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E A Plastic Recycling Guide for Hospitals

An Online Continuing Education ActivitySponsored By

Grant Funds Provided By

1

Getting Started Plastics Mapping Tool

The purpose of plastics mapping is to understand the overall flow of plastic materials through the hospital from entry, through usage, and exit as waste streams. By mapping the flow of plastic materials through your hospital, you can identify non-patient contact healthcare plastic materials that can be easily recycled and the optimum points to collect these materials for recycling. We have developed the Plastics Mapping Process Questionnaire to help you gather information within a specific functional area and to develop a plastics waste inventory for the area. As the information is gathered, it can be transitioned into a detailed map to show the flow of plastics through a specific functional area. This information will help you identify easy-to-collect, clean, non-infectious healthcare plastic materials for recycling; identify optimum locations for collecting these materials; and begin assessing processes by which you can collect and transfer these materials to a central dock-out area. This information will form the basis for developing a plastics recycling program for your hospital. Plastics Mapping Template CLICK ON IMAGE FOR ENLARGED VIEW

In Support of Healthcare Plastics Recycling Council (HPRC)

Welcome to

A Plastic Recycling Guide for Hospitals

(An Online Continuing Education Activity)

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PfiedlerEnterprises,2170S.ParkerRd.,Suite125,Denver,Colorado80023www.pfiedlerenterprises.comPhone:720-748-6144Fax:720-748-6196

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

3

OverviewA challenge that hospitals are facing is how to successfully integrate recycling practices into a patient care setting, and understanding the economic, regulatory, resourcing and infrastructure nuances that come with it. This continuing education module will address the process of activating a plastics recycling program in a patient care setting from initial planning and business decisions through program implementation and improvement considerations.

ObjectivesUpon completion of this continuing education activity, the participant should be able to:

1. Developabusinesscaseandevaluatefinancialimpactsofprogramimplementation2. Identify common recyclable healthcare plastics and conduct a waste characterization3. Select an optimal recycling strategy and recycling partner4. Assess critical resource and infrastructure requirements5. Establish metrics and audit guidelines to drive program improvements

Intended AudienceThis continuing education activity is intended for nurses and other healthcare providers who are interested in learning more about activating a hospital recycling program.

Credit/Credit Information State Board Approval for Nurses PfiedlerEnterprisesisaproviderapprovedbytheCaliforniaBoardofRegisteredNursing,ProviderNumberCEP14944,for2.0 contact hours.

Obtaining full credit for this offering depends upon attendance, regardless of circumstances, from beginning to end. Licenseesmustprovidetheirlicensenumbersforrecordkeepingpurposes.

The certificate of course completion issued at the conclusion of this course must be retained in the participant’s records for at least four (4) years as proof of attendance.

IAHCSMM The International Association of Healthcare Central Service Materiel Management has approved this educational offering for 2.0 contact hours to participants who successfully complete this program.

CBSPD TheCertificationBoardforSterileProcessingandDistribution(CBSPD)hasapprovedthisprogramfor2.0 contact hours.

Release and Expiration Date:This continuing education activity was planned and provided in accordance with accreditation criteria. This material was originally produced in June 2016 and can no longer be used after June 2018 without being updated; therefore, this continuingeducationactivityexpiresJune2018.

DisclaimerAccredited status as a provider refers only to continuing nursing education activities and does not imply endorsement of any products.

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

4

SupportFunds to support this activity have been provided by Halyard Health Knowledge Network.

Authors/Planning Committee/ReviewersThe guidance and tools presented in this continuing education module were prepared by the Healthcare Plastics Recycling Council (HPRC, www.hprc.org), a private technical coalition of peers across the healthcare industry including medical device andpackagingmanufacturers,healthcarefacilities,recyclingandwastemanagementindustriesseekingtoinspireandenable sustainable, cost-effective recycling solutions for plastic products and materials used in the delivery of healthcare. HPRCmembersarebrandleadingandgloballyrecognizedcompanies;currentmembersincludeBaxter,BectonDickinson,CardinalHealth,Covidien,DuPont,Eastman,HalyardHealth,Johnson&Johnson,Perfecseal,andSabic.Specialthankstothefollowingparties:AnteaGroupforprovidingleadershipandguidancetoHPRC,WasteManagementforproviding information about material recovery facilities, and HPRC Healthcare Facility Advisory Board (HFAB) members KrisanneHanson,DirectorofSustainabilityofStanfordUniversityMedicalCenterandTimEng,ProjectManagerofKaiserPermanente for their contributions to this project.

PfiedlerEnterprisesreviewedthematerialsandreformattedinanefforttomakethecontentanonlinecontinuingeducationactivity. The following served as reviewers.

Julia A. Kneedler, EdD, RN Denver, CO Program Manager /ReviewerPfiedlerEnterprises

Judith I. Pfister, MBA, RN Denver, CO Program Manager/ReviewerPfiedlerEnterprises

Melinda T. Whalen, BSN, RN, CEN Denver, COProgram Manager/ReviewerPfiedlerEnterprises

Disclosure of Relationships with Commercial Entities for Those in a Position to Control Content for this Activity PfiedlerEnterpriseshasapolicyinplaceforidentifyingandresolvingconflictsofinterestforindividualswhocontrolcontentforaneducationalactivity.Informationbelowisprovidedtothelearner,sothatadeterminationcanbemadeifidentifiedexternalinterestsorinfluencesposepotentialbiasincontent,recommendationsorconclusions.Theintentisfulldisclosureofthoseinapositiontocontrolcontent,withagoalofobjectivity,balanceandscientificrigorintheactivity.ForadditionalinformationregardingPfiedlerEnterprises’disclosureprocess,visitourwebsiteat:http://www.pfiedlerenterprises.com/disclosure

Disclosureincludesrelevantfinancialrelationshipswithcommercialinterestsrelatedtothesubjectmatterthatmaybepresented in this continuing education activity. “Relevant financial relationships” are those in any amount, occurring withinthepast12monthsthatcreateaconflictofinterest.A commercial interest isanyentityproducing,marketing,reselling, or distributing health care goods or services consumed by, or used on, patients.

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

5

Activity Authors/ Planning Committee/Reviewer Thecompaniesandexpertsinvolvedinthisprojectwerefundedbytheirrespectivecompanies.

Julia A. Kneedler, EdD, RN Noconflictofinterest

Judith I. Pfister, MBA, RN Noconflictofinterest

Melinda T. Whalen, BSN, RN, CEN Noconflictofinterest

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

6

Starting a Plastics Recycling Program at Your HospitalHealthcarefacilitiesintheUnitedStatesgenerateapproximately6,600tonsofwasteperday1.Itisestimatedthatbetween20and25percentofthat6,600tonscanbeattributedtoplasticpackagingandplasticproducts2.Inaddition,85percentofthewastegeneratedisnon-infectious3.Inconclusion,thepotentialforplasticsrecyclinginhospitalsissignificanttobothenvironmental and human health impacts.Whilehospitalshavebeenchampionsofrecyclingfordecades,effortshavelargelyfocusedonfoodserviceandadministrative functions. The challenges that hospitals are facing now are how to successfully integrate recycling practices into a patient care setting, and understanding the economic, regulatory, resourcing and infrastructure nuances that come with it. Focusing on clean, non-infectious healthcare plastic waste materials, the Healthcare Plastics Recycling Council (HPRC) has developed this guide with supporting tools to help hospitals navigate the process of initiating a plastics recycling program in a patient care setting from initial planning and business decisions through program implementation and improvement considerations.

Before You BeginBefore you begin implementing a healthcare plastics recycling program, there are several considerations that should be evaluated and implemented. A healthcare plastics recycling program is an advanced recycling option, so consider your hospital’scommitmenttosustainabilitytogaugewhetherthisisanappropriatetoolinyoursustainabilityprogram.Therearealsofinancialconsiderations,andresourcingandequipmentneedsthatshouldbeevaluatedpriortogettingstarted.

Initial Waste CharacterizationThe focus of this guidance document is to assist hospitals in establishing a recycling program for clean, non-infectious plasticproductsandplasticpackaging.Tohelpyouidentifythetypesofmaterialstotargetandapproximatequantitiesofwaste plastics, we have developed the following tools:

• Common Recyclable Healthcare Plastics• InitialWasteCharacterization

7

Before You Begin Common Recyclable Healthcare Plastics

Sterilization Wrap Commonly referred to as “blue wrap”, sterilization wrap is a sterile material that protects surgical instruments and other items from contamination. It is often clean material that can be easily collected. It is made from polypropylene (PP) and may be recycled with other #5 materials.

Made of polypropylene (PP) and can be recycled with other #5 plastics

Images courtesy of Kimberly Clark

Note: Sterilization wrap can be recycled. However, it is recommended that paper indicator tape be removed from sterilization wrap prior to recycling, as it diminishes the market value and use of the recycled product.

Images courtesy of Halyard Health

Irrigation Bottles Irrigation bottles are commonly used in operating rooms. These bottles are often easy to drain and collect for recycling. They are often made from polypropylene (PP), which can be recycled with other #5 materials. Some saline bottles are made from high density polyethylene (HDPE), which may be recycled with other #2 materials. Check with the manufacturer if you are not sure of the material.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Baxter

8

Basins, Pitchers, Trays Rigid colored and opaque plastic containers such as water pitchers and patient care basins and trays are typically made from polypropylene (PP) and may be recycled with #5 materials.

Pitcher

Trays

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Cardinal Health

9

Tyvek® Tyvek® is a common material utilized in sterile barrier packaging, typically as part of a chevron peel pouch or a lid on a rigid tray. Tyvek® is made from high density polyethylene (HDPE) and may be recycled with other #2 materials. It can be difficult to visually differentiate Tyvek® from paper. Both have a similar appearance; however, long intertwined fibers can be seen in Tyvek® material when a light source is placed behind the material. Also, paper tears easily while Tyvek® is difficult to tear, although some coated paper is also difficult to tear.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of DuPont

10

Flexible Clear Packaging Flexible clear packaging includes shrink wrap, stretch film, and plastic bags and is usually found in large quantities at incoming dock areas and as secondary and tertiary packaging for healthcare products. Flexible clear packaging is made from polyethylene (PE) and may be recycled with #2 materials.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Perfecseal, a Bemis Company

11

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Initial Waste Characterization

A hospital’s waste stream can be complex, and a few studies have been completed to characterize the waste profile, which we summarize below. Healthcare facilities in the United States generate approximately 6,600 tons of waste per day1. It is estimated that between 20 and 25 percent of that 6,600 tons can be attributed to plastic packaging and plastic products2. In addition, 85 percent of the waste generated is non-infectious3. Based on this general information, an initial estimate of the amount of the plastics available for recycling at your hospital might be calculated as follows: See the Economic Pro Forma Tool for assistance in calculating quantities and costs of plastics recycling. HPRC is conducting plastics recycling pilot studies with leading hospitals across the country and will publish additional hospital waste characterization data as the pilot studies are completed. REFERENCES 1 Kaplan, Susan, Sadler, Blair, Little, Kevin, Franz, Calvin, and Orris, Peter. “Can Sustainable Hospitals Help Bend the Health Care Cost Curve?”, The Commonwealth Fund, Issue Brief, November 2012. 2 Lee, B., M. Ellenbecker, and R. Moure-Eraso. “Analyses of the Recycling Potential of Medical Plastic Wastes.” Waste Management (2002): 461-470 3 Grogan, Terry. “Solid Waste Reduction in US Hospitals.” Hospital Engineering & Facilities Management (2003): 88‐91.

Total Estimated Amount of Plastics Available for Recycling (tons/year)

Total Amount of Hospital Waste (solid, hazardous,

regulated medical, recycled) (tons/years)

= x x 25% 85%

12

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

13

Commitment to SustainabilityBy considering recycling of healthcare plastics, it is apparent that your hospital is interested in advancing a sustainability program. Be prepared that the recycling of healthcare plastics is not as easy to implement as other sustainability initiatives maybe.Wehavedevelopedthesetoolstohelpyouassessifyourhospitalisreadytoimplementaplasticsrecyclingprogramandtodevelopabusinesscasetogainapprovalandsupportfromexecutivemanagement.

• ChecklisttoAssessReadiness• GuidetoDevelopingaBusinessCase

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

14

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Guide to Developing a Business Case

If approval from the hospital executive leadership team is required to implement a plastics recycling program, presenting a business case may be the best approach to request approval. This guide will help you prepare the business case. The purpose of a business case is to present a concise summary of an opportunity and a proposed plan. It typically has four parts: (1) an overview of the opportunity, (2) a description of the proposal, (3) the anticipated and/or desired outcomes, and (4) the request for approval and support. This guide is divided into three parts: 1. Tips for Preparing the Business Case 2. A Business Case Outline 3. Useful Background Information

Tips for Preparing the Business Case

• Keep it short – Assume that you will have 15 minutes of attention from the executive leadership team. Aim for 1-2 pages or 3-4 slides.

• If the business case is more than one page long, provide a one-paragraph Executive Summary at the beginning.

• Keep it clear and concise. Avoid jargon and use language that the executive leadership team will understand.

• Use the Economic Pro Forma tool to help estimate costs associated with implementing a plastics recycling program at your hospital. Use your hospital’s standard financial metrics when presenting the cost analysis.

Business Case Outline

Executive Summary if needed. Keep to one paragraph. • What is the opportunity? Describe hospital’s waste stream and opportunities for recycling plastic. • What is the proposal? Describe key aspects of the proposed hospital plastics recycling program.

Describe alignment with hospital sustainability strategy. • What are the anticipated / desired outcomes? Describe potential amount of diverted plastic waste

materials, cost savings, environmental benefits, and community benefits. • Request approval and support to implement program.

15

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

16

Economic AnalysisIsahealthcareplasticrecyclingprogramafinancially-viableoptionforyourhospital?TheEconomicPro-Formatoolwillhelpyourhospitalanswerthatquestionbywalkingyouthroughtheprocessofevaluatingyourwastestreamsandrecyclingprogramrequirements.Bepreparedforacostneutralrecyclingprogram–willthisbeacceptableinyourhospital?

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

19

Critical InfrastructureThere are several critical infrastructure components that are necessary to evaluate prior to including healthcare plastics in yourhospital’srecyclingprogram.

1. Dockspacetoconductsorting/processinganddock-outmaterialstransfer;and2. Equipment and supplies to manage the plastics (e.g. baler, compactor, carts, etc.)

At this point in the process, a preliminary evaluation of these infrastructure components is appropriate, with a more detailed evaluationtobecompletedduringthe“GettingStarted”phase.Wehavedevelopedthesetoolstoassistyourhospitalin evaluating your internal infrastructure so that you can assess if additional resources may need to be secured prior to initiating a healthcare plastics recycling program within your hospital.

• DockSpaceGuideline• Recycling Equipment Guideline

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Dock Space Guideline

In evaluating the amount of dock space needed to manage your plastics recycling program, consider the following variables:

• The amount of space that is available for your current recycling program• The amount of recyclable plastics that you expect to collect• Any sorting or segregation of plastics that is required by your recycling partner• Your recycling partner’s preferred dock-out processes and pick-up schedules• The footprint for any additional equipment (compactor, baler, dumpsters, etc.) that is planned for

plastics recycling• The most economically feasible combination of equipment and pickup scheduling. For example, if your

facility is charged by the bin, a larger bin with a compactor may be needed to accommodate the largerquantities of recycling that will be collected once a hospital plastics recycling program is initiated.

Though our plastics recycling pilot study work, HPRC is developing specific guidance on the amount of dock space needed to successfully manage a plastics recycling program.

20

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

21

1

Before You Begin Recycling Equipment Guideline *Content Under Development

Certain equipment can be very useful in managing collected recyclable plastics, depending on your recycler’s operations for transporting and processing plastics and other recyclable wastes. Equipment that should be considered includes a compacter, a baler, and additional dumpsters at the dock for dock-out processes and carts, bins, and totes for collecting and transferring materials from hospital functional areas to the dock. In evaluating this equipment, talk to your recycling partner about which waste streams can be combined to determine which equipment will be necessary and/or useful to your recycling program.

A compactor is a machine used to reduce the volume of waste materials through compaction. A compactor is usually powered by hydraulics but can also be electrically powered. Hospital employees place materials into the compactor, and materials are held within the compactor until they are removed by the recycler. A compactor can be used for single stream or mixed recyclables.

Consider an additional dumpster (with or without a compactor) if additional storage capacity is needed to keep recyclables separated from other waste streams.

A baler is a machine used to compress materials into compact bales that are easy to handle, transport, and store. Bales may be bound with twine, strapping, netting, plastic strips or wire. Hospital employees place materials into the baler, remove the compacted bales from the baler, and place the bales aside until they are removed by the recycler. Balers are especially useful for consolidating lightweight plastics and plastic film and wrap.

Installing a baler and/or compactor is most viable if a facility can use the equipment for more than one process or material type. Consider the amount of recyclables to be collected in your hospital, the amount of space available in your hospital, where items will be placed until pickup, and talk to your recycler about preferred dock-out processes and pick-up schedules to determine if a compactor, baler, and/or additional dumpster will be critical or “nice-to-have” to manage recyclables in your hospital.

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

22

Getting StartedOnceyouhaveconfirmedyourhospital’scommitmenttosustainability,andevaluatedeconomicviabilityandcriticalphysicalinfrastructurerequirements,itistimetodevelopyourhospital’shealthcareplasticsrecyclingprogram.Toolswithinthis section will help you characterize your waste, create partnerships to recycle selected healthcare plastics, and establish a recycling strategy for managing the plastics included in your program.

Detailed Waste Characterization

Intheinitialwastecharacterization,youidentifiedcommonrecyclablehealthcareplasticsandapproximatequantitiesofhealthcareplasticsthatmightberecyclableatyourhospital.Nowitistimetobeginpreparingamoredetailedwastecharacterizationofrecyclableplasticsforyourhospital,startingwithwastemapping.Wastemappingistheprocessofidentifying waste quantities and types generated from an activity or area, and mapping it from the time and place where the waste is created to the time and place where the waste is hauled off site.

The Plastics Mapping Tool will help guide you through the process of identifying plastics waste generated and how it is currently handled at your hospital – who currently moves it, where it goes within the hospital, how it is handled prior to the hauler receiving it. Review the section on common recyclable healthcare plastics to help identify recyclable plastic wastes at your hospital. Remember – the focus should be on recycling clean, non-infectious plastic waste materials.

Lastly, it is critical to understand the regulatory requirements associated with collecting, managing, transporting, and recyclinghealthcareplastics.Wehavelistedresourcestohelpyouidentifyandunderstandtheregulationsthatmayapplyto a healthcare plastics recycling program so you can be prepared when discussing recycling options with your recycling team and business partners.

• Plastics Mapping Tool• Common Recyclable Healthcare Plastics• Regulatory Compliance• InitialWasteCharacterization

1

Getting Started Plastics Mapping Tool

The purpose of plastics mapping is to understand the overall flow of plastic materials through the hospital from entry, through usage, and exit as waste streams. By mapping the flow of plastic materials through your hospital, you can identify non-patient contact healthcare plastic materials that can be easily recycled and the optimum points to collect these materials for recycling. We have developed the Plastics Mapping Process Questionnaire to help you gather information within a specific functional area and to develop a plastics waste inventory for the area. As the information is gathered, it can be transitioned into a detailed map to show the flow of plastics through a specific functional area. This information will help you identify easy-to-collect, clean, non-infectious healthcare plastic materials for recycling; identify optimum locations for collecting these materials; and begin assessing processes by which you can collect and transfer these materials to a central dock-out area. This information will form the basis for developing a plastics recycling program for your hospital. Plastics Mapping Template CLICK ON IMAGE FOR ENLARGED VIEW

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Getting Started Plastics Mapping Tool

The purpose of plastics mapping is to understand the overall flow of plastic materials through the hospital from entry, through usage, and exit as waste streams. By mapping the flow of plastic materials through your hospital, you can identify non-patient contact healthcare plastic materials that can be easily recycled and the optimum points to collect these materials for recycling. We have developed the Plastics Mapping Process Questionnaire to help you gather information within a specific functional area and to develop a plastics waste inventory for the area. As the information is gathered, it can be transitioned into a detailed map to show the flow of plastics through a specific functional area. This information will help you identify easy-to-collect, clean, non-infectious healthcare plastic materials for recycling; identify optimum locations for collecting these materials; and begin assessing processes by which you can collect and transfer these materials to a central dock-out area. This information will form the basis for developing a plastics recycling program for your hospital. Plastics Mapping Template CLICK ON IMAGE FOR ENLARGED VIEW

23

24

Before You Begin Common Recyclable Healthcare Plastics

Sterilization Wrap Commonly referred to as “blue wrap”, sterilization wrap is a sterile material that protects surgical instruments and other items from contamination. It is often clean material that can be easily collected. It is made from polypropylene (PP) and may be recycled with other #5 materials.

Made of polypropylene (PP) and can be recycled with other #5 plastics

Images courtesy of Kimberly Clark

Note: Sterilization wrap can be recycled. However, it is recommended that paper indicator tape be removed from sterilization wrap prior to recycling, as it diminishes the market value and use of the recycled product.

Images courtesy of Halyard Health

Irrigation Bottles Irrigation bottles are commonly used in operating rooms. These bottles are often easy to drain and collect for recycling. They are often made from polypropylene (PP), which can be recycled with other #5 materials. Some saline bottles are made from high density polyethylene (HDPE), which may be recycled with other #2 materials. Check with the manufacturer if you are not sure of the material.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Baxter

25

Basins, Pitchers, Trays Rigid colored and opaque plastic containers such as water pitchers and patient care basins and trays are typically made from polypropylene (PP) and may be recycled with #5 materials.

Pitcher

Trays

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Cardinal Health

26

Tyvek® Tyvek® is a common material utilized in sterile barrier packaging, typically as part of a chevron peel pouch or a lid on a rigid tray. Tyvek® is made from high density polyethylene (HDPE) and may be recycled with other #2 materials. It can be difficult to visually differentiate Tyvek® from paper. Both have a similar appearance; however, long intertwined fibers can be seen in Tyvek® material when a light source is placed behind the material. Also, paper tears easily while Tyvek® is difficult to tear, although some coated paper is also difficult to tear.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of DuPont

27

Flexible Clear Packaging Flexible clear packaging includes shrink wrap, stretch film, and plastic bags and is usually found in large quantities at incoming dock areas and as secondary and tertiary packaging for healthcare products. Flexible clear packaging is made from polyethylene (PE) and may be recycled with #2 materials.

Before You Begin Common Recyclable Healthcare Plastics

Images courtesy of Perfecseal, a Bemis Company

28

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Getting Started Regulatory Compliance

The goal of a healthcare plastics recycling program is to recycle clean, non-infectious plastics, including non-medical plastic waste and unused medical plastic waste that is not infectious. Identifying and understanding federal, state, and local laws that are applicable to your plastics recycling program and establishing a program that is compliant is critical. Here are some resources to help you get started in identifying regulations that may apply to your plastics recycling program. Federal Regulations • US Environmental Protection Agency

– Information on Medical Waste: www.epa.gov/osw/nonhaz/industrial/medical/index.htm – Information for Health Care Providers: www.epa.gov/hg/healthcare.htm

State Regulations • The Healthcare Environmental Resource Center

– www.hercenter.org

Local Regulations • Check websites for your local town or community

29

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Initial Waste Characterization

A hospital’s waste stream can be complex, and a few studies have been completed to characterize the waste profile, which we summarize below. Healthcare facilities in the United States generate approximately 6,600 tons of waste per day1. It is estimated that between 20 and 25 percent of that 6,600 tons can be attributed to plastic packaging and plastic products2. In addition, 85 percent of the waste generated is non-infectious3. Based on this general information, an initial estimate of the amount of the plastics available for recycling at your hospital might be calculated as follows: See the Economic Pro Forma Tool for assistance in calculating quantities and costs of plastics recycling. HPRC is conducting plastics recycling pilot studies with leading hospitals across the country and will publish additional hospital waste characterization data as the pilot studies are completed. REFERENCES 1 Kaplan, Susan, Sadler, Blair, Little, Kevin, Franz, Calvin, and Orris, Peter. “Can Sustainable Hospitals Help Bend the Health Care Cost Curve?”, The Commonwealth Fund, Issue Brief, November 2012. 2 Lee, B., M. Ellenbecker, and R. Moure-Eraso. “Analyses of the Recycling Potential of Medical Plastic Wastes.” Waste Management (2002): 461-470 3 Grogan, Terry. “Solid Waste Reduction in US Hospitals.” Hospital Engineering & Facilities Management (2003): 88‐91.

Total Estimated Amount of Plastics Available for Recycling (tons/year)

Total Amount of Hospital Waste (solid, hazardous,

regulated medical, recycled) (tons/years)

= x x 25% 85%

30

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

31

Recycling PartnerSelecting a recycling partner/materials recovery facility (MRF) is a critical component of developing the recycling strategy. Yourrecyclingpartnercanprovidevaluableinsightforrunningyourprogrameffectively.Also,yourrecyclingpartner’soperationswillaffectyourprogramdependingonwhethertheycantakeasinglestreamofmixedrecyclables,includingplastics,orrequiresomelevelofsegregation.Yourrecyclingpartner’scoststructurewillbeacriticalportionofthebusiness case and economic pro forma, as well.

Toidentifyarecyclingpartner,startwithyourcurrentrecyclingpartnertodetermineiftheycanorwilltakehealthcareplastics.Thetoolsbelowprovidesuggestionsonfindingapartnerandguidingthediscussiontohelpfindtherightpartner.

• WhatisaMRF?• Finding a Recycling Partner• QuestionstoAsk

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Getting Started What is a MRF?

Materials Recovery Facility Materials Reclamation Facility Materials Recycling Facility A MRF, pronounced “murf”, is a specialized facility that receives recyclable materials, separates them, and processes them for delivery to an end-use manufacturer. Clean MRFs accept recyclable commingled materials that have already been separated at the source from municipal solid waste generated by either residential or commercial sources. The most common type of clean MRF is a single stream clean MRF, where all recyclable material is mixed into a single waste stream. There are also dual stream MRFs, where recyclables have been separated into two streams: (1) a mixed container stream (typically glass, ferrous metal, aluminum and other non-ferrous metals, and plastics) and (2) a mixed paper stream. At a clean MRF, the material is sorted and then processed through baling, shredding, crushing, compacting, etc. in preparation for shipment to market. A dirty MRF accepts a mixed solid waste stream (recyclables and non-recyclable wastes) and then separates out the recyclable materials through a combination of manual and mechanical sorting. After separation, the recyclable materials are sorted and processed similarly to the clean MRF operations. Watch this video http://www.youtube.com/watch?v=_GP3JuiX5BY

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Getting Started Finding a Recycling Partner

Current Partner

Start with your current waste hauler, current recycling partners, as well as other current services providers (perhaps others like your secure document destruction providers, linen haulers, product distributors, etc). • Does your waste hauler have a recycling program? • Can your recycling vendors expand the recycling program to take plastics? Describe the proposed

plastics waste stream in detail. • Do current service providers have extra hauling capacity and/or interest in expanding services to your

institution? Is there compatibility with adding this type of material to the load? Discuss your expectations and questions with them (see the Questions to Ask tool for guidance). New Partner

If your hospital does not currently have a recycling program, or the current hauler does not wish to receive healthcare plastics, then consider the following resources to find a new partner, then discuss your expectations and questions with them (see the Questions to Ask tool for guidance). Trade groups, Industry Associations, Non-Profit Organizations • Earth 911, http://earth911.com

– Earth911 is a privately owned, for-profit company that specializes in providing consumers with accessible and actionable recycling information across the country. Earth911 Recycling Directory contains recycling information for over 300 materials with search capabilities for people to find their nearest recycling options and resources.

• 1-800-Recycling, http://1800recycling.com/find/recycling-locations/plastic/ – 1-800-RECYCLING.com is a dynamic recycling and green living-focused site that makes

recycling, conserving, reusing and living wisely easy. 1-800-RECYCLING.com features a comprehensive recycling location database that gives the user the ability to easily assemble a recycling to-do list. The database is location based, and aims to make his/her recycling needs as easy as possible.

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

2

Getting Started Finding a Recycling Partner

Trade groups, Industry Associations, Non-Profit Organizations (continued) • Association of Post Consumer Plastics Recyclers, http://www.plasticsrecycling.org/

– The Association of Postconsumer Plastic Recyclers is the national trade association representing companies who acquire, reprocess and sell the output of more than 90 percent of the post-consumer plastic processing capacity in North America. Its membership includes independent recycling companies of all sizes, processing numerous resins. APR promotes development of the plastics recycling industry by providing leadership for long-term industry growth and vitality.

• Recycling Centers.org, http://www.recyclingcenters.org/ – RecyclingCenters.org exists to provide a resource for communities to find places to recycle a

wide variety of products in their neighborhood. • ACC find a plastics recycler, http://www.plasticsmarkets.org/plastics/search.html

– This site's purpose is to connect suppliers and buyers of all types of scrap plastic (from bales to post consumer resin). It's supported by the plastics industry and intended for use by the recycling industry in the United States and Canada.

• North American Plastics Recycling Network, http://www.recyclingplasticwaste.com/ – The North American Plastic Recycling Network is a membership based regional information

exchange servicing companies and individuals who BUY / SELL / TRADE commodities, materials, goods and services relevant to this industry.

• American Chemistry Council, http://plastics.americanchemistry.com/Product-Groups-and-Stats/FFRG – The American Chemistry Council's (ACC's) mission is to deliver business value through

exceptional advocacy using best-in-class member performance, political engagement, communications and scientific research. ACC is America’s oldest trade association of its kind, representing companies engaged in the business of chemistry—an innovative, $760 billion enterprise that is helping solve the biggest challenges facing our nation and the world. The ACC Flexible Film Recycling Group (FFRG) is working to significantly increase the collection and recycling of all flexible films and to educate the public about the importance of recycling.

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

3

Getting Started Finding a Recycling Partner

Area-Specific Recycling Resources • California, CalRecycle Plastic Recyclers,

http://www.calrecycle.ca.gov/Plastics/Recyclers/RecyclerList.aspx?MaterialTypeIDList=&CountyIDList=&FacilityName=&FormsAccepted=&MinimumQuantityAccepted=&QuantityAcceptedUnitsID=1

– California's Department of Resources Recycling and Recovery (CalRecycle) brings together the state's recycling and waste management programs and continues a tradition of environmental stewardship.

• Oregon Metro, http://www.oregonmetro.gov/index.cfm/go/by.web/id=1383 – As the elected regional government for the Portland metropolitan area, Metro works with

communities, businesses and residents to create a vibrant and sustainable region for all. From packing peanuts to propane tanks, get sustainable solutions for unwanted materials using Metro's recycler directory with more than 400 local recycling and reuse sites.

• Maryland, http://www.mdrecycles.org/recyclingDirectory.php?sec=plastics – On mdrecycles.org, you'll discover which materials are recyclable, find companies that will pick

up recyclable material, and learn how to reduce your waste management costs while helping to create a cleaner environment for all of us.

• Canadian Plastics Industry Association, http://www.plastics.ca/Recycling/FindARecycler/index.php – The Canadian Plastics Industry Association (CPIA) is the voice of the Canadian Plastics

Industry. With over 3,198 companies employing 91,530 workers, Canada’s $26.3 billion plastics industry is a sophisticated sector encompassing plastic products manufacturing, machinery, molds, and resins. CPIA is committed to increasing the amount of plastic and the different types of plastic waste being diverted from landfill through the use of various waste management options, such as reuse, recycle and energy recovery.

Material-Specific Recycling Resources • DuPont™ Tyvek®, Garment Recovery Systems (GRS), http://garmentrecoverysystems.com

– Since 1985, Garment Recovery Systems has been helping companies reduce solid waste and disposal fees by recycling their Tyvek apparel. We recycle with hundreds of Fortune 500 companies in the U.S., Canada, Europe and Puerto Rico.

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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1

Getting Started Question to Ask a Recycling Partner

Questions to Ask When talking with a potential recycling business partner, use the following list of questions and discussion topics to help guide the discussion. • What plastics materials can the MRF/recycler accept? Are all of the plastics from your waste

characterization accepted? – Type of plastics (PET, PETG, PE, HDPE, PS, PP) – Form of plastics (rigid plastics vs. flexible plastics) – Shapes of rigid plastics (bottles versus other shapes may affect processing equipment) – Contamination (paper labels, mixed plastics, glass, cardboard, wet materials, etc.) – Mixing and compacting medical plastics waste stream with post-consumer recyclables may

result in contamination with broken glass.

• In what form can the MRF/recycler accept materials (bales, gaylords, truckload, etc.) and what will be the dock-out process?

• Discuss nonconforming materials: – From hospital perspective, nonconforming materials usually means that infectious materials are

accidentally mixed with the plastics recycling stream. The MRF/recycler will expect that the material it receives is not contaminated, so be prepared to discuss measures that you will implement to keep recyclable materials from being contaminated.

– From MRF/recycler perspective, nonconforming materials usually means that unacceptable types of plastic and/or other unacceptable materials are accidentally mixed with the plastics recycling stream.

• How will the MRF/recycler manage nonconforming materials? Review MRF/recycler “emergency management plan” and how nonconforming materials will be managed. Discuss the safety issues and control measures at the MRF/recycler.

Questions to Ask a Recycling Partner

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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2

Getting Started Finding a Recycling Partner

Questions to Ask (continued) • What is the final disposition of the plastics? There might be further downstream processors.

Does this impact the materials we intend to recycle?

• What kind of data can the MRF/recycler collect and report?

• What type of EHS management system does the MRF/recycler have? Does the MRF/recycler have any EHS management system certifications?

• Ask where the materials will be recycled. Will they be handled locally, domestically, internationally? Which industries/products might the recycled materials ultimately be reutilized in?

• Can the MRF/recycler provide you with a statement or certificate that its operations are in compliance with all applicable federal, state, local regulations.

– Consider reviewing EHS permits, certifications, registrations, etc. – Consider establishing a signed contract with the MRF/recycler to describe agreement conditions,

including service deliverables and legal commitments to cover any liability if improper practices occur.

Invite MRF/recycler representatives to tour the hospital to understand the hospital recycling operations and how the hospital will send only approved materials to the MRF/recycler.

Questions to Ask a Recycling Partner

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Recycling StrategyThere are several different strategies for healthcare plastics recycling that can be implemented in a hospital, depending on theresourcesavailable.AlimitedprogrammaybeappropriateduetospecificplastictypesacceptedbytheMRFortopilotaprogramwithinaparticularareaofthehospital.Wehavedevelopedguidesforafewprovenstrategiestoconsiderwhensetting up your program.

• Recycling Strategy Selection

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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1

Getting Started Selection of Recycling Strategy

Limited Products

This plastics recycling strategy consists of picking one or two main items and implementing collection and recycling of selected item(s) across multiple areas. After successfully initiating recycling of one or two items, start adding other items. This strategy may be best if your recycler only accepts a limited number of products and/or if there is a particular plastic waste item that is generated in large quantities across many areas. Choose an easily identifiable item that is generated in large quantities. Use information from your plastics mapping to help identify items. Here are some suggested items to evaluate: • Irrigation bottles (PP) – Large quantities and usually easy to recycle • Rigid plastic trays and basins (PET, PETG, PS, HDPE) – Large quantities and usually easy to recycle • Plastic non-woven sterilization wrap (“blue wrap,” PP) – Large quantities but may be limited regional

options for recycling • Flexible clear packaging (shrink wrap, stretch film, plastic bags (PE) – Large quantities especially at

incoming dock areas, usually easily recycled Caution Flexibles and films packaging can be difficult to segregate and recycle because of mixed materials, such as paper tape or labels on the film. Ambiguous materials should be avoided, such as plastic products with similar appearances where one type of plastic product is acceptable and a similar-looking product is not acceptable. An example is a metalized plastic bag with a shiny metal layer, like the packaging found on a scrub brush with antimicrobial and skin cleaner, which may not be acceptable for recycling.

Recycling Strategy Selection

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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2

Getting Started Recycling Strategy

Selected Areas

This plastic recycling strategy consists of implementing a complete mixed plastics recycling program in a selected area and/or a limited number of rooms. After successfully initiating mixed recycling in the selected area, start expanding the program to other areas. This strategy may be best if there is a particular area that generates a large quantity of recyclable plastics, if staff within a particular area have a strong commitment to and passion for recycling, and/or a well-established recycling program is already in place in a certain area. Choose areas with a small physical footprint, large volumes of patient processing, repetitive activities, clean or sterile space, no high-pressure activities (controlled patient care setting, non-trauma), and a consistent group of staff involved for ease of training. Here are some suggested areas to evaluate: • Cath Lab – sterile area • Interventional Radiology – sterile area • Pharmacy – clean area • Ambulatory Surgery Center – sterile area • Primary Surgery Department (planned cases) – case cart prep area of other sterile area • Anesthesia Work Rooms/Prep Areas – clean area Alternatively select a high impact area, such as the operating room, and learn which materials are recyclable and easy to collect, and implement a program there to capture a high volume of materials. Caution Flexibles and films packaging can be difficult to segregate and recycle because of mixed materials, such as paper tape or labels on the film. Ambiguous materials should be avoided, such as plastic products with similar appearances where one type of plastic product is acceptable and a similar-looking product is not acceptable. An example is a metalized plastic bag with a shiny metal layer, like the packaging found on a scrub brush with antimicrobial and skin cleaner, which may not be acceptable for recycling.

Recycling Strategy Selection

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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3

Getting Started Recycling Strategy

Similar Streams

This strategy is a combination of the Limited Products and Selected Areas strategies. Choose service lines or care teams with similar types of plastic products that can be recycled. Pick one or two items , following guidance from the Limited Products strategy, and implement plastics recycling across the entire service line or care team. Clustered service lines or care teams will have aligned leadership structure to support a recycling program within their areas. Caution Flexibles and films packaging can be difficult to segregate and recycle because of mixed materials, such as paper tape or labels on the film. Ambiguous materials should be avoided, such as plastic products with similar appearances where one type of plastic product is acceptable and a similar-looking product is not acceptable. An example is a metalized plastic bag with a shiny metal layer, like the packaging found on a scrub brush with antimicrobial and skin cleaner, which may not be acceptable for recycling.

Recycling Strategy Selection

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Whendevelopingyourrecyclingstrategy,considerthefollowingsafetyaspects:

• Establishyourfirstrecyclingprograminlowpatientacuityareasfirst,developingtheprocessfullybeforeexpandingto high patient acuity areas such as ER/ICU.

• Utilize appropriate personal protective equipment (PPE), both at the hospital for staff collecting the plasticmaterials and at the MRF/recycler for incoming inspection of materials.

Ambiguous materials should be avoided, such as plastic products with similar appearances where one type of plastic productisacceptableandasimilar-lookingproductisnotacceptable.Anexampleisametalizedplasticbagwithashinymetallayer,likethepackagingfoundonascrubbrushwithantimicrobialandskincleaner,whichmaynotbeacceptableforrecycling.

Running the ProgramAreyoureadytoimplementyourhealthcareplasticsrecyclingprogram?Thefollowingtoolsprovideguidanceandtipsforsetting up the resources and logistics for running the program, establishing a training program, measuring progress and success,andtrackingtheprogrameconomics.

Resources

Nowthatyouarereadytostartyourplasticsrecyclingprogram,ensurethattheresources,infrastructureandlogisticsareestablished and well aligned for program implementation. Consider how you will run this program internally and assign appropriateequipmentandresources.UnderstandhowtheMRF/haulerwouldliketoreceivethismaterialandagreeuponamutuallybeneficialdock-outsolutiontominimizedockspaceandpreventcross-contamination.Ideally,yourplasticsrecyclingprogramwillbewellalignedwithexistingrecyclingprogramsandwastemanagementworkflowtominimizeadditional efforts associated with recycling plastics. Consider any staff concerns or union contract negotiations that will be required as you identify the resources necessary for implementation of the recycling program.

The following guidance will help you establish and align the right resources needed to run the plastics recycling program, includingasetofhelpfultipstohelpyoudevelopastreamlinedmaterialsflowprocessforidentifying,collecting,sortingand segregating (as needed), and transferring healthcare plastics.

• DockSpaceGuideline*• Equipment Guideline• Materials Flow and Logistics

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Before You Begin Dock Space Guideline

In evaluating the amount of dock space needed to manage your plastics recycling program, consider the following variables:

• The amount of space that is available for your current recycling program• The amount of recyclable plastics that you expect to collect• Any sorting or segregation of plastics that is required by your recycling partner• Your recycling partner’s preferred dock-out processes and pick-up schedules• The footprint for any additional equipment (compactor, baler, dumpsters, etc.) that is planned for

plastics recycling• The most economically feasible combination of equipment and pickup scheduling. For example, if your

facility is charged by the bin, a larger bin with a compactor may be needed to accommodate the largerquantities of recycling that will be collected once a hospital plastics recycling program is initiated.

Though our plastics recycling pilot study work, HPRC is developing specific guidance on the amount of dock space needed to successfully manage a plastics recycling program.

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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1

Before You Begin Recycling Equipment Guideline *Content Under Development

Certain equipment can be very useful in managing collected recyclable plastics, depending on your recycler’s operations for transporting and processing plastics and other recyclable wastes. Equipment that should be considered includes a compacter, a baler, and additional dumpsters at the dock for dock-out processes and carts, bins, and totes for collecting and transferring materials from hospital functional areas to the dock. In evaluating this equipment, talk to your recycling partner about which waste streams can be combined to determine which equipment will be necessary and/or useful to your recycling program.

A compactor is a machine used to reduce the volume of waste materials through compaction. A compactor is usually powered by hydraulics but can also be electrically powered. Hospital employees place materials into the compactor, and materials are held within the compactor until they are removed by the recycler. A compactor can be used for single stream or mixed recyclables.

Consider an additional dumpster (with or without a compactor) if additional storage capacity is needed to keep recyclables separated from other waste streams.

A baler is a machine used to compress materials into compact bales that are easy to handle, transport, and store. Bales may be bound with twine, strapping, netting, plastic strips or wire. Hospital employees place materials into the baler, remove the compacted bales from the baler, and place the bales aside until they are removed by the recycler. Balers are especially useful for consolidating lightweight plastics and plastic film and wrap.

Installing a baler and/or compactor is most viable if a facility can use the equipment for more than one process or material type. Consider the amount of recyclables to be collected in your hospital, the amount of space available in your hospital, where items will be placed until pickup, and talk to your recycler about preferred dock-out processes and pick-up schedules to determine if a compactor, baler, and/or additional dumpster will be critical or “nice-to-have” to manage recyclables in your hospital.

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Running the Program Materials Flow and Logistics

Preventing contamination and developing a streamlined materials transfer process are key to a successful recycling program. Work with your recycling partner and your hospital’s EVS team, nursing team, and others that will be involved in the plastics collection, transfer, and dock-out processes to develop a streamlined process for your hospital. Here are some helpful tips in developing your plastics recycling program.

• Colored bags, containers, labels, etc. can be very useful for collecting and sorting the recyclable plastics.

• Posters, photos and even examples of acceptable materials placed above recycling containers are a handy reference for staff involved in collecting recyclable plastics.

• Identify a specific location in each area where collected recyclable plastics will be accumulated prior to transfer to the central outgoing waste storage area.

– Ideally, recyclable plastics are accumulated in a location where other waste materials and recyclables are accumulated to streamline waste management efforts.

– Signs and colored containers are effective methods to keep accumulated recyclable materials separated from other waste streams.

– Have a large enough accumulation area so that recyclable materials can be collected and transferred to the central outgoing waste storage area on the same schedule as other waste materials.

• Within the central outgoing waste storage area, use signs and colored containers to keep accumulated recyclable plastics separated from other waste streams. Keeping recyclable waste plastics in closed plastic bags prevents contamination by other waste streams.

• Think creatively about how to make the best use of limited space. Is there a spot which is not always used, that might be able to share functionality, i.e. perhaps a bin that is usually utilized for soiled linens, but which is idle when the cleaned room is being prepared for the next case and plastics waste is being generated?

• Transparent tinted bags are ideal so that the MRF/recycler can confirm there is no medical waste in the waste stream. The safety of all people involved in the process is very important.

• Train all staff involved in the plastics recycling program on the colored indicators, signs, labels, materials flow, etc. Use flow diagrams or the plastics mapping tool to show material flow and logistics from point of use, material collection, internal transfer to central waste storage area, and final pick-up by the MRF or recycler.

• Carefully consider available space and recycling/processing wait times (schedules) when developing a logistics plan. For example, how much space is available within the functional area or department for collecting and accumulating recyclable plastics before someone picks up the material and transfers it to a central dock-out area? How much space is available within the central dock-out area before your recycler or reprocessor picks up the materials?

Have a few people test the recycling procedures and comment on them before the procedures and training materials are finalized. You may discover that something that is obvious to you, is not so obvious to someone else.

45

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

46

Training ProgramTraining will be a necessary component of any healthcare plastics recycling program to ensure that safety and program requirements are maintained throughout the process and that MRF/recycler requirements are met for successful recycling. Successful programs will require a training component for involved personnel, as well as tools that serve to remind staff placedinvisibleandstrategiclocations.Considerestablishingminimumrequirementsandqualificationsforthetrainer,suchasrequiringtrainerstohavevisitedtherecyclingpartner’soperationsatleastoncetounderstandhowcollectedmaterialsareprocessedandspecificrestrictionsforcollectedmaterials.

Trainingtemplatesandtoolsaresharedinthemodulesbelow,andshouldbemodifiedtoreflectyourhospitalsspecificprogram with respect to affected personnel, departments, and plastics included in the program.

• Poster Template

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Running the Program Poster Template

Visual training materials are important to the successful implementation of a healthcare plastics recycling program. Specifically, posters that are located in areas designated for program implementation will help ensure that staff clearly understand what materials are and are not part of the program.

The next page provides a general template that you can use to help develop a poster specific to your hospital recycling program.

47

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

2

Recycling Program Name Tagline or Mission of Program

Hospital Logo

PRODUCT #1 PRODUCT #2 PRODUCT #3 PRODUCT #4

PRODUCT #1 PRODUCT #2 PRODUCT #3 PRODUCT #4

RECYCLABLE

NON RECYCLABLE

PHOTO OF PRODUCT #1

PHOTO OF PRODUCT #2

PHOTO OF PRODUCT #3

PHOTO OF PRODUCT #4

PHOTO OF PRODUCT #1

PHOTO OF PRODUCT #2

PHOTO OF PRODUCT #3

PHOTO OF PRODUCT #4

PHOTO OF RECYCLING

RECEPTACLE

PHOTO OF DISPOSAL

RECEPTACLE

48

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

49

Remember to continue the training program through periodic refresher training and training for new personnel. As your programmaturesandinformationiscollectedfromhospitalandMRF/recycleraudits,incorporateauditfindingsintothetrainingmaterials.SeekfeedbackfromyourMRF/recycleroncomplianceandenhancementstotheprogram,andincorporatethisfeedbackintothetraining.Andupdateyourtrainingmaterialsaspoliciesorprocedureschange.

As a best management practice, consider providing coaching and training to the MRF/recycler on materials that will be sent from your hospital, how to identify what should not be in the waste stream, what needs special handling, how to identifyifsomethingisorisnotmedicalwaste,andhowtomanagemedicalwasteandotherunknownandnonconformingmaterials. This training can help the MRF/recycler with its safety program and help the staff there respond appropriately to unknownandnonconformingmaterialsinyourwastestream.

Metrics of SuccessMetricstomeasuresuccessofyourplasticsrecyclingprogramareakeytoeffectivelongtermmanagementoftheprogram.Becausehealthcareplasticsrecyclingisarelativelynewinitiative,thehealthcareindustryhasnotdefinedstandardmeasuresyetforplasticsrecycling.Asageneralbenchmark,hospitalsshouldbeabletoroutinelyachieveoverallrecycling rates of 15%.

There are several typical types of information that should be gathered from the MRF/recycler and within your hospital thatwillhelpmonitorprogressandgaugeyourprogram’seffectiveness.SeeourmetricsguidetohelpyouestablishdatacollectionpointsandbegindevelopingKeyPerformanceIndicatorstohelpyoutrackprogressandcommunicatesuccesses.

• Metrics Collection Guideline

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

1

Running the Program Metrics Collection Guideline

It is important to collect data so that you can track progress and set goals for your plastics recycling program. Here are some suggestions for data points that can be collected by the MRF/recycler and by your hospital, and some suggestions for Key Performance Indicators (KPIs) that can be used to track progress. Information Collected by the MRF/Recycler

• Tons or pounds of plastics collected from hospital for recycling – If plastics are segregated, identify amount of each type of plastics collected

• Tons or pounds of plastics that were collected but were not acceptable for recycling – Identify the reason for rejection

• Types and amount of contamination in recyclable plastics (if this information is available) – Identify the type of contamination, such as paper, cardboard,etc. – Quantify the amount of contamination as much as possible

Information Collected by the Hospital

• Tons or pounds of waste generated – Do not include construction and demolition debris because of the significantly heavier weights of

these waste materials and the sporadic nature of this waste stream • Waste breakdown

– Tons or pounds of solid waste – Tons or pounds of recycled waste – Tons or pounds of regulated medical waste – Tons or pounds of hazardous waste

• Number of staffed beds • Total and adjusted patient days per month • Number of procedures or operations per month Suggestions for Key Performance Indicators

• Total tons or pounds of recycled plastics • Pounds of recycled plastics per staffed bed

– Calculate based on staffed beds in recycling program area • Pounds of recycled plastics per adjusted patient day

– Calculate based on adjusted patient days in recycling program area • Pounds of recycled plastics per operation or procedure

– Calculate based on operations or procedures recycling program area

50

1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

51

Program EconomicsOnce the program has been implemented and operational for a period of time, it is a good practice to revisit the economic pro-formaandreplaceinitialassumptionswithactualdatatodeterminethefinancialimpactoftheprogram.Reviewtheeconomic pro-forma periodically, and especially as changes are made to the recycling program, to monitor the economic aspects of your program and identify opportunities for more cost savings.

• Economic Pro-Forma Tool

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1

Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Improving the ProgramMaintaining effectiveness and achieving continuous improvement in metrics is often a desire when implementing recycling programs, especially after running the program for a period of time. After reviewing the metrics and updating the economic pro-forma, it will be useful to develop targets and goals and establish a communication plan to share the results with your colleaguesandotherinterestedstakeholders.Toensurecontinuedeffectiveness,itisalsoimperativetoregularlyaudittheprogrambothwithinthehospital,attheMRF,andattherecycler.Iftherearefindingsintheaudits,youmaychoosetoofferincentivesaspartofthisprogramtoencouragecontinuousimprovementstowardsamoreefficientoreffectiveprogram.Finally, problems will arise within this program. A FAQ tool has been developed to offer preliminary answers to some common questions or problems that arise.

Setting Targets & Goals

After the plastics recycling program has been established and baseline data and metrics have been collected and validated,itistimetoestablishtargetsandgoalsforcontinuousimprovementintheprogram.Wehavedevelopedguidance on factors to consider when developing targets and goals and suggestions on plastic recycling goals that can be considered for your hospital.

• Target and Goal Guideline

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Improving the Program Target and Goal Guideline

Once the plastics recycling program has been established and some data and metrics have been collected and validated, it is time to establish targets and goals for continuous improvement in the program. What is the difference between goals and targets? Goals provide a broad vision of what a hospital is trying to accomplish. Targets are the more specific measures that are being undertaken to achieve the goal. For example, the goal for the plastics recycling program may be to increase plastics recycling by 25% by weight in the next year. The targets associated with that goal might be (1) implement recycling in two new functional areas within the next quarter and (2) add blue wrap to the recycling program within the next six months. Both goals and targets should be measurable to be able to evaluate progress and completion. Accountabilities and timelines also should be clearly defined. Goals and targets for your hospital will depend on the type of data available and Key Performance Indicators that are being tracked (see Beginning to Collect Metrics), the financial feasibility (see Economic Pro Forma), and other sustainability and recycling initiatives within your hospital. As you develop goals and targets for your plastic recycling program, consider the following information: • Between 20-25% of a hospital waste stream is plastic packaging and products • Hospitals should be able to routinely achieve recycling rates of 15% • Approximately 85% of a hospital waste stream is non-infectious

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Communication Plan

Nowthatthehealthcareplasticsrecyclingprogramhasbeenimplemented,incorporateitintoyourhospital’soverallsustainabilitycommunicationsstrategytosharesuccessesandreceivecontinuedbuy-infromthestakeholders.

TracktheprogrammetricsandKPIsandsharesuccessesinternally,withbusinesspartners,andwithotherstakeholders.Collect/reviewandprovidefeedbacktohospital(picturesandvisualaids)/retrainpersonnel.Reviewthecommunicationplan guidance for more tips on successful communication on plastics recycling.

Considerwhat,ifany,externalcommunicationplansmaybeneeded.Thismayincludeinformationonthehospitalwebsiteorapplicationsforexternalawardandrecognitionprograms,includingthosefromnationalhealthcareorganizationsorlocal/ state level recycling or sustainability organizations.

• Communication Plan Guideline

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Improving the Program Communication Plan Guideline

Communications is important in sharing successes, sharing lessons learned, and keeping key stakeholders motivated in your hospital’s plastics recycling program. In developing a communications plan, consider the following: • Information to be communicated • Target audience, internal and external • Request for action (if any) Suggestions for Topics to be Communicated

• Program Launch • Progress and Milestone Achievements • Consider reporting estimated environmental benefits associated with quantities of plastics recycled • Audit Findings and Lessons Learned • Program Expansion (materials and/or areas) Consider these Communication Channels

• E-mail • Meeting presentations • Bulletin board postings • Posters • Internal and external newsletter Consider what, if any, external communication plans may be needed. This may include information on the hospital website or applications for external award and recognition programs, including from national healthcare organizations or local / state level recycling or sustainability organizations.

Environmental Benefits from Recycling Plastics

Use the following information to estimate the environmental benefits associated with the quantities of plastics recycled at your hospital. Recycling one ton of plastic saves: • 16.3 barrels of oil1

• 30 cubic yards of landfill space1

• 5,774 Kwh of energy1, enough to power an average house for 6 months2

REFERENCES 1 http://sanjoaquinvalley.wm.com/recyclingfacts.asp; http://bgm.stanford.edu/pssi_faq_benefit 2 http://205.254.135.7/tools/faqs/faq.cfm?id=97&t=3

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Audit Program

After implementation of a healthcare plastics recycling program, periodic review and auditing should be conducted to ensure proper adherence to the program, maintaining safety at the hospital and MRF by ensuring contamination does not occur.

Follow-up at the hospital is essential – the program must be reviewed on a regular basis. Audit the collected recyclable plasticsandthecollection,transfer,anddock-outprocesstoprovidecontinuousfeedbacktothoseimplementingtheprogram. A regular training process for new employees involved in the program will also help ensure continued success.

Consider implementing an audit program to review MRF/recycling operations on a regular basis. The audit can include a regulatory compliance evaluation and as well as review of any changes in operations that might affect your hospital recycling program.

The audit guidelines can help you estimate an audit program for your hospital and for your MRF/recycling partner.

• Hospital Audit Guideline• MRF/Recycler Audit Guideline

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Improving the Program Hospital Audit Guideline

Auditing your hospital’s plastics recycling program is a key element of improving your program. Auditing your program can be divided into two parts: (1) auditing the plastic materials that are collected and (2) auditing the plastics collection, segregation, and transfer process. The purpose of auditing the collected plastics materials is to check that the targeted plastics are being collected. Here is a series of suggested steps for conducting a materials audit: • Select a sample of collected plastic materials and a sample of solid waste from the department or area

to be audited • Establish sorting/auditing area • Sort through collected plastics and identify conforming and nonconforming items. Identify types of

contamination (paper, cardboard, unacceptable plastics, infectious waste, etc.) • Sort through the solid waste sample and identify other plastics that could have been recycled • Interview key staff to identify materials that are confusing to them The purpose of auditing the collection, segregation, and transfer process is to check that the appropriate health and safety precautions are being followed, that cross-contamination is minimized, and that material flow logistics are optimized. Here is a series of suggested steps for conducting a process audit: • Select the department or area to be audited • Identify key staff involved in collecting, segregating, and transferring the plastics • Review the plastics collection, segregation, and transfer processes either through direct observation or

through interviews with key staff to observe: – Health and safety precautions – Use of labels, colored bags, and other indicators to prevent cross-contamination

• Interview key staff for suggestions on streamlining the materials flow. • Identify deviations from standard waste management processes and look for ways to combine or align

the recycling process with standard waste management processes without sacrificing health and safety or contamination concerns

For both the materials audit and the process audit, provide results to the audited department or area through photos, do’s and don’ts, etc. Incorporate audit findings into training materials, and retrain staff as needed. As you establish and build your audit program, develop audit protocols for easier repeat audits. Involve more people in your audit as an opportunity for additional training. And share audit results in a positive manner and as an opportunity for improvement.

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Improving the Program MRF Audit Guideline

Your MRF/recycler is a key business partner in a successful plastics recycling program. As a best management practice, consider implementing an audit program to review your MRF/recycler operations on a regular basis. Consider the following topics to include in the audit: • Evaluation of regulatory compliance • Review of permits, certifications, registrations, etc. and confirmation that they are current • Review of health and safety measures • Review of contingency plan for handling non-conforming wastes • Review of acceptable materials – are there other healthcare plastics that can be accepted? • Review of recycling operations – are there any changes in operations that might affect your hospital

recycling program? • Review of any management system certifications Consider establishing a formal review process on a semi-annual or annual basis – What went wrong, what went right, how to improve. The MRF/recycler may have ideas for streamlining and improving your plastics recycling program. Also consider a quarterly update with your MRF/recycler to review material types and quantities received from your hospital, any changes needed for process improvement, and any questions. This would be a good time to collect data for metrics and KPIs.

MRF/Recycler Audit Guideline

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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Stakeholder Incentives

Asyourplasticsrecyclingprogrammatures,considerincentiveprogramsasencouragementfordifferentstakeholders.

Incentives for the HospitalConsider competitions between different areas based on % increase in quantity and/or % decrease in contamination levels.Thinkofrewardsthatwillmotivateemployeesatyourhospital.Considerhavingteamscontributeand/orcollectinformation for applications to regional and national recognition programs, and consider having them participate in award presentations.

Incentives for the MRF/RecyclerDiscussincentiveoptionswithyourMRF/processorforincreasingwastequantitiesandreducingcontaminationlevels.

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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HPRC is a private technical coalition of industry peers across healthcare, recycling and waste management industries seekingtoimproverecyclabilityofplasticproductswithinhealthcare.HPRCismadeupoftenbrandleadingandgloballyrecognizedmembersincludingBaxter,BD,CardinalHealth,Covidien,DuPont,EastmanChemicalCompany,EngineeredPlasticsInc.,Johnson&Johnson,HalyardHealth,PerfecsealInc.,andSABIC.ThecouncilconvenesbiannuallyatmeetingshostedbyanHPRCmemberthatincludefacilitytourstofurtherlearningandknowledgesharingopportunitiesthroughfirst-handdemonstrationofbestpracticesinsustainableproductandpackagingdesignandrecyclingprocesses.For more information, visit www.hprc.org.

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Before You Begin Checklist to Assess Readiness

Use this checklist to see if your hospital is ready to consider a plastic recycling program. What is the Hospital’s Passion for Sustainability?

Is there a commitment from executive leadership? Will executive management endorse and support this program? Is plastics recycling aligned with your hospital’s sustainability strategy? Are Key Stakeholders Engaged and Committed?

Have key stakeholders been identified? Consider Department Chairs, Department Leaders, Departmental Green Champions, Nursing Teams, Environmental Services, and other groups that will be key to a successful recycling program.

Do the majority of key stakeholders agree with a plastics recycling program? Are employees passionate about sustainability and recycling? Will there be any staff concerns or union contract negotiations required? Consider the Timing

Is your hospital ready for a new sustainability initiative? Implementation or new initiative fatigue can be an issue.

Are other recycling programs already implemented and operating smoothly? Can this recycling initiative be combined with another recycling initiative or another sustainability

initiative? Can this recycling initiative be added as part of enhancing or streamlining an existing recycling

program? If the majority of these boxes are checked, your hospital is ready to evaluate implementation of a healthcare plastics recycling program. If several boxes remain unchecked, the Guide to Developing a Business Case Tool may be useful to demonstrate the benefits and gain the support and approval needed to implement a healthcare plastics recycling program in your hospital.

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