Warren Alpert Medical School of Brown University, Providence, Rhode Island.
New York University Grossman School of Medicine, Department of Population Health, New York, New York.
West J Emerg Med. 2020 Aug 24;21(5):1211-1217. doi: 10.5811/westjem.2020.6.47900.
Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals' waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction.
We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. All waste generated in the ED during the study period was collected, manually sorted into separate categories based on its predominant material, and weighed. We tracked deviations from hospital waste policy using the hospital's Infection Control Manual, state regulations, and Health Insurance Portability and Accountability Act standards. Lastly, we calculated direct pollutant emissions from ED waste disposal activities using the M+WasteCare Calculator.
The ED generated 671.8 kilograms (kg) total waste during a 24-hour collection period. On a per-patient basis, the ED generated 1.99 kg of total waste per encounter. The majority was plastic (64.6%), with paper-derived products (18.4%) the next largest category. Only 14.9% of waste disposed of in red bags met the criteria for regulated medical waste. We identified several deviations from waste policy, including loose sharps not placed in sharps containers, as well as re-processable items and protected health information thrown in medical and solid waste. We also identified over 200 unused items. Pollutant emissions resulting per day from ED waste disposal include 3110 kg carbon dioxide equivalent and 576 grams of other criteria pollutants, heavy metals, and toxins.
The ED generates significant amounts of waste. Current ED waste disposal practices reveal several opportunities to reduce total waste generated, increase adherence to waste policy, and reduce environmental impact. While our results will likely be similar to other urban tertiary EDs that serve as Level I trauma centers, future studies are needed to compare results across EDs with different patient volumes or waste generation rates.
在美国，医疗保健行业贡献了 10%的温室气体排放，并且每年产生 200 万吨废物。减少医疗保健废物可以降低医疗保健对环境的影响，并降低医院的废物处理成本。然而，迄今为止，尚无文献研究美国急诊部（ED）的废物管理。本研究的目的是量化和描述 ED 产生的废物量，确定与废物政策的偏差，并探讨减少废物的领域。
我们在一家城市三级保健学术医疗中心进行了为期 24 小时（工作日）的 ED 废物审核。在研究期间，收集了 ED 中产生的所有废物，根据其主要材料手动分类到单独的类别中，并进行称重。我们使用医院的感染控制手册、州法规和健康保险流通与责任法案标准来跟踪与医院废物政策的偏差。最后，我们使用 M+WasteCare 计算器计算了 ED 废物处理活动产生的直接污染物排放量。
ED 在 24 小时收集期间共产生 671.8 千克（kg）总废物。按每位患者计算，ED 每次就诊产生 1.99 千克的总废物。大部分是塑料（64.6%），其次是纸制品（18.4%）。在装入红色袋子中丢弃的废物中，只有 14.9%符合规定的医疗废物标准。我们发现了一些与废物政策的偏差，包括未放入锐器容器中的松散锐器，以及可再处理的物品和受保护的健康信息被扔进医疗废物和固体废物中。我们还发现了 200 多个未使用的物品。ED 废物处理每天产生的污染物排放量包括 3110 千克二氧化碳当量和 576 克其他标准污染物、重金属和毒素。
ED 产生了大量的废物。目前的 ED 废物处理实践为减少总废物产生、增加对废物政策的遵守以及减少环境影响提供了几个机会。虽然我们的结果可能与其他作为一级创伤中心的城市三级 ED 相似，但需要进一步研究来比较不同患者量或废物产生率的 ED 之间的结果。
