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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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