. in the correct amount without having to handle the chemical. The 3-gallon containers can be refilled from central storage once they are empty; hence, no waste containers are generated.

Savings/Other Benefits The savings have been significant: In the laundry, less than half of the chemicals once used were no longer needed. The initial change from powder to liquid product reduced the cost of laundry product by one-half-approximately $5,000/year. The following information illustrates the additional advantage of the new system:

The cost of housekeeping chemicals was reduced $5,755/year - from $6,520 in 1990, to $765 in 1994. This is an 88% reduction in cost. The dispensing equipment was supplied by the vendor at no cost for both laundry and housekeeping so no initial investment was required. Savings for both housekeeping and laundry chemicals combined is over $13,000/year.

Additional side benefits include the following: Handling fewer chemicals Purchasing fewer chemicals, less often Reduced storage, handling and disposal Fewer vendor contacts-time savings. Longer machine life by reduced loads from improved linen poundage

In 1990, the facility had to dispose of 258 chemical containers and any contained chemicals. In 1994, they did not have to dispose of any chemical containers or chemicals.

WRAP recommends consolidation and simplification of chemicals and chemicals management wherever feasible. This approach can also enhance the changeover to less toxic chemicals. This is a remarkable savings for a 99 bed facility. This facility was the first to advise WRAP of the alternative linen product. WRAP has provided other health care facilities with information about the potential for chemical reduction and alternative. linens.




WASTE STREAM Commodities

MODIFICATIONS Recycling: Implementation. Initiated commodities recycling.

BENEFITS Reduced landfill 88 tons/year and costs $15,000 per year. Earned revenues of $6,000/year.

Opportunity By incorporating and building on the concepts generated through Earth Day 1990, the Iowa City VAMC has established an ongoing recycling effort involving all organizational levels. This facility has an inpatient population of 150, outpatient population of 300/day and 1,100 permanent employees. The development of an employee-requested program was key to the program’s success. Encouragement and support from the Director, Associate Director, and the Chief of Building Management Service fostered an atmosphere of commitment which enlisted professional, technical, and line-employee support for this recycling initiative. Top management encouraged employees to lay the groundwork before developing the paperwork. Management authorized the necessary financial commitment, and allowed the program to make and learn from mistakes. A formal Recycling Committee, facilitated by a coordinator, was established in 1990.

Change A major roadblock confronting the establishment and implementation of this program was the maze of federal regulations. Included were Privacy Act considerations, fire and safety concerns dealing with collection containers and locations, disposition of revenues generated, and space and storage constraints. Once again, top management assisted the team to work through these problems. By working closely with the District Counsel, the Safety Engineer, and the Recycling Committee the intent of the law was followed in making decisions necessary to form a viable collection and disposal system for recovered materials.

The title of the program is Recycling, however, the effort is really three-pronged: recycling, reusing, and reducing material in the waste stream. The employees who attend Recycling Committee meetings constantly bring innovative strategies to be discussed. Success stories include:

Radiology Department purchasing 5-gallon, returnable containers of supplies rather than 1 -gallon throwaways. (continued on back)





Cardiac Cath Laboratory is reusing original containers to store developed film.

These are two examples of positive waste reduction efforts brought about solely by employee suggestions.

This recycling program includes:

Implementation cost about $30,000, part of which was provided by a grant from IDNR. Purchase of a baler and building for sorting were partially funded through the Landfill Alternatives Financial Assistance Program.

Savings/Other Benefits Changes in operations and other waste related projects have made direct measurement difficult. However, it appears the recycling effort has reduced the landfill cost approximately $15,000 per year. In addition, some $6,000/year in revenues have been generated which are used to help defray the costs of the program.

The Waste Reduction Assistance Program (WRAP) estimated that the VAMC was recycling at least 90% of the incoming cardboard. The strategic placement of recycling containers and employee commitment have put into place one of the most successful recycling programs WRAP has seen. Jobs have been generated for handicapped individuals that do the sorting.

A nearby hospital delivers its recyclable plastics to VAMC to help with creating a large enough volume to attract a buyer as well as to divert materials from the landfill. Reducing the general waste stream by a monthly average of 23% allows this facility to exceed the goal of 25% reduction/diversion goal in the Comprehensive Waste Management Plan mandated by Iowa law and reviewed by the Department of Natural Resources.

CASE SUMMARY COMPANY Veterans Affairs Medical Center



WASTE STREAM Energy Consumption

MODIFICATIONS Energy Efficiency: Technology & Equipment Changes. Improved building envelope, lighting and equipment

BENEFITS Savings of $139,200 in energy costs are projected over the next five years

Opportunity The VAMC at Iowa City is an older building with numerous inefficient energy consuming systems. The Veteran Affairs system has been mandated to reduce total energy consumption, system wide, by 30% from the base year of FY (fiscal year) 1985 by FY 2005. The plan for activities to achieve this goal locally has been developed through FY 2000.

The windows are original and are energy inefficient. Some of the roofs need to be replaced and better insulation needs utilized. Several interior equipment systems can be upgraded to improve energy efficiency, including HVAC, chillers and hot water recirculation. In addition, the interior lighting can be upgraded to improve energy efficiency.

Change In the VAMC five year energy plan, there are plans to:

Upgrade the HVAC systems in Bldg. 1 Upgrade the Operating Room energy systems Replace the roofs on Bldgs. 1 & 16 Replace the utility tunnel for Bldg. 3 Replace a 700 ton chiller Replace the hot water recirculating system Replace interior light systems.

All of these actions are included in the local Fiscal Year Energy Plan to be completed between 1995 and the year 2000.

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900 East Grand Avenue Ph: 515/281-8927 Des Moines, IA 50319-0034 Fx: 515/281-8895



Case Study 94-9 Page 2

Savings/Other Benefits The following lists the schedule of savings and implementation:

Full estimates of implementation costs have not been developed. However, the plan was constructed utilizing technologies and equipment with previously established efficiency.

WRAP recognized the potential for this phased approach to energy efficiency improvement during an on-site opportunity assessment and urged VAMC to implement the plan.

CASE SUMMARY COMPANY Des Moines General Hospital

LOCATION Des Moines, Iowa Karen Knape Polk County 515/263-4 147

PRODUCT/INDUSTRY Health Care Services (SIC Code 8000)

WASTE STREAM Overall solid, hazardous, and infectious waste generated throughout the facility.

MODIFICATIONS Implementation of overall facility wide pollution prevention plan using an in-house committee.

BENEFITS By implementing educational programs regarding waste generation and improved methods for waste reduction or disposal Des Moines General Hospital has made a commitment to reduce the generation rate of waste on a hospital-wide project scope. This helps avoid costs for disposal and improves employee communications between departments.

Opportunity The goal of the state is to reduce the amount of materials in the non-hazardous landfill waste stream, existing as of July 1, 1988, 25% by July 1, 1994, and 50% by July 1,2000, through the practices of waste volume reduction at the source and recycling. Des Moines General Hospital summarized the amounts of waste they had generated over the past two years and realized that their generation rate had actually increased. In July, 1994 they contacted the Iowa Waste Reduction Assistance Program (WRAP) and asked for an on-site assessment to be conducted at their facility.

Change Des Moines General Hospital (DMGH) has implemented many of the recommendations made by the Waste Reduction Assistance Program (WRAP) from both the on-site assessment and the follow-up workshop. The latter helped to outline the components of successful facility wide pollution prevention plans. DMGH used data collected to quantify waste streams as an indicator for successful waste reduction and improved recycling programs. Some of the action steps already taken by the committee are as follows:

Established a hospital wide non-hazardous waste management policy which has been

Monitored existing recycling and source reduction activities for successful implementation approved by the President & CEO and added to Safety Manual.

using quantities reduced. (continued on back)

900 East Grand Avenue Des Moines, IA 50319-0034 Ph: 515/281-8927

Fx: 51 5/281 -8895




Made improvements to the existing recycling programs for batteries, pop cans, white paper,

Beginning to analyze “desk top” recycle programs for implementation A review of infectious waste procedures was referred to action by the Safety Committee Director of Dietary was contacted in regards to reusable products and source reduction of

Purchasing developed specifications and has contracted to replace the oxygen tank with an

Revised procedures for operating the incinerator following the recommendations of WRAP.

old linens, and plastics.

cardboard.

improved system.

Savings/Other Benefits DMGH has made a commitment to reduce the amount of waste it generates to meet Iowa’s waste reduction goals. By the implementation of the above projects and measurement of wastes reduced it will be possible to monitor progress and program effectiveness. Decreased waste generation will save DMGH money in purchase costs, handling costs, and disposal costs. Employee involvement in recycling and waste reduction programs will help create the environment needed to be successful.

CASE SUMMARY COMPANY Des Moines General Hospital

LOCATION Des Moines, Iowa Karen Knape Polk County 515/263-4 147

PRODUCT/INDUSTRY Health Care Services (SIC Code 8000)

WASTE STREAM Oxygen Cost

MODIFICATIONS Appropriately size storage facility to accommodate larger purchases.

BENEFITS 25.3% reduction in cost for oxygen purchases. A two-year payback on upgraded equipment.

Opportunity Des Moines General Hospital is a full service hospital with an average patient population of 139 and 700 employees operating on a three-shift basis. The hospital asked the Iowa Waste Reduction Assistance Program (WRAP) to conduct an on-site assessment at the facility in July 1994. WRAP encouraged DMGH to review the gas systems in detail for improved maintenance. In the process of doing this, the hospital identified an additional opportunity and shared the following information with WRAP.

The existing oxygen storage and distribution system was of a size and in a location that required frequent deliveries of relatively small amounts to keep the unit filled to required levels. Space constraints and accessibility allowed only small vehicles to make deliveries. This directly affected the cost of oxygen.

Change A new 6,000 gallon capacity tank replaced the old 1,517 gallon oxygen storage tank. Adequate roads were built to accommodate the use of a full size over-the-road semi-tanker truck to fill the tank. Before the changeover, two deliveries were required each week to maintain adequate supply. The larger tank enables deliveries of about one time each month to maintain adequate supply. This avoids the need for the local oxygen distributor to transfer to a smaller tanker truck for delivery. All of this directly affects the cost of oxygen.

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Case Med95-11 Page 2

Savings/Other Benefits Actual performance data is not yet available. The following presents the project justification:

This is a 25.3% reduction in cost per cubic foot. The savings reflect decreased unit cost for bulk quantities and decreased handling expenses.

Other benefits include: Upgraded piping that will reduce losses from leakage. Less frequent purchase orders and fewer accounting requirements. Improved productivity. Enhanced safety.

WRAP encourages all clients to review compressed gas systems in detail. Improved supply logistics can often lead to safer, more efficient operations in addition to reducing costs.

The Environmental Protection Agency- Region 7 of Kansas City granted the Iowa Department of Natural Resources' Waste Reduction Assistance Program (WRAP) a set-aside grant to work with Iowa's health care industries. The Waste Reduction Assistance Program utilizes senior industry professionals, consultants, and engineers to conduct on-site waste reduction opportunity assessments.

A group of advisors from the Iowa Hospital Association, the Iowa Society of Hospital Engineers, the Iowa Medical Society, the Iowa Department of Public Health, the Iowa Waste Reduction Center, the Waste Management Assistance Division of Iowa Department of Natural Resources, and the Environmental Protection Agency provided guidance for all phases of this project in the form of sponsorship and promotion of the project.

A total of seven health care facilities had on-site assessment conducted by the WRAP team. The following case summaries represent some of the exemplary projects health care facilities are doing to prevent pollution and save money. If you would like additional information please contact the Waste Reduction Assistance Program in Des Moines, Iowa at 515-281-8927.

pollution prevention works for iowa: health care case...

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