INSIDE:
Integrated Pest Management in Healthcare Facilities
Page 9
Asepsis: Still a Best Practice in Infection Prevention and Control
Page 11
Recommended Practices in the Care of Healthcare Laundry
Page 13
Framing Your Practice in Sustainability
Page 19
Determining Appropriate
Surface Disinfection: Tech Talk
Page 21
Evidence Based Practice in
Pharmaceutical Waste Management
Page 24
2012 | Volume 32 | Number 2 | Quarter 2

3 President’s Message
Evidence-Based Practice
Kent L. Miller, MHL, CHESP
6
7
4 About AHE
5 Leadership
AHE 2012 Calendar
AHE Chapter Events
8
9
New Members
Integrated Pest Management in Healthcare Facilities
11 Asepsis: Still a Best Practice in Infection Prevention and Control
13 Recommended Practices in the Care of Healthcare Laundry
15 EXCHANGE 2012
18 AHE Updates
19 Framing Your Practice in Sustainability
21 Determining Appropriate Surface Disinfection: Tech Talk
24 Evidence Based Practice in Pharmaceutical Waste Management
27 CHESP

I would like to offer the following for your consideration: best practice is evidence-based; yes, uninformed practice can do more harm than good; yes, barriers to change do exist; and, yes, you should do something.
Evidence-based practice does not mean utilizing one individual research study. Evidence-based practice requires the use of a methodology that includes developing search strategies, identifying quality data, analyzing all research on a particular practice, synthesizing research, and integrating it with individual expertise. The concept of “best practice” connotes combining the systematic use of evidence with specific knowledge of the individual case. EVS professionals need to continually work to assure the input of best-in-class knowledge on which to base practice, openness to new evidence when encountered, and a process to promote its implementation.
An Institute of Medicine report called for evidencebased practice in 21st-century health care (Greiner
& Knebel, 2003). The concept of evidence-based practice is new in health-care history; but, more and more, it has become an important topic among health-care professionals in the past decade. An increase in the amount of readily-available research and the ability to easily share knowledge mean health-care professionals can no longer rely on an apprenticeship system of learning or implement a particular practice simply because their parents or teachers did so. The conscious and systematic implementation of best practices is dynamic.
AHE created a model to follow related to the Institute of Medicines (IOM) Six Aims for Improvement
(see the AHE website for more information). Aim two from the IOM stresses effectiveness. Likewise, evidence based medicine, fast becoming the
“mantra” of healthcare professionals, focuses on efficacy. Three areas are central to this IOM aim:
(1) best research evidence; (2) clinical expertise; and, (3) patient values that may be unique, individual concerns and expectations that need to be met. The EVS department can work on best Kent L. Miller, MHL, CHESP practice through collaboration with other professionals in the field. Indeed, our organizations are excellent models for this aspect.
Also an effective EVS department would verify that service delivery matches sound science. One example is the use of neutral cleaners on floors versus routine use of disinfectants in non-critical areas. This has been a debate for many years.
The Centers for Disease Control and Prevention
(CDC)’s guidance document titled Guidelines for
Environmental Infection Control in Health-Care
Facilities served as a catalyst for open discussions on floor care (n.a., 2003) with the assertion that the use of disinfectant on non-critical surfaces such as walls and floors is no longer necessary.
In this current issue of The Phoenix Newsletter we present a number of articles which examine evidence-based practices as well as promising practices.
Articles include practices for pharmaceutical waste management, environmental cleaning, and surface disinfection, infection prevention, sustainability,
HLAC and care of laundry, and integrated pest management. Take a look at these practices and evaluate their feasibility for your facility, and most importantly identify opportunities to implement them. I encourage you to contact the authors of the articles for additional information, if needed.
Finally, we realize there is often resistance to change. Practice feels so much more comfortable and secure when it does not change, even if that change means improved outcomes. Considering all of the above, you should not be surprised to find that others may lack the confidence to question whether common practice is evidencebased. They may not understand the need to do so.
Nevertheless, as today’s environmental services leaders, let’s continue to improve outcomes by implementing evidence-based practices. And while we are at it, let’s demonstrate to others our pursuit of excellence and our successes.
3 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

The Association for the Healthcare Environment (AHE) of the American Hospital Association is the professional organization of choice for over 2,300 directors and managers caring for the patient and resident care environment across all care settings, including hospitals, long term care, continuing care retirement communities and ambulatory care. AHE represents, defines, and advances the professionals responsible for care of the healthcare environment to ensure quality outcomes and healthy communities.
of the American Hospital Association
155 N. Wacker Dr., Ste. 400 | Chicago, IL 60606
312-422-3860 | ahe@aha.org | www.ahe.org
© 2012 Association for the Healthcare Environment™ of the American Hospital Association. All rights reserved.
4 The Phoenix • 2012 Volume 32 Number 2 Quarter 2
This publication is published by the Association for the Healthcare Environment for educational and informational purposes only. AHE is not undertaking to render specific professional advice. AHE does not endorse any specific products, services, companies, methods, processes, practices, or sources of information contained in the publication, and the publication should not be referenced in any way which would imply such approval or endorsement.
AHE makes no guarantee, representation, or warranty, and expressly disclaims any and all guarantees, representations, or warranties whatsoever, as to the validity, accuracy, or sufficiency of the information set forth in the publication.
AHE assumes no liability or responsibility in connection with the use or misuse of the publication or the information included in it.

President:
Kent L. Miller, MHL, CHESP
Director, Environmental
Services
Jackson Hospital & Clinic
Kent.Miller@jackson.org
Term: 2010 – 2012
Vice-President:
Robert M. Hodnik, CHESP
Director, Facilities
Management
UPMC Health Plan hodnikrm@upmc.edu
Term: 2011 – 2012
Industry Liaison:
Hank Carbone
Senior Product Development
Program Leader
ECOLAB
Hank.Carbone@ecolab.com
Term: 2012-2014
At-Large Board Members:
Michael Bailey, CHESP
Director, Environmental
Services
Greenville Hospital System
University Medical Center
RBailey@ghs.org
Term: 2012 – 2014
Alba L. Hernandez, MS, RD,
CHESP
Director, Nutrition and
Hospitality
Service Center
James J. Peters VA Medical
Center alba.hernandez@va.gov
Term: 2011 – 2013
John McAllister, CHESP
Director Environmental
Services
Cambridge Health Alliance jmcallister@challiance.org
Term: 2011-2013
Lisa Ford, CHESP
EVS Director/General Manager
Our Lady of Lourdes Medical
Center
FordL@lourdesnet.org
Term: 2012-2014
Patti Costello
Executive Director
Sandra Rials, MS
Education Manager
Marthe Lyngås Forster
Membership & Chapter
Relations Specialist
Sharren Smith, MA
Education Specialist
Carrie Witt
Marketing & Communications
Coordinator
Megan Burnette
Governance & Operations
Coordinator
5 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

July 9, 2012 – September 21, 2012
Foundations for Success in Environmental
Services Management
The course duration is ten (10) weeks.
Member Price: $189 | Non Member Price: $239
July 12, 2012
Clean and Quiet: Realistically Influencing
HCAHPS Scores and Outcomes
Webinar: 11 AM CST
Member Price: FREE
Non Member Price: $139
July 30, 2012 – September 7, 2012
Online CHESP Study Group
The course duration is six (6) weeks.
Member Price: $109 | Non Member Price: $149
August 15, 2012
HAI Prevention: The New Rules of Engagement
Webinar: 1 PM CST
Member Price: FREE
Non Member Price: $139
September 16 – 19, 2012
EXCHANGE 2012 Phoenix, Arizona
September 27, 2012
The EVS Leader: Surprising Truths about
What the C-Suite Requires
Webinar: 11 AM CST
Member Price: $99 | Non Member Price: $139
6 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Ohio Association for the Healthcare Environment, Inc.
July, 18, 2012
ConneXions
3:30pm – 5:00pm
UH Case Medical Center, Cleveland, OH
Ohio Association for the Healthcare Environment, Inc.
August 8, 2012
Annual Conference & Trade Show
DoubleTree by Hilton Hotels Conference Center
Independence, Ohio
Florida
Greater Midwest
New England
Ohio
Greater Philadelphia South Carolina
Michigan Texas
Alabama Georgia
Aztec (San Diego &
Imperial Counties)
Delaware
Kentucky
Northern California
North Carolina
Do you know your region? AHE divides the
United States and Territories into 9 regions.
9
8
6
7
5
4
3
2
1
Are you interested in starting a Chapter in your region? Chapters provide environmental services professionals with invaluable networking, education and leadership at the local level.
To understand the steps necessary to starting and maintaining your own society, an updated chapter handbook will be available soon.
If you have any questions about starting a Chapter in your area, contact Marthe Lyngås Forster,
Membership & Chapter Relations Specialist, at ahe@aha.org or via phone at 312-422-3860.
7 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Judy Abbott
Jim Aldrich
Jared Alexander
Shekita Allen
Tamara Almquist
Luis Alvarez
Paul Amos
Colleen Andrews
Dwanjai Baker
Stephen Bartek
Robert Barthol
Dustin Beasley
Babette Beene
Trent Belcher
Farica Blade-
Muhammad
Robert Bland
Doug Borruso
David Bourke
Corey Bowman
Courtney Brady
Gary Brehm
Meikel Brewster
Richard Bridgewater
Katrina Brooks
Jeff Brown
Megan Burnette
Annie Butler
Javier Caballero
Amy Cadger
Carlos Canas
Marlene Castillo
Angelica Cerrato
Sue Chappell
Gina Cicio
Joan Cinque
Phyllis Colwell
Robin Cramer
Randy Da’Camara
Alin Daba
Mark Daniels
Kenneth Dantin
David Dell
Don DeRossett
Travis Diffenbaugh
Randy Donaldson
Rebecca Ellis
Les Etscheidt
Gregory Evans
Demeatrus Farrington
Marta Ferrando
Joseph Ferrier
Donna Flores
Jake Foster
Tammy Gardea
Steven Gohn
Sharon Goldsmith
Kathia Gonzalez
Heather Gray-McDaniel
Marc Gregoire
Ginger Gregory
Chris Grubb
Debra Hageman
Julie Hale
Marilyn Hannett
Ellen Harbeson
Amy Harmon
Scan Harris
Eileen Hartnett
Kenneth Hawkins
Tammy Holt
Keith Hopkins
Shelia Irby
Jason Irvin
Serderick Jennings
Phillip Jessie
Brian Johnson
David Johnson
Rodmann Jones
Betty Jones
Aubrey Kilpatrick
Bryan Kilpatrick
Anthony King
Antonia Kolokythas
Paulette Kosinski
Ria Lacher
Lisa Lee
Neil Levitt
Kevin Lewis
Ray Liva
Pamela Marshall
Shannon McCown
James McIntyre
Kevin McKinney
Gwen McNeill
Kathryn Meyer
Beth Meyers
Paul Miller
Noel Miller
Sheila Miller
Luis Morales
Mark Morgan
Latanya Morris
Oliver Murray
Jeremy Myers
Eric Noonan
Iris Osteen
Larry Page
Philip Palomino
Dermot Pelletier
Michael Peterson
Mark Peterson
Lee Peterson
Brian Petiy
Tammy Philson
Jim Posey
Edward Radtke
Shauntel Ragland
Carol Ramsey
Edith Rathbun
Tyrone Ray
Janice Reppert
Joseph Ricci
Angela Riebl
Dena Riley
Sam Rivera
Carlos Rivera
Giselle Rodriguez
Marion Ross
Tammy Ryans-Cook
Ronald Sample
Damian Scott
Chris Scroggins
Maurice Singleton
Sharren Smith
Leonard Speth
Will Sullivan
Emma Swift
Sarah Tanguay
Jonathan Theodore
Grace Thornhill
Scott Thornton
Jonna Toler
Carlos Torres
Dennis Tychan
Lucita Vaca
Paul Vicario
June Vieu
Stephen Wadlinger
Steve Walker
Angela Walker
Frank Wardzinski
Dean Waters
Mark Weachock
Steve Weems
John Wendelberger
Pam Whalen
Denise Wheeler
Lori Whisman
Samuel Whyte
Dana Williams
Jo Williby
Pamela Wong
Bill Worthy
Billy York
James Young
List pulled 6/1/2012
8 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by Dr. S. John Barcay
Dr. S. John Barcay is a senior scientist at
Ecolab Inc., the global leader in water, hygiene and energy technologies and services that provide and protect clean water, safe food, abundant energy and healthy environments.
Hospitals, long-term care, emergency medical care, and physical or mental rehabilitation facilities have similar pest pressures and pest management requirements. Hospitals in particular have a critical need for intensive pest management, as there are important medical reasons for maintaining a pest-free environment. This article focuses on best pest management practices in hospitals, but also has relevance to other healthcare facilities.
Health Pests. Cockroaches, mice, rats and filth flies are important pests for hospitals to control. All are considered
“health pests,” known to carry and vector pathogens such as cholera, dysentery, salmonella, tuberculosis, strep and other organisms. Other pest concerns for the healthcare industry include small flies, ants and birds, as well as bed bugs, which continue to make their way into healthcare facilities on the personal belongings of staff, patients and visitors.
If pests come into contact with patients or their surroundings, pathogens can potentially cause infections through contact with skin or wounds, or by contaminating food or medical supplies and equipment. Pest management professionals (PMPs) must be highly qualified and well trained, capable of communicating effectively with and educating hospital staff.
Integrated Pest Management. The sensitivity of the hospital environment demands an integrated pest management program (IPM) focused on non-chemical methods and only secondarily on pesticide applications. Key aspects of a hospital IPM program include
(1) staff education, (2) inspections and pest monitoring, (3) exclusion and structural repairs, (4) sanitation maintenance, (5) physical control, and (6) limited pesticide use.
Education. A well-educated staff is a great asset to the pest management program if they understand how to recognize and report pest presence. They should also be educated on how to address conditions conducive to pests, by maintaining strict sanitation and structure in patient rooms and throughout the facility.
Inspection and Monitoring. During inspections the PMP should refer to floor diagrams and checklists, and keep accurate records.
Reporting sheets or logbooks should be placed strategically for nurses and other employees to report pest sightings. The PMP should conduct frequent and thorough inspections, particularly in areas considered pest ‘hot spots.’ These areas can include employee locker and break rooms, laundry rooms, food service areas,
9 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

vending machine areas, food carts, bedside furniture, floor drains, sink areas, surgical suites and trash areas. In addition, pest monitoring devices and traps can be used to detect, and in some cases reduce, pest presence. Sanitation and structural deficiency recommendations should be shared with the infection control, housekeeping and maintenance staff for corrective action.
Exclusion and Structural Repairs. The PMP should maintain records of structural concerns and make recommendations for repairs and alterations. Some PMPs will offer pest exclusion services, which can include installation of door sweeps, air doors and sealing of exterior pest entry points. This attention to pest exclusion and structural maintenance is a good investment toward better pest management with reduced reliance on pesticides.
Sanitation. Good sanitation will limit food, water and harborage for pests and can improve the performance of some pesticide applications. Routine cleaning and disinfecting of all floor drains will minimize small fly breeding. Good sanitation efforts must include frequent communication and follow-up between the PMP and hospital staff.
Physical Control. To assist in minimizing the need for pesticides, physical control measures such as freezing and heat treatment of equipment such as food carts may be used.
For example, cockroaches can be controlled by freezing at temperatures of less than 20° F for several hours, or heating at 120° F for several hours. Other physical methods include trapping and vacuuming pests. These methods can be very effective and leave no pesticide residue, but PMPs must exercise caution not to damage sensitive items such as electronics.
Pesticides. Despite a focus on non-chemical approaches, the use of some pesticides will be necessary in most IPM programs. Pesticides used in healthcare facilities must be properly labeled for use against the target pests and sites of application. PMPs will need to work with hospital staff to clearly identify both highly sensitive (i.e., patient care) and less sensitive areas.
Approval from hospital staff should always be obtained before using a pesticide in patient care areas. Relatively low-toxicity, non-volatile pesticides, such as baits and crack-and-crevice applications of residual insecticides, are preferred. Sprays should not become airborne. Patients should not be present during pesticide application, and the area should be vacated until all odors and vapors are gone.
The PMP must keep detailed and accurate records of all pesticide applications and provide the label and MSDS of any insecticide product to infection control and other responsible personnel.
References:
Bennett, G.W., Owens, J. M., and Corrigan, R. M. 2010.
Truman’s Scientific Guide to Pest Management
Operations, seventh edition. Questex Media Group LLC,
Cleveland, OH. 652 pp.
Mallis, A. 2011. Handbook of Pest Control, tenth edition.
Mallis Handbook LLC. 1599 pp.
Granovsky, T. A. 1987. “Health Care Facilities – Solving the Puzzle.” Pest Control 54(6): 14 – 18.
Ecolab is a trademark of Ecolab USA Inc.
10 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by Sue Crow, RN, MSN, CIC
Sue Crow, RN, MSN, CIC authored Asepsis, the
Right Touch: Something Old is Now New. This treasure on the simple basics of asepsis contains points applicable to Environmental
Services. Asepsis principles are still relevant to today’s health care industry. Sue has a compassionate, caring commitment to patients everywhere to “first do no harm.” Healthcare personnel have a parallel mantra to also safeguard the patients from infections and adverse outcomes.
Pressure from numerous external entities has placed healthcare personnel and their performance under a microscope for close examination, counting the infractions and penalizing financially. Now may be an appropriate time to review asepsis basics, especially those applicable to
Environmental Services (EVS).
Crow defines aseptic technique as the foundation of infection prevention and control which focuses on:
1. reducing the number of microbes to an irreducible number
2. preventing their transfer to others, and thus
3. maintaining a contamination-free patient environment
Simply put, asepsis is the purposeful prevention of infection transfer. Crow further lists the cornerstones of asepsis as:
1. Knowing what is dirty
2. Knowing what is clean
3. Knowing what is sterile
4. Keeping these conditions separate
5. Remedying contamination immediately
These cornerstones are integral to safe and effective performance by EVS professionals.
When this message is practiced, EVS professionals positively impact patients, health care personnel, and the environment by reducing the proliferation and survival of the microorganisms.
Rational thinking based on principles, common sense, and evidence enhances the application of asepsis in all situations surrounding patient and environmental care. Common sense is the name of the game. Communication and collaboration with Infection Preventionists also strengthens the EVS performance toward a safe environment.
According to Crow, decontamination is a dirty procedure performed by skilled, experienced personnel. This describes EVS professional’s primary tasking within the health care facility.
EVS are the frontline preventionists, combating the microorganisms that
11 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

contaminate the environment. Their job is endless as they are persistent in conquering the invaders and their mobility.
Further pearls of wisdom appear in Crow’s last chapter as reminders for EVS and hold true to best practices...
1. When purchasing a product, it should be the best product for the purpose. From an
Infection Control and fiscal responsibility perspective, that product should also be the best value for the money available.
2. Accurate and comprehensive cost analysis can aid in deciding which products are best for facilities. Disposables may not be as cost effective as reusable (e.g., healthcare textiles). Comprehensive analysis includes considerations such as the purchase price, reprocessing costs, labor time and salary, and means of disposal.
3. Use the principles of asepsis, instead of wasting money on new gadgets that can make the environment cleaner. Remember, people are the primary disease carriers.
New and advanced technologies (e.g., vapor devices, adenosine triphosphate [ATP] reflective light units, microfibers) to clean the patient’s room must be critically evaluated before an informed decision can be made. Questions to ask include: is the technology appropriate, what is the impact on staffing, what are the advantages and disadvantages, are there any negative factors to consider, and what are the initial versus long-term costs.
5. Environmental culturing revisited...avoid routine culturing of environmental surfaces unless there is an outbreak investigation in progress where the surfaces are suspect.
Put available monies into training personnel in aseptic practices instead.
There appears to be a resurgence of environmental sampling to ensure patient room cleaning. Setting the benchmark of organism colony-forming units (cfu) or bioluminescence range should be criteriabased for the institution as no national or validated manufacturer’s range is available.
6. Treat all cases (i.e., surgical patients) as dirty and follow the current AORN
Recommended Practices. Use the room immediately after it has been cleaned; no need to wait for arbitrary timeframe.
Asepsis is pertinent even today. A return to the basics has been voiced as still relevant and worthwhile. Although written in 1989, Crow’s book serves to remind us that principles are
enduring even as technologies evolve to present better means to accomplish the asepsis. Common sense and critical thinking are paramount to EVS professionals and the control of microbes.
Reference
Crow, S. Asepsis, the Right Touch: Something Old is Now
New. Louisiana: The Everett Companies, 1989.
12 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by: Sandra J. Hensley, RN, BSN, MSEM, CIC and John Scherberger, BS, CHESP,
Board Members of the Healthcare Laundry Accreditation Council (HLAC)
According to the American Productivity and
Quality Center, best practices are: “Those practices that have been shown to produce superior results; the practices selected by a systematic process and judged as exemplary, good, or successfully demonstrated.”
Why institute recommended practices in your healthcare laundry plant? You haven’t had any complaints. You’ve passed your regulatory inspections. So why bother?
Healthcare facilities are being pummeled by emerging pathogens, many of them antibiotic resistant. Patients are contracting healthcareassociated infections (HAIs) at alarming rates.
The latest report from the Centers for Disease
Control and Prevention (CDC) estimates
100,000+ deaths and over two million infections result from HAIs. That’s more than
1 million deaths and 20 million infections from
HAIs in the past decade. These are not just numbers, they are real people who have died or had their lives and livelihoods impacted.
In the effort to save lives, healthcare laundries have an obligation to produce the safest product possible for the patient. After all, healthcare textiles touch the largest organ a patient has, the skin.
Healthcare laundries have a direct impact on the overall outcome of patients. And healthcare facilities require the best performance from all of their laundry partners to achieve the best.
Healthcare laundries are an integral part of the multidisciplinary team approach necessary for improved patient outcomes. According to the
CDC, U.S. healthcare laundries process more than 5 billion pounds of soiled linen a year and, providing the clean products are not inadvertently contaminated before use, the clean textiles carry negligible risk to healthcare workers and patients. This is a very enviable position to be in, but one that must not be taken for granted.
So the questions arise: “What are recommended practices in healthcare laundry operations?
Where do you find recommeded practices for your laundry? How do you determine what recommeded practices are right for your operation? How can healthcare laundries affect the impact of HAIs on patients? These questions and hundreds more can plague and frustrate even the best facility director or manager.
Where is one to turn for solid, trusted, and proven best practices; practices that will pass the scrutiny of regulatory agencies?
As many healthcare laundry operations have found, the Healthcare Laundry Accreditation
Council (HLAC) provides the answers to those questions and others. The HLAC has taken best
13 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

practices to a higher level and established
Standards that incorporate the best practices of successful laundries as well as the requirements of governmental and nongovernmental regulatory agencies.
During the formation of the HLAC organization and its Standards, it was recognized that no one single source of expert knowledge existed.
Therefore, multiple experts in a variety of fields were consulted to present and develop content to formulate the standards that would be used to support and define best practice for processing of health care linens and the laundries providing this process.
Standards were based on existing models, current methods of processing, safety recommendations and input from experts in the laundry processing field, linen manufacturers, and governmental bodies.
The CDC, OSHA and HICPAC were consulted, as were end users. Laundry production staffs were queried; published resources and standards defining expectations of the care and handling of linen, including inspection of linen processing plants, and infection control programs from organizations such as the AHE,
APIC, AORN, and TJC were appraised and incorporated as applicable.
From these initial Standards came improvements in individual laundry processors and standardization and quality demands from customers in healthcare.
The Standards were revised in January 2012 by the HLAC and, after months of study and deliberation of new and revised information and a public comment period, the revised
Standards were published in June 2012. These
Standards provide a foundation for laundries to improve their processes and the products delivered to their healthcare customers. These
Standards also provide a method to inform customers that the laundry processing plant subscribes to and has achieved accreditation from HLAC by meeting these Standards.
What areas are addressed in the HLAC’s
Standards? Everything from the basic elements such as textile control procedures, equipment, personnel, customers, quality assessment, to contingency planning is addressed. The textile processing cycle is covered in detail as well.
Have a question about handling, collection and transportation of soiled healthcare textiles?
You’ll find Standards that provide best practice guidance on sorting, washing and extraction, drying, finishing, storage and delivery of clean healthcare textiles. The HLAC also provides
Standards for surgical pack assembly rooms.
These Standards, these best practices that support the HLAC accreditation achievement, promote the laundry processors’ commitment to quality practices and processes as well as supplying the safest product available to the ultimate end-user, the vulnerable patient.
To return to the first question posed above,
“Why bother instituting recommeded practices?” The answer, clear and simple, is that recommended practice often leads to improved safety efforts and quality patient outcomes. Healthcare laundry operations have a moral and ethical obligation to patients and a contractual obligation to clients to produce the safest product they can. By partnering with the HLAC and implementing the HLAC
Standards they are well on their way to meeting those obligations.
References
American Productivity and Quality Center (2012).
Retrieved May, 2012 from: http://www.apqc.org/
Klevens, R., Edwards, J., Richards, C., Horan, T., Gaynes,
R., Pollack, D., and Cardo, D. Estimating Health Care-
Associated Infections and Deaths in U.S. Hospitals, 2002.
Public Health Reports. March–April 2007. Volume 122
14 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

At this year’s annual conference you can take your professional development to new heights through top-notch learning and networking opportunities. As if you didn’t have your reasons lined up already, here are the top 10 reasons for attending EXCHANGE 2012:
10. Learning, learning, and more learning.
You will take part in three full days of best-in-class education that will help you build skills and a network that you can bring back to your facility and share with your team.
9. Share your knowledge.
Bring back concrete examples, best practices and hands-on technologies that you can share with your colleagues and team.
8. Phoenix, Arizona.
Even if you’ve visited many times, Phoenix is one of those cities you can get to easily and enjoy often. Enveloped by breathtaking scenery, “the Valley of the Sun,” is located in one of the most lush and colorful deserts in the world.
7. Networking opportunities abound!
Sometimes the most valuable things you can learn will happen through networking with and learning from other professionals. At Exchange, you’ll have plenty opportunities to network and share best practices.
6. Case studies and real life examples.
Many of the sessions feature real-world examples that you can learn from and apply immediately.
5. Healthcare Marketplace.
Looking to connect with industry partners for new products or services? Carve out a chunk of time to talk one-on-one with the leading companies in the industry at Exchange, where exhibitors are ready to provide you with innovative business products and solutions, as well as demonstrations of the latest technology. Be sure to take AHE’s Meet the Exhibitor’s Challenge Guide with you as you talk with your industry partners.
4. Keynote presentations and a panel of industry experts: Featuring Michael Rogers, the Practical Futurist who helps organizations worldwide think about the future; Brian Lee, one of North America’s leading experts in the field of world-class healthcare Patient
Satisfaction; William Rutala, PhD, MPH, worldrenown expert in Epidemiology, disinfection and sterilization; and Alan Whitson, a popular author, consultant and speaker pegged the
“Green Building Guru.”
3. Time and money.
Think about it this way:
Learning just one thing could potentially save your facility a great deal of money and time down the road. A small investment now will have big pay-off later.
2. Continuing Education Credit: AHE’s strong line-up of educational sessions provides ample opportunities to earn CPEs.
1. You can’t afford NOT to!
We’ve hit it out of the park with this year’s education programs, speakers, networking events, and Healthcare
Marketplace. With new sessions on improving patient satisfaction, infection prevention, environmental cleaning and sanitation, topnotch keynote presentations on effective leadership, ample opportunities to network and connect with peers and speakers, and expert career development tools, how can you afford
NOT to attend?

Management Meets the Future of
Technology
Michael Rogers, Mr. Rogers brings not only his own experience and expertise, but the journalism and research skills to engage and prepare management for the new technology frontier.
The Future is Now
Nina Antoniotti, RN, MBA, PhD,
Director, Marshfield Clinic
TeleHealth Network. Dr. Antoniotti, is an expert in strategic planning, facilities development, operational planning and community development, focusing on health care trends and needs.
Environmental Surface Disinfection:
Pushing the Envelope
William Rutala, PhD, MPH, CIC,
Professor, Division of Infectious
Diseases, Department of
Medicine, Director, Statewide
Program for Infection Control and
Epidemiology, University of North
Carolina School of Medicine (Chapel Hill) and
Director, Hospital Epidemiology, Occupational
Health, and Safety Program at UNC Health
Care System. Dr. Rutala is certified in infection control and is one of the country’s most renowned experts in the field.
The HCAHPS Hospital of Choice
Brian Lee, CSP, Founder and CEO,
Custom Learning Systems Group,
LTD. Brian is one of North America’s leading experts in the field of world-class healthcare, patient satisfaction and change leadership.
16 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Learning labs for Exchange 2012 have been designed to help attendees maximize their learning potential with new skills, technologies, research, solutions and information. Learning labs have been arranged into educational tracks so that attendees can focus on those sessions that are of primary interest and importance to them. Choose from four tracks: Prevention, Education, Standards, and Management.
15 CPEs available for education
PREVENTION PREVENTION
Explore cutting-edge research and evidence-based practices in environmental sanitation, infection prevention, surface disinfection, monitoring and assessing, and pest management — presented to help prevent and reduce HAIs, and improve patient care and safety.
STANDARDS STANDARDS
Investigate and identify the latest and most relevant regulatory standards and guidelines impacting the healthcare environment. Recognize the critical importance of these standards and receive toolkits to assist you with compliance in the operation of today’s healthcare facilities.
EDUCATION EDUCATION
Discover the most critical trends, advancements, and data in healthcare and environmental services management. Designed to build and optimize your knowledge and skills, learning labs in this track include workplace safety, Healthcare Reform, the
Global Harmonized System, and sustainability.
MANAGEMENT MANAGEMENT
Get introduced to new and practical strategies, tactics and tools to help you excel as a manager and leader in the current healthcare environment.
Discover how to identify and leverage strengths and abilities in the management of individuals, teams, and departments.
Digital Housekeeper®, the web-based environmental service management solution, allows you to access your operations from anywhere. Check on assignments, projects, productivity, quality, staffing and more. And now with Digital Housekeeper Mobile™, it’s even easier to complete your inspections—all from the palm of your hand. Call us or visit our website to find out how facilities like yours can benefit from the flexibility and ease-of-use of Digital Housekeeper and Digital Housekeeper Mobile.
Think Outside the [Software] Box
Be accurate.
Be efficient.
Be ready.
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17 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Enhanced Access to
Top Jobs
AHE CareerLink has been updated to include titles in upper level management positions for professionals caring for the healthcare environment. AHE
CareerLink is the premier electronic recruitment resource for the industry. Here, employers and recruiters can access the most qualified talent pool with relevant work experience to fulfill staffing needs.
AHE’s valuable membership provides members with a wealth of benefits. These benefits will increase over the next six months as the AHE board announces a new and exciting membership program that includes select products and services members have told us they need most.
September 9 - 15
AHE knows your work is essential in achieving patient safety and quality care. You work in ensuring a clean, healthy patient care environment is greatly appreciated. From surface disinfection to enhancing the patient’s experience, the work accomplished by you and your staff does not go unnoticed. We hope you take some time to celebrate, recognize your staff, and highlight the role of those that contribute to the healthcare environment in your facility.
Being a current member in good standing is the only way you can receive member discounts at the time of an AHE purchase or registration. AHE will no longer offer non-members the opportunity to receive the member discount at the time of purchase, including Annual Conference registration.
Non-members may join at the time of registration, but membership pricing applies at the next purchase. For this reason, it is crucial that your membership is kept current.
We understand that membership is your choice. When you choose AHE, we are pleased to offer member-only discounts to you as thanks for your confidence and loyalty. We will also continue to offer only the highest quality services at the most economical rate for members. Membership has its privileges.
Individuals wishing to renew their membership may do so by checking the “membership renewal” field on the registration form. Note that if the membership has expired, or is terminated, AHE now requires conference registration payment at the non-member rate, in addition to the membership dues payment, if purchased simultaneously.
18 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by Laura Brannen
Laura Brannen has been working in healthcare for 25 years. As the founding Executive
Director of Hospitals for a Healthy Environment
(H2E), she helped launch the organization to become the first membership organization in the country dedicated to improving the healthcare sector’s environmental impacts.
Her experience is grounded in using practical and collaborative approaches to making lasting change to improve our collective environmental footprint. Brannen is a national and international speaker in the field of healthcare waste and environmental programs management.
Those of us who work in sustainability have come to realize that true sustainability is a journey, rather than a final destination. As with any long journey, you need good planning, knowing where you’re going, and setting destination goals along the way.
Sustainability is also about the triple bottom line: finding the nexus where goals and outcomes align around the three key sustainability performance indicators (PIs). These are:
1. the planet (any project has to provide an environmental improvement)
2. profit (any project must have financial benefits, even if there is a longer but still reasonable payback)
3. people (any project must improve health, happiness and welfare).
AHE’s Certificate program is a big destination goal in any healthcare sustainability journey.
Whether you are working to reduce your waste, reduce your use of chemicals; making strategic decisions to use your resources wisely; saving money; or engaging your staff, patients and the community, you should consider applying for AHE’s Sustainability
Certificate. Fundamentally, the certificate recognizes the efforts your staff and organization are making towards improving the PIs. One of the most underutilized tactics in moving sustainability forward is recognizing staff for their hard work and accomplishments. Recognition for a job well done helps to provide the fuel to drive the effort towards the next destination.
The AHE’s Sustainability
Certificate Program is more than just a piece of paper on the wall, however. It is designed to define silver, gold, and platinum levels of achievement, and working to achieve it fundamentally helps you prioritize critical program implementation, policy development, and planning for ongoing operations.
The Certificate Application measures performance. As such, it requires a comprehensive waste analysis that includes total waste generated in each and every waste category. If you are not collecting data and taking advantage of the power locked inside that data, you are likely to be literally “tossing
19 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

resources.” The effort will identify areas where you are likely to find operational and cost savings. Moreover, when you implement improvements, it is only with data that will you be able to report and celebrate your successes.
If you need more help, the AHE Sustainability
Roadmap has some good tools to help you collect and analyze your data. AHE’s Waste
Target Setting Tool and the AHE Waste
Management Tool can be found at http://www.
sustainabilityroadmap.org
. Whether you eventually apply for the AHE Certificate or not, it’s critical to start measuring, verifying and reporting on your data today.
Maintaining a program requires staff engagement and leadership across the organization.
The Certificate requires that you have developed an organizational infrastructure that will support your efforts to truly make it sustainable in a traditional sense. Likewise, a policy and procedure review assesses that you have real
“teeth” in your programs. Do you have an
Environmentally Preferable Purchasing policy?
A Waste Management Policy? Pest Management?
Green Cleaning? There are many more.
If you were to list other essential components of a Certificate-deserving EVS department, would you include…
• A hazardous materials, pharmaceutical waste management, and Integrated Pest
Management program. AHE recognizes that EVS may not have full decision making responsibility in all of these programs, but
AHE still assumes that you are engaged at a high level. Report on your level of engagement and how you are pushing the bar in your organization to purchase less toxic materials, use them less often and dispose of them according to a “beyond compliance” approach.
• Cleaning for health and the environment.
If you do not have a well-informed and implemented “green cleaning” program that specifies safer chemicals, equipment and supplies with less environmental impact, you probably aren’t ready to apply for your
Certificate this year. So get on it and work to apply next year.
• Waste minimization across all categories.
This is a huge category and “the bar” has been set pretty high today, when compared to even a few years ago. Today’s best practices (and the Certificate) demand RMW generation of 10-15 percent or less, at least
20 percent recycling. Some facilities are approaching rates closer to 30 percent or more, construction and demolition recycling, a donation and reuse program, and more.
See the Sustainability Roadmap website for more ideas.
Environmental Services professionals really are the foundation for a healthy Healthcare
Environment. Today, as organizational charts are being realigned to incorporate new sustainability professionals, leaders are emerging from nursing, materials management, administration, energy management and facilities, and even risk management. While we don’t want to suggest competition, EVS should not pass up the opportunity to facilitate and drive the sustainability message and tactics throughout an organization. Leadership in this area (along with infection control of course), will elevate your department’s status and improve operations across your facility. The
Certificate Program is dedicated to EVS
Departments, and it does more than simply encourage AHE members to implement core programs. Instead, it aims to raise the tide for all boats.
For more information please visit: http://www.sustainabilityroadmap.org
20 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by Kathy Thompson, CIH, MT (ASCP), MPH, MS, 3M Company
Kathy Thompson, CIH, MT (ASCP), MPH, MS, has been with the 3M Company for 17 years working in industrial hygiene, chemical product stewardship and technical service roles. Prior to this, Kathy was employed for 10 years in hospitals performing clinical laboratory and microbiology analysis, infection control and hospital safety services. She is a Certified
Industrial Hygienist (CIH) and Medical
Technologist (MT) and holds a Masters in
Public Health (Environmental Health) as well as an MS in Chemistry. In her current position,
Kathy provides technical support for the cleaning chemical and disinfectant products and healthcare markets for the Building and
Commercial Services Division of 3M.
This Tech Talk is based on the regulatory framework for disinfectants for non-critical surfaces in the United States, which may vary from requirements in other countries.
Local regulations should always be consulted when evaluating disinfectant claims outside of the U.S.
Surface disinfection is used to help minimize the risk of infection from contaminated surfaces, so when determining what cleaning and disinfection practices are appropriate for a given situation, it is often helpful to use a risk assessment approach — along with an understanding of the regulatory framework for disinfectants — to obtain the maximum risk management benefit from your surface disinfection resources. Understanding the disease transmission cycle is important to the risk assessment process. Also known as the
“chain of infection,” this cycle needs to be broken in at least one place to help prevent infection. While surface disinfection can help manage the risk where an infectious agent can be transmitted to a susceptible host from a contaminated surface, it is just one example of a way to break the chain. Other well-known examples are: vaccination — so individuals are no longer susceptible — and isolation/ respiratory protection for airborne diseases.
A risk assessment approach to disinfection was used by Dr. Spaulding in a well-known classification scheme that goes by his name.
The Spaulding Classification Level for objects that touch only intact skin is called Non-
Critical, and has a lower risk category than
Critical or Semi-Critical levels applied to medical devices which enter sterile tissue or touch mucous membranes.
In fact, because the risk is considered lower, an option to just clean rather than disinfect is part of the Non-Critical classification.
1
Additional guidelines and standards can be used to help determine appropriate cleaning
21 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

and disinfection practices, including those from the Centers for Disease Control and Prevention
(CDC) 2 and industry-related professional associations. A legal requirement for
Salmonella cholerasuis (Gram Negative), and
Pseudomonas aeruginosa (Nosocomial). These products may also be referred to as low-level disinfectants.
4 disinfection comes from the Occupational
Health and Safety Administration (OSHA)
Standard to protect workers from bloodborne pathogens. Disinfectants used to clean up blood and other potentially infectious materials covered by that standard originally were required to be bleach or carry tuberculocidal claims, but for over a decade now, products with
EPA-approved Human
Immunodeficiency
Virus (HIV) and
Hepatitis B Virus
(HBV) claims can help meet this requirement.
3
Surface disinfection products and practices are often targeted specifically toward organisms more likely than others to be a cause of infectious risk. Frequently touched, or “high-
touch surfaces,” act as a common mode of transmission in the infectious disease cycle. Pathogenic microorganisms such as Norovirus,
Clostridium difficile, and Acinetobacter species are often targeted by those products and practices as they are easily transferred from such surfaces.
5 Other
Disinfectants for Non-Critical surfaces are regulated as pesticides by the Environmental
Protection Agency (EPA) under FIFRA (Federal
Insecticide, Fungicide, and Rodenticide Act).
Formulated chemical disinfectant substances are approved by the EPA after submitting acceptable data and granted an EPA Registration Number, which must then appear on the product label.
That number can be used to retrieve the EPAallowed claims for that product from the EPA website for the Pesticide Product Label System at www.epa.gov/opp00001/pestlabels and is a useful reference for critically evaluating disinfectant product claims.
microorganisms, though environmental contamination may not be a significant mode of transmission, are used as markers of efficacy (effectiveness) for disinfectants because they may be more difficult to kill than common vegetative bacteria. The causative agent of tuberculosis is an example of that type of microbe, and disinfectants with that intermediate level of efficacy are called tuberculocidal.
There are several types of disinfectants in the
EPA regulatory framework, and for a product to be labeled as Hospital Grade, it must have efficacy against certain bacteria considered representative of that type of microorganism:
Staphylococcus aureus (Gram Positive),
In general, the structure of the microorganism influences the level of disinfectant needed, and low-level disinfectants are considered to have general efficacy against vegetative bacteria, while an intermediate level may be needed for harder-to-kill microorganisms. Spore-forming bacteria, like Clostridium difficile, need a high-level or sporicidal disinfectant, as they form a shell-like spore coat around the cell that renders it resistant to most conventional disinfectants.
6
22 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

It should also be noted that in some cases, the same disinfectant formulation can be used for harder-to-kill microorganisms if the contact time (how long the surface needs to stay wet with disinfectant) is lengthened.
This general information, as well as the EPAapproved claims for a disinfectant product, can be used to make professional judgments about appropriate surface disinfection as part of the risk assessment process. However, if the application is covered by the OSHA Bloodborne
Pathogen Standard, then the disinfectant product and process used must comply with that regulation.
When conducting a risk assessment, some of the considerations for what cleaning and disinfection products and processes will be appropriate are the type of facility and patient population involved, as well as the infection prevention surveillance data for that facility.
A review of the type of information presented here, and the relevant peer-reviewed literature, should also be part of your risk assessment that demonstrates a thoughtful decision process on appropriate surface disinfection to manage the risk of infection from contaminated surfaces in your facility.
7
• Start your risk assessment process by understanding your facility in relation to the chain of infection.
• Do you have patient populations with differing levels of susceptibility, such as bone marrow transplant or burn units?
• What does your surveillance data tell you about infection types, rates, and problem areas in your facility?
• Next, understand your disinfectants by reviewing the chemistry and EPA label information, and relate the claims back to your facility disinfection needs.
• Are you mainly concerned with low-level bacterial and/or bloodborne pathogen claims to manage risk?
• Or do you need to manage to a higher level of efficacy so that a tuberculocidal claim or contact time is needed?
• Do you have a Norovirus concern, so the products and processes important for that virus should be used?
This process should help utilize your disinfection resources to obtain the maximum risk management benefit and to maintain compliance, but also should be considered dynamic and be periodically reviewed as new infection prevention challenges arise.
References
1. Rutala, et al, Clin. Inf. Dis. 2004;39:702-9
2. 1.1. Rutala, WA, Weber, DJ, and HICPAC. Guideline for
Disinfection and Sterilization in Healthcare Facilities,
2008. Available from cdc.gov.
3. Fairfax, R. OSHA Standard Interpretation Letter July
15, 1999 at www.osha.gov
4. US EPA DIS/TISS-1 January, 1982
5. Role of hospital surfaces in the transmission of emerging health care-associated pathogens:
Norovirus, Clostiridum difficle, and Acinetobacter species. Weber, David J., and Rutala, William A., et al,
Am J Infect Control 2010;38:S25-33
6. S. Block, Disinfection, Sterilization and Preservation,
Lea & Febiger, Philadelphia, 1991
7. Rutala, WA, Disinfection and Sterilization: Current
Issues and New Technologies, presented at 2011 APIC annual conference, Baltimore, MD
23 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

Written by Charlotte A. Smith, R. Ph., M.S. Senior Regulatory Advisor, PharmEcology
Services, Waste Management Healthcare Solutions, Inc.
The management of pharmaceutical waste has changed dramatically in just the past few years. For many experienced nurses and pharmacists, “just put it in the sharps,” or down the drain, was accepted practice. The primary concern was diversion or accidental poisoning.
And while diversion and poisoning remain real concerns, studies published by multiple agencies over the past few years have demonstrated that putting drugs down the drain does not destroy them, the practice just sends them somewhere else.
1 Since red sharps containers are often autoclaved instead of incinerated, and the contents often shredded, placing drugs in these containers often results in the drugs entering the waste water just as if they had been flushed.
The only federal regulation that applies directly to pharmaceuticals is the Resource Conservation and Recovery Act (RCRA). Passed in 1976,
RCRA defines hazardous chemical waste and applies to between 4% and 5% of drugs in the market. Because it has not been updated since
1976, more than 100 chemotherapy drugs, which are very toxic and should be managed as hazardous waste, are not listed. And while a few states have regulations that are stricter and require specific management of most drugs, most states are silent on the disposal of nonhazardous drugs from a regulatory standpoint.
The EPA Office of Water provided an initial draft of BMPS (Best Management Practices for Unused
Pharmaceuticals) in 2010 2 after considerable research, including over 700 surveys and interviews. The summary of these findings was not divided by type of waste generator, resulting in somewhat confusing recommendations.
The Office of Water will be re-issuing these guidelines after the
Office of Resource Conservation and Recovery publishes a proposed rule-making in spring of 2013.
3 We don’t need to wait that long, however, to understand where the EPA is heading in terms of best management practices that may one day be regulations.
Let’s consider current requirements and then move to best management practices.
24 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

1. Federally, any pharmaceutical that meets the definition of a hazardous waste must be managed as a hazardous waste. This includes drugs such as warfarin, which have been unit-dosed at the pharmacy and are not eligible for credit. These should not be sent through reverse distribution but should be managed as hazardous waste at the facility.
2. Packaging that held P-listed pharmaceuticals must be managed as hazardous waste or triple-rinsed and the rinsate discarded as hazardous waste.
5 Since triple-rinsing is unrealistic, warfarin and nicotine packaging must therefore be managed as hazardous waste. Based on a memo 6 issued by EPA
OCRC on Nov. 4, 2011, only the “residue” on the packaging needs to be counted towards hazardous waste generator status.
3. The pharmaceutical waste management program must include such considerations as generator status, satellite accumulation, storage accumulation, waste profiling and land disposal restrictions forms (usually managed by the hazardous waste transporter), and training appropriate to the generator status. Additional information on these topics may be accessed at Managing Pharmaceutical
Waste: A Ten Step Blueprint 7 and Pharmaceutical Wastes in Health Care Facilities.
8
4. State regulations may be stricter than federal regulations and the generator must be aware of and comply with any additional relevant state regulations.
1. Based on the EPA Office of Waster Guidelines and the continuing concerns being expressed among the scientific community around the subtle effects of pharmaceuticals in the environment, 9,10 healthcare facilities should plan to manage the majority of pharmaceutical waste through incineration at an appropriate hazardous or nonhazardous facility, rather than through routine drain disposal. Regulated medical waste facilities and many waste-to-energy combustors are permitted to accept nonhazardous pharmaceutical waste.
2. “Bulk” chemotherapy (e.g. non-empty vials, ampules, IV bags) should be managed as hazardous waste as a best management practice, since only nine chemotherapy drugs are currently listed under the RCRA regulations.
3. Controlled substances should be disposed in a manner that prevents diversion. Options include reverse distribution and, in many states, drain disposal. As more states enact regulations that prohibit any drain disposal, healthcare facilities are being forced to spend valuable staff time and money sending waste controlled substances through reverse distribution. The Drug Enforcement
Administration (DEA) has not offered any method for rendering controlled substances non-recoverable other than sewering or incineration. 21 CFR 1307.21 offers only very general instructions as to disposal practices.
11 The current Pharmacist’s Manual on the DEA Diversion website offers only reverse distribution as a suggested method of disposal for healthcare facilities.
12
4. Management of used fentanyl patches presents an even greater challenge since these cannot be sent through reverse distribution and may cause problems with plumbing in older facilities if flushed. The most common practice is to fold them or cut them into smaller pieces and place into a sharps container with a counter-balanced lid to discourage diversion. A recent Alert from the Institute for Safe Medication Practices (ISMP)
25 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

References
1. Disposal of Unused Medicines: What You Should
Know. US Food and Drug Administration. Retrieved from: www.fda.gov
2. Guidance Document: Best Management Practices for
Unused Pharmaceuticals at Health Care Facilities, EPA
Office of Water, 26 August 2010, may be accessed at http://water.epa.gov/scitech/wastetech/guide/upload/ unuseddraft.pdf.
3. EPA Status Update may be accessed at http://www.
epa.gov/osw/hazard/wastetypes/universal/pharmrule.htm.
4. 40 CFR 261.20 – 261.24, 40 CFR 261.33 definitions of hazardous waste may be accessed at http://ecfr.
gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=
%2Findex.tpl
5. 40 CFR 261.3
6. EPA Memo Nov. 4, 2012 Containers that Once Held
P-listed Pharmaceuticals can be accessed at http:// yosemite.epa.gov/osw/rcra.nsf/0/57B21F2FE337351
28525795F00610F0F/$file/14827.pdf
7. Managing Pharmaceutical Waste: A Ten Step
Blueprint may be accessed at http://www.hercenter.
org/hazmat/tenstepblueprint.pdf.
8. Pharmaceutical Wastes in Health Care Facilities may be accessed at http://www.hercenter.org/hazmat/ pharma.cfm.
9. Pharmaceuticals in the Environment, Annual Review may be accessed at http://www.annualreviews.org/ doi/abs/10.1146/annurev-environ-052809-
161223?journalCode=energy.
10. Pharmaceuticals and Personal Care Products may be accessed at http://www.epa.gov/ppcp/.
11. 21 CFR 1307.21 Disposal of Controlled Substances may be accessed at http://www.deadiversion.usdoj.
gov/21cfr/cfr/1307/1307_21.htm.
12. DEA Pharmacist’s Manual 2010 may be accessed at http://www.deadiversion.usdoj.gov/pubs/manuals/ pharm2/pharm_manual.pdf.
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26 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

The renewal cycle for the
CHESP credential is three years, with expiration on the last day of the month in which certification expires.
Renewal may be achieved either through participation in acceptable continuing professional education (Alternative
I) or through retaking and passing the CHESP
Examination (Alternative II) within one year prior to your expiration date. A certificant who fails to renew is no longer considered certified, must relinquish his/her certificate and certification pin, and cease using the certification credential and all merchandise reflective of CHESP certification. A certificant who fails to renew before expiration may regain certification only through re-examination.
Attendance at this conference is an eligible education activity for certification renewal and should be reported on the Certification
Renewal Application. Candidates who successfully pass the Exam at this conference and subsequently become certified may report this activity toward the certification renewal requirements for the first renewal cycle.
For information regarding certification renewal, please contact the AHA Certification Center at certification@aha.org, 312.422.3711, or
312.422.3715.
AHE is pleased to offer the CHESP Exam
Scholarship to assist AHE members who desire certification. The Scholarship Fund is currently supported by proceeds from the raffle at the
AHE Annual Conference and Marketplace and by the generous support of STERIS. Please visit www.ahe.org and click on the CHESP link to review the scholarship application and candidate handbook for guidelines, eligibility, and instructions. To contribute to the scholarship fund contact AHE at 312.422.3860.
Did you know that you can earn nine (9) continuing professional education (CPE) credits towards your CHESP renewal by taking the online CHESP Study Group course? Join the
Study Group and refresh your knowledge of the CHESP domains and connect with colleagues online to share your knowledge!
Lea L. Beach
Javier Caballero
Peter Cain
Gabriel Centeno
William C. Clough
Paulette Craun
Mark D. Dunham
Michael Longtin
Cora M. McCarthy
Guillermo A. Reyes
Ronald E. Sample
Mark Savage
Todd Shiplett
Brian J. Tallmadge
James T. Fengel
Harold W. Jones
Dean R. Waters
Edward G. Van Cleve, Jr.
27 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

28 The Phoenix • 2012 Volume 32 Number 2 Quarter 2

SEPTEMBER 16-19, 2012 • PHOENIX, ARIzONA
SHERATON PHOENIX DOWNTOWN HOTEL AND CONVENTION CENTER
“Like registration on line and that you get a receipt.”
“Panel discussion was fabulous.”
“Enjoyed the positive interaction, training and valuable information provided.”
“Every speaker was great.”
“Nice without any problems that is what
I love about
AHE”
“Overall great conference.”
“Very organized and communication was excellent.“
“Awesome program!”
“The presentations and educational lectures were excellent and great delivery.”
• Networking —Schedule time to talk with industry partners, speakers, experts and peers.
• EXCHANGE of ideas, resources, skills —Evaluate best practices and hands-on technologies that you can share with your colleagues and team.
• Leadership —Discover the most critical trends, advancements, and data in healthcare and environmental services management.
• EXCHANGE 2012 Mobile App —We’re bringing our mobile app back with more features to enhance your conference experience and put information and resources at your fingertips.
• Education —Take part in three full days of best-in-class education that will help you build skills to bring back to your facility.
• High Tech solutions, systems, products —Carve out time to talk one-on-one with industry experts ready to provide you with innovative products and solutions, as well as demonstrations of the latest technology.