Successful contract management Successful contract management of healthcare waste collection and treatment contractors

Contains of course Cooperation with external disposal companies Regulations for the transport of hazardous goods on streets Standards recommendations for vehicles and equipment The waste manifest Controlling of the contractor and the treatment company

Why are disposal companies needed? The task of a hospital is the treatment of patient and not the treatment of waste! Problem of small quantities: A lot of kinds of waste are produced only in small quantities. Own treatment plants are often not working economical Problem of staff: Specialized staff for waste transport, treatment and management is often not available Problem of equipment: Mostly, hospitals can not afford own trucks, collection equipment, plants, etc. Problem of financing: Financing of waste equipment is always a problem in hospitals as this is not the core business of the hospital

Central treatment Advantages: Disadvantages: Economical treatment also for small portions of waste Better utilization of the investment (2 or 3 shift operation) Operation by specialized operators Lower operation costs, comparable lower investment cost No “mushrooming” of treatment plants Disadvantages: Disposal security depends only on some plants Risk of monopolies and increasing disposal costs Problematic external hazardous waste transport (Proximity principle is not for 100 % followed.) Difficult to control by the waste generator

General aspects of waste contracting Ideas of the hospital: To get rid of the waste in an easy way To get the service as cheap as possible To give away the responsibility for the waste management, treatment and disposal To avoid problems with the government and the public Ideas of the contracting company: To make profit! To transport, treat and dispose of the waste in an accepted way as cheap as possible Easy and smooth collection, operation and disposal

Understanding of contractors Main cost of the contractor: Collection and transportation costs Storage and treatment costs Disposal cost of residues Cost of the waste management Ideal contracts for a contracting company: Long term contracts Fixed price, independent from waste generation or based on volume Low frequent pick up, high amounts of waste Take back duty in case of segregation mistakes

Understanding of hospitals Main cost of the hospital: Contracting costs Internal transportation cost including packing material Cost for the interim waste storage Cost of the waste management Ideal contracts for a hospital: Medium term contracts Price, based on the weight of generated waste High frequent pick up on fixed times Complete take over of the responsibilities by the contractor

Cooperation instead of conflicts! Generally: The waste generator is responsible for the waste until the final disposal! But the contractor takes over the handling responsibility. Points of negotiation between hospital and contractor: Length of contract Frequency of pick up Kind and supply of packaging Time and place of pick up Kind of payment (weight, volume, lump sum, etc.) Handling of documents Responsibilities – transport and treatment standards Additional services e.g. waste stream analysis, etc.

Consumer = Waste Generator Central Collection point External Disposal Logistic centre Cross Docking Internal Transport External Transport Container Transfer Transport in suitable trucks Record keeping of the disposed of waste Data collection for the waste balance sheet Clear interface between hospital and contractor Supplier Internal Transport External Disposal Consumer = Waste Generator External Transport De-central Collection points Internal Transport Central Collection point

Waste Logistic – internal/external interface Hospital Hospital waste is collected and will be interim stored in approved waste containters. As example, UN proved 770 litre waste containers, colour coded and signed with the international biohazard sign can be used. The containers should be wheeled and lockable, UV- and heat-resistant, easy to clean and equipped with lockable wheels. For tracing the containers, they can be equipped with a bar code or transponder system.

Transport of hazardous waste External Transportation: Periodically or on request, the governmental licensed disposal company comes and takes the waste to the treatment plants. The hazardous waste must be transported according to the applicable laws. The carrier must endorse the receive of the quantity and quality of the waste and will be responsible for the waste after signing. After treatment, the carrier will inform the generator about the disposal in accordance with the regulations

Recommendation for transportation I Hazardous waste bags should never be placed loose in the body of the truck as they may open during transportation If possible, waste bags and containers should be put in transportation containers during transport The body of the truck should be of a suitable size, with a internal height of about 2 metres It should be a bulkhead between driver‘s cabin and the loading body of the truck A system should be available to secure the load during transportation

Recommendation for transportation II Safety equipment: Spillage kit for liquid waste, protective clothing, basic tools, reserve bags and container should be on board Fire extinguisher (Class A-C) and first aid box must be available The truck driver must be special trained for the transportation of hazardous waste Operation proceedings for emergency situations must be available Transport documentation must be always available for inspections

Recommendation for transportation III If possible, the hazardous waste transport vehicles should not be used for other purposes Hazardous waste vehicles must be periodically cleaned and disinfected (at least weekly) After every incident, cleaning and disinfection is needed If no other vehicles for the transportation are available, ambulances may be used and must afterwards be cleaned and disinfected The used vehicles should be kept looked at all time, except loading and unloading

Recommendation for transportation IV Internal angels should be rounded, other sharp edges, etc. should be avoided The vehicle must be marked with the name and address and telephone number of the carrier The international hazard signs for the transported kinds of waste must be clear displayed on the vehicle

Sample of transportation container Safe transportation of Hospital waste To avoid risks for the public by spillages, etc. infectious waste must be transported under consideration of the potential dangers by the waste. For this, a transport in special containers is necessary. Example: 770 l container for bio hazardous waste ADR proved for the transportation of hazardous goods on streets UN proved according waste class 6.2

Why setting up of a waste manifest? The waste manifest Why setting up of a waste manifest? To be able to trace the waste during the complete disposal chain To be able to monitor the correct transportation and treatment To document against the government the correct treatment To control the production of hazardous waste in a region and a country

Minimum requirements - waste manifest Contains of the waste manifest: Who produced the waste, who is internal responsible for the waste management (with signature, date) Planned transportation and treatment Kind of waste, characterisation of the waste, quality and quantity of the waste Who is transporting the waste to where, who is responsible (with signature, date) Who is treating the waste, where and in which facility. Who is internal responsible (with signature, date)

Consumer = Waste Generator Central Collection point External Disposal Logistic centre Cross Docking Internal Transport External Transport Container Transfer Supplier Exhausting recycling possibilities Minimizing of disposal costs Environmental friendly disposal Documentation of the disposal Internal Transport External Disposal Consumer = Waste Generator External Transport De-central Collection points Internal Transport Central Collection point