1995 N.H. Pollution Prevention Internship Program
Internship Final Report
Project Title:
Waste Management Plan
Intern:
Lauren Desrochers
Home Phone: (603)926-7789
14 Tobey St.
Work Phone: (603)628-2114
Hampton, N.H. 03842
Fax: (603)647-4420
E-mail:
laurend@christa.unh.edu
(when faxing:
Lauren Desrochers
Facilities Management)
Facility:
Elliot Hospital
1 Elliot Way
Manchester, N.H. 03103-3599
Contact Person:
Dave St. Laurent
Operations Foreman, Facilities Management
(603)628-2295
EXECUTIVE SUMMARY
Elliot Hospital, located in Manchester, New Hampshire, was in need of a pollution
prevention student intern to research various parts of the facility. This included things as a
recycling program for solid wastes (i.e. batteries, ballasts, aluminum, glass, and paper, etc.), a
hazardous waste management plan, various hazardous chemicals (i.e. nitrous oxide, ethylene
oxide, mercury, formalin, and xylene), emergency eye wash stations, community needle
collection plan, reviewing the accuracy of the MSDS books for the hospital and the laboratory,
and a Hazardous Materials and Waste Management section for the Environment of Care Manual.
Ida began with the solid waste recycling program leaving myself to take a closer look at the
hazardous waste streams within and leaving the hospital. This meant looking at each individual
waste stream to see which department the waste originated from as well as what chemicals were
contained within the waste stream.
Several departments were surveyed and investigated. Following this procedure,
recommendations were made for their waste streams. An emergency eye wash survey was part
of this research. Several departments were found to have been using potentially dangerous
chemicals without the accessibility of an eye wash station. From this discovery,
recommendations for the installation were made and taken to the Safety Committee meeting for
approval. The community needle collection plan is currently being reviewed by the Safety
Committee and once passed through will be sent to the state for signature of approval. This plan
will then be moved to higher personnel within the hospital and once approved will be
implemented. The Hazardous Materials section of the Environment of Care Manual was created
using the CMC version as background information. Procedures for both hospitals are very
similar, therefore causing many areas of the manual to remain the same. A hazardous waste plan
packet has also been put together for future investigation of this subject. This is a packet of
information that anyone can pick up and read to learn the codes and regulations that must be
followed to recycle or dispose of hazardous waste. Working with a master list of chemicals and
the over fourteen hundred MSDS sheets, I went through one by one to make sure these were the
same. Lastly I tried to learn as much as possible about everything and anything in the short time
I had at Elliot Hospital.
INTRODUCTION / BACKGROUND
Elliot Hospital was founded in 1890 and is located in Manchester, New Hampshire.
Today Elliot Hospital is part of Optima Health due to a merger with Catholic Medical Center
(CMC) in February of 1994. Elliot is a very large facility serving the city of Manchester as well
as surrounding cities and towns. Elliot employs approximately twenty-five hundred people with
four hundred fifty beds for service.
One of the projects to complete during the internship was to look closely at all waste
streams leaving the hospital. About fifty percent of all waste leaving the facility is considered
infectious waste and is incinerated. “Infectious waste is any waste which, because of its
infectious nature, may cause or significantly contribute to an increase in mortality or an increase
in serious irreversible or incapacitating reversible illness; or pose a substantial present or
potential hazard to human health or the environment when improperly treated, stored,
transported, disposed of or otherwise managed.” (NHDES Technical Bulletin #WMD-1993-10).
The solid waste makes up most of the remaining fifty percent and most of this is also
incinerated. This includes any waste that is not considered to be infectious or hazardous. Any
small amount left is attributed to the hazardous waste generated here at the hospital. This waste
is disposed of by off site vendors. This hazardous waste primarily originated in the laboratory
and the OR. The last portion of waste is the incinerator ash. This is tested to see if is hazardous,
then will be disposed of accordingly. Approximately ninety percent of all waste generated at the
hospital is incinerated. About four thousand pounds of waste is burned daily. Heat from the
incinerator generates steam to control the temperature of the hospital, either to heat or cool the
facility.
GOALS / OBJECTIVES
There are numerous bad habits that take place at the hospital that have been developed
over the years. My main goal was to try and break some of these long standing bad habits.
When I first arrived at Elliot Hospital, I did not know where to begin. I walked through the
facility and saw so many things that needed to change. This was only the first and easiest step to
originating a plan. This step makes up for approximately one percent of the overall plan. The
second step is to determine how things will change for the better. This is about four percent, and
requires researching codes and regulations to be followed. The last and most difficult step is to
actually implement the plan. This accounts for the remaining ninety-five percent of a procedure.
The first subject I looked at was the Material Safety Data Sheets for the hospital and the
laboratory. I was given a master list and all the MSDS sheets and needed to compare accuracy of
the two.
The second project was to survey the emergency eye wash stations within the hospital. I
answered the following questions for each department:
1.
2.
3.
4.
5.
Does the department have an eye wash station?
Is it plumbed? (Does it use city water?)
Is it covered?
Is it signed?
Is it accessible?
Once these questions were answered I made recommendations for the addition of eye wash
stations in several departments. These recommendations were taken to the Safety Committee
meeting for approval. All locations were approved leading to the implementation of this project.
Memos will be sent out to the departments informing them that each individual department is
responsible for funding for the eye wash station and Facilities Management will install them.
Another project consisted of typing the Hazardous Materials and Waste Management
section of the Environment of Care Manual. This manual is a sort of instructional book for the
hospital, including topics as codes, department responsibilities, and fire safety. This explains just
about any kind of action to be taken for various problems or concerns. CMC currently includes
this section in their manual and was used as a guide in creating this for Elliot.
The next project consisted of forming a Hazardous Waste Management Plan. I took a day
to spend at the New Hampshire Department of Environmental Services, gathering as much
information as I could find. It turns out that the NHDES has just made a plan for Hazardous
Waste Management including all the regulations to comply with. It is a condensed version of the
Hazardous Waste Management in New Hampshire Manual. A packet of materials has been
bound together including Small and Full Quantity Generator Requirements, RCRA Checklists,
the Pitstops Manual, as well as this plan created by the NHDES. This packet will be turned over
to the person implementing this program.
Another project to look at was the most dangerous materials in the facility. These
include: gludaraldehyde or cidex, formalin, formaldehyde, xylene, nitrous oxide, and ethylene
oxide. The goal for the cidex, which is used as a sterilant and disinfectant, was to limit the
number of departments containing this chemical. This meant researching which departments had
cidex and what it was used for. The next step was to try to eliminate the chemical by using
another method, possibly combining departments that were close to eachother to only have one
supply instead of two.
My final goal was to create a community needle collection plan. This would involve
researching the various regulations to comply with and developing a working plan based around
these regulations. Researching the incinerator permit as well as state regulations that needed to
be followed. The plan would be for people who have diabetes etc. and use needles at home.
This program would provide a safe way to dispose of these hazardous and possibly infectious
materials. The needles would need to be put in a plastic soda bottle before being deposited into
the mailbox type of container for disposal.
APPROACH / METHODOLOGY
The first few weeks here I spent going to orientation, reading the Environment of Care
Manual, and investigating how things are currently run here. This was some essential
background information to learn before I began any projects. It was also important to learn how
things were run in the past and whether this was successful.
A very similar approach was used on each of the projects. The first step was always to
research and collect as much information as possible. Researching if and how it was ever done
before within the hospital and then contacting other facilities to see if they have a similar
program. Regulations for storage, usage, disposal, and transportation were researched when
looking at the hazardous materials.
For the emergency eye wash stations, I first took a tour of the facility to see how the
currently used eye wash stations were set up. Based on this information obtained from the tour
and researching the required regulations, I was able to make recommendations for several
departments to have the addition of an eye wash station.
The community needle collection plan also required an abundance of researching
regulations. This required investigating the incinerator permit to determine if burning
community product was acceptable. Once this was ruled safe and that the incinerator permit
would not have to be changed, I could move forward to research how a program such as this
could work, and not put anyone at danger of injury or exposure. It was determined that a
mailbox type collection bin would be ideal. This box would be outside and accessible to the
community and at the same time, closely monitored by the staff here at Elliot. It has to be bolted
into the ground and securely locked at all times. If any problems arise that can’t be taken care of
the program will be terminated.
The Hazardous Materials and Waste Management section of the Environment of Care
Manual was almost identical to that of CMC’s version. Most procedures are the same at the two
hospitals making the Elliot section easy to create. Obtaining background information during the
first few weeks was helpful here. I was able to make the necessary changes from CMC to Elliot.
CHEMICAL USAGE / EQUIPMENT NEEDS
None
RELEASES / WASTES GENERATED AT THE FACILITY
There are many wastes generated at a hospital, from solid to infectious to hazardous.
Most of the hazardous waste originates in the laboratory while the majority of the infectious
waste is from the operating room. The nonhazardous, noninfectious solid waste comes from all
over but mostly from the kitchen. The laboratory waste includes such materials as:
formaldehyde, formalin, xylene, and mercury. The infectious waste includes a number of items:
sharps, radioactive materials, chemotherapeutic materials, and blood or blood products. A major
gaseous waste is nitrous oxide, otherwise known as laughing gas. Waste is produced any time
anesthesia is administered within the hospital. Rooms should be well vented and have constantly
circulating air to dispose of this gas.
WORK ACCOMPLISHED / PROJECT RESULTS
There were many projects that were completed in my ten week stay at Elliot Hospital.
Some of these included:
1. Organized the MSDS books
2. Eye wash station survey
3. Consolidated gludaraldehyde (cidex)
4. Hazardous Waste Management Plan
5. Hazardous Materials section of the Environment of Care manual
6. Nitrous Oxide Report
7. Ethylene Oxide Alternatives
8. Collected information for CFC Refrigerants
9. Infectious waste control
10. Community needle collection plan
11. Marketing for recycling
The largest result from this work is that Elliot Hospital is a safer place. With some of
these results, the hospital will be more likely to pass the Joint Commission Accreditation for
Hospital Organizations (JCAHO) inspection in the fall. Some of these areas were not in
compliance and now they currently are. Another large result was that people working in the
facility may have learned a few things. Many of the employees didn’t realize they needed an
emergency eye wash station until I explained the reasoning. I felt good that I was able to make
other people aware of the danger they may work with everyday.
POLLUTION PREVENTION BENEFITS
The benefits to my work are that I lessened the amount of possible injury to employees,
patients, and visitors in the hospital. I also assisted Ida in her recycling program, therefore
reducing waste in this field is a definite benefit.
RECOMMENDATIONS FOR FUTURE EFFORTS
The only recommendation is to have someone follow the path I have created. Don’t let
the work I’ve done come to a halt. I would like to see the installation of the emergency eye wash
stations, the MSDS books to remain organized and up to date, and finally to see the needle
collection plan be approved and implemented.