United States
Environmental Protection
Agency
Risk Reduction
Engineering Laboratory
Cincinnati, OH 45268
Research and Development
EPA/600/S2-91/024 Aug. 1991
&EPA Project Summary
Hospital Pollution Prevention
Case Study
In this study, the U.S. Environmental
Protection Agency (EPA) Investigated
the disposables used in patient care at
the U.S. Department of Veterans Affairs
Cincinnati Hospital and the associated
Fort Thomas Medical Center (DVA-Cin)
to identify future opportunities for mini-
mizing solid waste. These facilities al-
ready practiced effective waste minimi-
zation, particularly in their use of du-
rable cloth gowns and drapes. The waste
minimization Assessment Team found
several additional opportunities to mini-
mize waste generation, e.g., using com-
mercial reprocessing of Petri dishes
rather than disposing of them; reassess-
ing the use of surgical sponges and
chucks so they are not employed where
reusable linens could be substituted.
This Project Summary was developed
by EPA's Risk Reduction Engineering
Laboratory, Cincinnati, OH, to announce
key findings of the research project that
Is fully documented In a Separate report
of the same title (see Project Report
ordering Information at back).
Introduction
The EPA has instituted a broad pollution
prevention research program through its
Office of Research and Development to
support continued environmental improve-
ments throughout the nation. The Agency is
also responding to the national concern in
regards to the generation and disposal of
medical wastes.
To effectively implement its pollution pre-
vention programs, the EPA is also investi-
gating how the departments and agencies
within the Federal community can help each
other reduce "waste generation." As a part
of these efforts, EPA's Risk Reduction En-
gineering Laboratory (RREL) provides staff
and support to conduct waste minimization
assessments under the Waste Reduction
Evaluations and Assessments at Federal
Sites (WREAFS) Program. Under the
WREAFS program, the DVA-Cin offered to
host an assessment of pollution prevention
opportunities at their facilities. This study
investigated the use of disposables in pa-
tient care in order to identify research op-
portunities for future solid waste minimiza-
tion.
The dramatic rise in hospital and health
care costs throughout this decade is com-
monly attributed to the cost-plus-fee reim-
bursement structure of medical insurance.
Under this system, the health care facility is
able to pass on direct costs, a portion of
overhead costs, and service fees to each
patient for eventual reimbursement by an
insurance carrier following an established
rate scale.
Department of Veteran's Affairs' facili-
ties, however, are not reimbursed for health
care services; each facility operates under
a budget fixed by the Department for the
fiscal year. Therefore, individual facilities
such as DVA-Cin are very sensitive to cost,
since achieving cost savings translates into
an ability to extend their services.
Because an earlier study had previously
emphasized the opportunities for hazard-
ous waste minimization, RREL and DVA-
Cin chose to look for pollution prevention
alternatives for minimizing the discarded
medical supply wastestream. The DVA-Cin
is uniquely suited to such a study because
of the cost sensitivity of DVA facilities. The
need to deliver services under a fixed bud-
get has led DVA-Cin both to adopt and to
continue practices that reduce the amount
of waste and, hence, reduce possible pollu-
tion. For example, the DVA-Cin Medical
Center carefully segregates its waste to
minimize the volume that will have to be
transported by the infectious waste hauler
(unit costs for infectious waste disposal far
exceed those for general refuse). Also, tak-
ing advantage of its access to a DVA-oper-
ated laundry in Dayton, Ohio, DVA-Cin still
uses durable cloth gowns and drapes
(wovens) instead of the disposable paper
garments. Hospital staff with work experi-
ence in other Cincinnati area hospitals esti-
mated that DVA-Cin's consumption of dis-
{>_T; Printed on Recycled Paper
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posable gowns and drapes was the lowest
in the metropolitan area.
Disposable Waste Profile
The majority of waste generated by a
hospital consists of disposable products.
According to DVA-Cin personnel, approxi-
mately 80% of the hospital's supplies are
disposed of after a single use. The DVA-Cin
saw a change f rom reusables to disposables
10 to 15 years ago and an additional in-
crease in the use of disposables in the last
2 to 3 years, because of concern over both
patient safety and staff occupational expo-
sure to the AIDS virus. Therefore, the in-
crease results from greater use of existing
disposable supplies (i.e., single-use sponges
for patient surgery, and disposable gloves
and masks worn to protect hospital staff and
prevent cross contamination) rather than
from the use of newly developed disposable
items.
This section profiles the major dispos-
able items ordered by these DVA-Cin de-
partments: Laboratory Services; Surgery;
Surgical Intensive Care Unit (SICU); 5 South
(a patientfloor); Medical Intensive Care Unit
(MICU); Hemodialysis; and the Outpatient
Clinic.
Laboratory Services
This department performs analyses on
specimens taken from patients. In a nine-
month period ending June 30, 1989, the
laboratory had conducted 41,097
venipunctures, 9,935 bacterial cultures,
4,730 blood cultures, 854 fungal cultures,
and 815 tuberculosis cultures. The Labora-
tory consists of four laboratory areas: he-
matology, clinical chemistry, microbiology,
and histopathology.
Hematology Laboratory
Hematology draws and analyzes blood
samples from 50 to 60 patients daily. The
technicians visit the patients to draw samples
and then return to the laboratory to conduct
the analyses. Hematology generates two,
30-gallon bags of infectious waste each
day. It is rendered noninfectious via auto-
claving and is disposed of as general trash.
Sharps (needles, broken glass) are placed
in sharps containers, and those containers
are collected by housekeeping staff for
weekly incineration.
Clinical Chemistry Laboratory
Clinical chemistry conducts urine and
blood serum analyses on samples drawn by
the hematology technicians. This Labora-
tory area also generates just under two, 30-
gallon bags of autoclaved waste each day.
The hemotology and clinical chemistry labo-
ratories are adjacent and share the same
autoclave.
Microbiology Laboratory
The greatest amount of discarded sup-
plies by weight is produced in this Labora-
tory area, because most of the wastes are
glass products. At least three 30-gallon
bags of autoclaved waste are produced
each day from this area.
Histopathology Laboratory
This area is responsible for analyzing
tissue specimens and body parts from sur-
gery and the morgue. Histopathology pro-
duces no more than one, 5-gallon bag of
autoclaved waste per day. Pathological
wastes are incinerated on-site. Disposable
specimen containers containing formalde-
hyde are autoclaved and then incinerated
on-site.
Surgery Department
Surgery handles approximately 15 cases
daily. Surgery carefully segregates wastes
as they are generated. The Surgery Depart-
ment generates between one and two, 30-
gallon bags of blood and body fluid waste
per case, or 15 to 30 bags per day. Approxi-
mately 70% of the waste in these bags is
estimated to be contaminated paper waste.
According to DVA-Cin officials, other Cin-
cinnati hospitals are estimated to generate
three, 30-gallon bags of waste per case.
DVA-Cin maintains its lower, waste-gen-
eration rate through the continued use of
wovens.
The greatest volume of medical supplies
requiring disposal after a single use are
exam gloves and surgical sponges. Surgi-
cal sponges have been reused in the past.
However, these are now disposed after a
single use, because of concerns over the
AIDS virus.
Surgery also uses operating room packs
that are prepared with all the disposable
products necessary for a specific type of
operation. The packs are generally used in
full, although occasionally specific items
may not be used and are wasted.
Sharps are placed in sharps containers,
which are clear-bagged to prevent leakage
and sent to the on-site incinerator. Blood
and body fluid is collected by a contract,
infectious waste hauler for off-site treat-
ment and disposal. All other waste is gen-
eral trash.
Surgical Intensive Care Unit
(SICU)
Almost all of SICU's eight beds are occu-
pied on a regular basis. Cloth gowns are
worn by patients and staff and are laun-
dered for reuse. Procedure trays are
resterilized on-site and reused. However,
SICU staff would like to use disposable
packs such as those used in surgery.
Waste is segregated into three catego-
ries: sharps, blood and body fluids, and
general trash. Blood and body fluid waste(s)
generated by SICU consists mainly of suc-
tion liners and tubes. Foley bags and chest
tubes are flushed of their fluids and placed
in general trash. Intravenous (I-V) bags go
directly into general trash. Sharps are boxed
and incinerated on-site.
Blood and body fluid wastes are strictly
segregated into one to two, 30-gallon bags
per day. However, for those patients requir-
ing isolation, SICU may generate as many
as ten, 5-gallon bags of waste per day for
each patient. The number of patients in
isolation varies.
Five (5) South: Patient Floors
Thirty Six (36) beds, of which 29 to 32 are
occupied at any given time, are located in
Five South. Pre- and post-operative care
services, including administration of medi-
cations and changing of dressings, are pro-
vided in Five South. Cloth gowns are gener-
ally worn on patient care floors, although
disposable gowns are used whenever cloth
is unavailable.
Waste is segregated into sharps, blood
and body fluids, and general trash. One to
two, 30-gallon bags of blood and body fluid
waste are generated per day. In practice,
nurses often dispose of nonblood and body
fluid waste(s) into the blood and body fluid
waste container.
Medical Intensive Care Unit/
Cardiac Care Unit (MICU/CCU)
The MICU/CCU has eight beds, all of
which are constantly occupied. MICU/CCU
reuses woven gowns and pressure bags.
Pressure bags are used to introduce blood
to a patient and are cleaned for reuse.
Waste is segregated into sharps, blood
and body fluids, and general trash. How-
ever, the Assessment Team again noticed
that the segregation procedures were not
always implemented by the staff. For ex-
ample, empty disposable urinals were ob-
served in the blood and body fluid contain-
ers.
Hemodialysis
This unit has nine treatment stations.
Treatment occurs in shifts, and the unit has
a capacity to treat 55 patients each week.
Treatment takes about 5 hours.
Nearly all products are disposable, in-
cluding aprons and masks. As is common
practice in many hospitals, disposable dia-
lyzers are resterilized and reused approxi-
mately 20 times before disposal. The prac-
tice of reusing disposables in health care is
controversial and is discussed further in this
report.
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At least four, 30-gallon bags of bbod and
body fluid are generated each day. Most of
the disposable items are discarded in the
blood and body fluid containers. Sharps are
placed in sharps containers, clear-bagged
and incinerated.
Outpatient Clinic
The clinic services approximately 500
patients each day. The services include:
surgical procedures; medical exams; chem-
otherapy, dermatology; urology; plastic sur-
gery ; orthopedics; and ear, nose and throat.
Plastic-coated paper gowns are worn for
chemotherapy procedures (which are dis-
posed of as cytctoxic waste) and often for
other outpatient treatment and procedures.
Reusable wovens include sheets, pillow
cases, towels, and blankets. Badly soiled
linens are often discarded rather than laun-
dered. Gomco suction apparatus, suture
removal sets, and scalpels are all reused.
The Outpatient Clinic fills one, 30-gallon
bag of blood and body fluid wastes each
day. Chemotherapy wastes are packaged
in white plastic containers, and eventually
transported to final disposal, off-site, by a
licensed cytotoxic waste hauler. Sharps are
handled as previously indicated for other
areas.
DVA-CIn Waste Generation
Compared With Other Hospitals
On average, hospitals generate between
0.5 and 4 Ib of infectious waste per patient
each day. The DVA-Cin facility produces
approximately 0.6 Ib of infectious waste per
patient each day, placing DVA-Cin at the
low end of the spectrum.
Infectious waste is defined differently in
different states. For example, under Ohio
regulations, OVA-Cin is able to classify its
laboratory wastes as general trash after
autoclaving. However, a hospital in New
Jersey would continue to list such wastes as
infectious, despite the autoclave treatment.
If the quantity of infectious wastes at DVA-
Cin included laboratory wastes, the genera-
tion rate would increase to 0.87 Ib per pa-
tient per day — still quite low when com-
pared to that at other hospitals. As with
other areas, the continued use of wovens at
DVA-Cin is probably the primary reason for
this lower rate.
Pollution Prevention
Opportunities at Hospitals
In addition to developing the waste pro-
files presented above, the Assessment
Team identified and evaluated the opportu-
nities to minimize waste. This analysis in-
cludes discussions of issues affecting deci-
sion-making; the benefits/costs of dispos-
able versus reusable products; the repro-
cessing of disposable items intended for
single-use; the factors that combine to pro-
mote reliance on disposables; and the abil-
ity to implement better operating practices.
Choosing Between Disposable
and Reusable Products
Four major factors support the medical
profession's preference for disposables.
These are: health and safety; cost; conve-
nience; and space constraints. With the
advance of technology, intricate devices
are mass-produced and sold as single-use
items. They are prepackaged and sterilized
to relieve the hospitals of quality assurance
concerns related to reuse. Thus, labor and
reprocessing costs are being replaced by
the 'apparently' lower costs of treatment,
destruction, or disposal of single-use mate-
rials. Packs of disposable goods are cus-
tom-fitted, used and discarded, alleviating
operating room (OR) prep time and simpli-
fying inventory control.
An excellent example of how cost and
convenience affected decision making can
be found in the demise of hospital laundries.
Hospital laundries experienced a rising de-
mand for all linen products because inpa-
tient services increased at the time that
disposable products were being introduced.
Older laundering operations were unable to
process and sterilize the increased load.
Acquiring disposable linens ensured an
adequate supply of products, relieved an
overburdened laundry, and provided cost
savings by allowing hospitals to abandon or
further downgrade this service, rather than
invest in capital improvements. The As-
sessment Team forthe DVA-Cin Study sug-
gested that the DVA-Cin's use of linens,
processed at the Dayton laundry, was a
significant factor in explaining DVA-Cin's
very low waste generation rate.
Reusing Single-Use Devices
Hospitals and other health care facilities
have attempted to reduce costs by repro-
cessing disposable, single-use devices/
products. The most commonly reused dis-
posable products are hemodialyzers, car-
diovascular catheters, respiratory therapy
breathing circuits, biopsy needles, cautery
devices, anesthesia breathing circuits, and
endotracheal tubes. Although the issue of
reusing disposable devices is highly de-
bated, health care professionals agree that
if a product is to be reused it must be as
functional, sterile and safe as when new.
In making this decision, health care pro-
fessionals must consider the possibility of
disease transmission or infection, assump-
tion of product liability, reliability, and cost.
The less critical an item, the more likely it
can be reused. For example, because a
bedpan is considered to be a noncrrtical
item by the Center for Disease Control
(CDC) and the risk of infection is minimal,
reuse could be considered. An arterial
embolectomy catheter, however, is consid-
ered critical, and the potential risks from
reuse are great. Hospitals will always choose
health and safety over issues of economics
or waste neutralization.
Factors Affecting Continued
Reliance on Disposables
Infection control is the primary limiting
factor when considering reusable, or 'du-
rable', products and/or reuse of disposable
products as a means for reducing the rate of
waste generation and the associate waste
handling costs. The CDC's Universal Pre-
cautions state that all blood and body sub-
stances must be treated as potentially in-
fectious. As the first line of defense against
pathogen transmissionsfrom these sources,
the medical community employs physical
barriers including: gloves, protective cloth-
ing, masks and eye protection. Single-use
versions of these above items, which are
intended for personnel protection, provide
hospitals with added assurance against
accidental transmissions because they are
used once, rendered noninfectious through
autoclaving and either hauled off-site as
general trash or incinerated on-site. This
practice eases the quality control burden for
the hospital.
Another obstacle to converting back from
a single-use to a reuseable product or de-
vice is that such products may no longer
exist or may be too expensive to employ.
The DVA-Cin procurement office indicated
that use of disposable products had, in
many instances, completely eliminated the
market for durable goods. As a result, the
durable version is either no longer available
or only available through special-order sup-
ply companies unable to guarantee long-
term availability, unable to provide suffi-
ciently large quantities, or both. These con-
ditions, in turn, drive up the cost of the
durable versions, potentially making them
cost-prohibitive.
Specific DVA Pollution
Prevention Opportunities
A wide variety of disposable devices,
such as syringes, hemodialyzers, Petri
dishes, and bedpans, contribute to thegrow-
ing waste streams from DVA health care
facilities. To successfully reduce waste, DVA
hospitals must reconsider applications of
single-use devices/products and evaluate if
these disposables are still the most appro-
priate option. If a reusable version can pro-
vide comparable reliability, sterility, and
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safety, it would be reasonable to consider
reverting to reusable versions. Moreover,
when the hospital is reprocessing single-
use devices, use of the more durable ver-
sion would be even more attractive, be-
cause it would have a longer use life and
use of the disposable version has not re-
lieved the hospital of resterilization require-
ments, quality assurance checks, and all
associated labor and management costs.
Because of the diversity of the areas
toured at DVA-Cin, it is appropriate to dis-
cuss pollution prevention opportunities by
work area. The major waste minimization
opportunities for each area are summarized
as follows.
Laboratory Services
Nearly all items used in Laboratory Ser-
vices' areas are disposable. Glass products
consist of test tubes, sample cups, Petri
dishes, slides, pipettes, and pipette tips.
Although, in most cases, glass could be
reprocessed for reuse, immediate treatment
and disposal lessens handling time and
decreases the chance of exposure to acci-
dents and spills.
Plastic products (e.g., pipettes, pipette
tips, test tubes, testing items, specimen
bags, cuvette rings, etc.) are autoclaved
and disposed of after a single use. Of these,
only cuvette rings are reused, because of
their high unit cost. Since the only good,
durable substitutes for plastics are made of
glass, and glass is not reprocessed, substi-
tution in this case would only increase the
weight of the wastestream.
One significant exception to the above,
however, may be in the Microbiology Labo-
ratory, which disposes of 1500 Petri dishes
each week. Because the dishes are glass,
there is an opportunity to reprocess the
dishes and prepare them with new media.
Although they are difficult to clean and agar
preparation is very labor intensive, use of an
off-site reprocessing facility should be con-
sidered. Such an alternative would allow
the lab to continue functioning, without the
disruption of inhouse reprocessing activi-
ties, and would significantly decrease the
weight and volume of the wastes generated
in the laboratory. As there are eight other
large hospitals within a two-mile radius of
DVA-Cin, recycling of petri dishes would
seem to offer a reasonable entrepreneurial
opportunity.
Surgery
DVA-Cin extensively uses woven gowns,
drapes, and instrument wraps, throughout
the Hospital. Thus, greatest volume and
weight of disposables in medical wastef rom
surgery consist of surgical sponges and
exam gloves. Although waste sponges
should continue to be considered poten-
tially infectious, it would be worthwhile to
investigate, as a waste minimization alter-
native, whether sponges are being also
used for purposes better suited for absor-
bent, reusable towels (i.e., cleanup activi-
ties).
SICU/MICU/CCU
The major disposable products used in
this Hospital area are catheters, tubing,
suctioning equipment, I-V bags, needles
and syringes. Catheters, tubing, and
suctioning equipment come into contact
with body fluids during use and must be
treated as potentially infectious. In accor-
dance with Universal Precautions, needles
and syringes are destroyed in a medical
incinerator. I-V bags, however, never come
into contact with body fluids and remain
unoontaminated during use. Therefore, plas-
tic I-V bottles could be safely reused for a
single patient, and should be considered as
a substitute for the I-V bags. ,
Five South: Patient Floors/
Outpatient Clinic
The disposable products regularly used
on the patient floors include suctioning equip-
ment, tubing, catheters, blood transfusion
equipment, chucks, and dressing supplies.
Because of the inherent contact with blood
and body fluids, these products are as-
sumed to have a high risk of disease trans-
mission. Thus, the only pollution prevention
option suggested is in the use of chucks.
Chucks act as linen and surface protectors,
absorbing blood and body fluids, so that the
reusable linens do not become grossly soiled
and surfaces will be easier and safer to
clean. Chucks are present throughout the
hospital; for example, because of their ease
of use, chucks are used in the laboratories,
as well, to contain small spills at work sta-
tions. DVA-Cin, may want to review the use
of chucks to determine whether their avail-
ability has led to use in situations where
they are not needed.
Hemodlalysls
The major disposable products in this
ward are I-V bags, tubing, gloves, and dia-
lyzers. With respect to high-tech items,
hemodialyzers are believed to be the only
devices, studied by the health care profes-
sion in sufficient depth, to showthat function
is not impaired through reuse. With this
technical knowledge as evidence of safety
and reliability, hospitals are able to write
policies allowing dialyzer reuse as a waste
reduction option.
At DVA-Cin, the dialyzers are reused
approximately twenty times before their dis-
posal.
The reuse of dialyzers has been found to
be a common practice in health care institu-
tions. An informal survey on the reuse of
disposables, conducted at the 1984
Georgetown University International Con-
ference, showed 46% of the respondents
reporting the reuse of this item in their
institutions.
Additional Observations on
DVA-Cln's Pollution Prevention
Efforts
This DVA hospital has already realized
many of the waste reduction opportunities
arising from product substitution and waste
segregation practices. The hospital's stan-
dard use of wovens is a significant part of
the reason that DVA-Cin's waste genera-
tion rates are so low in comparison to indus-
try average. For example, the use of wovens
in surgery accounts for the fact that DVA-
Cin produces 50% to 65% of the waste
normally produced during operations in Cin-
cinnati area hospitals.
There has been some consideration by
DVA-Cin on the reprocessing of glassware.
The recycling of glassware made from
sodalime (e.g..pasteur pipettes) may greatly
reduce the volume and weight of a hospital's
current wastes. A large percentage of the
glassware used in laboratories is, however,
made of borosilicate, which cannot be re-
cycled with general consumer waste glass.
Also, despite the reliability of disinfection
from autoclaving, there is a stigma ascribed
to medical waste that may restrict or elimi-
nate recycling as a pollution prevention
option. Community recycling centers should
be contacted regarding their policies for
accepting waste glass from health care
facilities.
The Outpatient Clinic uses both woven
and plastic-coated paper gowns. For most
treatments, the woven gown is a safe, reli-
able barrier against infection and should be
the primary gown worn by the Outpatient
staff. The use of the paper gowns are best
limited to those treatments, such as chemo-
therapy, that require more stringent infec-
tion control and increased personnel pro-
tection.
Research and Development
Opportunities
In conducting these studies, RREL also
looked for those areas in which research
and development may support advancing
new alternatives. In learning of the con-
cerns, difficulties, and successes of the
health care profession, RREL hopes to ex-
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pand EPA's experience in the medical waste
area to provide a solid basis for planning
future research. Suggestions for further re-
search in the health care industry are pre-
sented below.
Evaluate Reuse Potential of
Single-Use Devices
Hemodialyzers are reused because the/
have been closely studied and evaluated to
determine that "such reuse neither impairs
thef unction nor compromises patient safety."
Most other disposable products have not
yet been studied in sufficient depth to make
reliable determinations of their suitability for
reuse. A cooperative effort could be estab-
lished between EPA and representatives of
the health care community to undertake
research that would provide substantive
data to either support or reject specific re-
use considerations. Research data of these
kinds would give health care professionals
a firm basis on which to make such deci-
sions, as well as the potential to discover
cleaner alternatives to some of the dispos-
able products being reused.
Quality Assurance
Manufacturers' disclaimers of warranty
after reuse are among some of the more
important legal and ethical considerations
associated with the reuse of disposables.
Although there is agreement that manufac-
turers can offer a higher assurance of steril-
ity than can an individual health care facility,
research conducted by the EPA, in coop-
eration with health care professionals, other
Federal agencies (such as the Food and
Drug Administration), and trade associa-
tions, could form the basis for developing a
protocol for reuse that would give hospitals
standards for operating procedures and in-
stitutional policies.
Hidden Cost Factors
When comparing the relative costs of
disposables versus reusables, the unit cost
of a disposable often does not represent the
full cost of actually using that product. Dis-
posal costs are becoming an increasingly
important factor, as landfill and incineration
regulations become increasingly more strin-
gent. Conversely, reusable products also
carry storage and handling costs. Analytical
studies in conjunction with health care facili-
ties, to quantify these costs conducted by
EPA, would act as an aid in decision mak-
ing.
Development of Reprocessing
Capacity
Two pollution prevention alternatives cited
by this paper involved reprocessing ser-
vices. Space and labor constraints, coupled
with thegeneral availability and convenience
of disposables, appear to be the major
obstacles to on-site reprocessing of durable
materials. As health care cost containment
gains increasing importance, reprocessing
may become cost effective for some items.
The potential for developing a local repro-
cessing capability should be explored, par-
ticularly where there is high density of medi-
cal facilities.
Developing a Reusable Market
Certain bills in Congress to amend the
Resource Conservation and Recovery Act
(RCRA) will require that Federal agencies
meet certain objectives for use of recyclable
products. Together, the EPA and DVA
should consider developing procurement
guidelines forthe DVA that will stimulate the
production and distribution of reusable and
recyclable products.
Conclusions
The waste reduction Assessment Team
was impressed by the difficult challenges
undertaken by the DVA-Cin hospital profes-
sionals to perform their duties of human
care while attempting to minimize the effect
of those activities on the environment. Fol-
low-up discussions indicate that this is a
dynamic process for DVA-Cin, as it devel-
ops initiatives in training, information shar-
ing, and cooperation with other Federal
agencies.
EPA intends to pursue future cooperation
with DVA to seek health care professionals'
advice and guidance in planning and imple-
menting research programs to respond to
the needs of the medical community in the
areas of hazardous waste, infectious waste,
and other wastestreams. Opportunities to
reduce these wastes do exist, and addi-
tional opportunities would likely be uncov-
ered through research. Research would
also provide the data on which to make
operational decisions of benefit to health
care facilities, better encompassing envi-
ronmental considerations.
The full report was submitted in partial
fulfillment of Contract No. 68-C8-0062 by
Science Applications International Corpo-
ration under the sponsorship of the U.S.
Environmental Protection Agency.
ft U.S. GOVERNMENT PRINTING OFFICE: 1992 - 64X-OSO/402I9
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This Project Summary was prepared by staff of Science Applications International
Corp., McLean, VA 22102.
Kenneth R. Stono is the EPA Project Officer (see below).
The complete report, entitled 'Hospital Pollution Prevention Case Study," (Order No.
PB91-216 440/AS; Cost: $17.00, subject to change) will be available only from:
National Technical Information Service
5285 Port Royal Road
Springfield, VA 22161
Telephone: 703-487-4650
The EPA Project Officer can be contacted at:
Risk Reduction Engineering Laboratory
U.S. Environmental Protection Agency
Cincinnati, OH 45268
United States
Environmental Protection
Agency
Center for Environmental Research
Information
Cincinnati, OH 45268
BULK RATE
POSTAGE & FEES PAID
EPA PERMIT NO. G-35
Official Business
Penalty for Private Use $300
EPA/600/S2-91/024
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