Okay, back to clean hospital waste. As I said in my earlier post today, there is a lot waste from hospitals that doesn’t belong in the trash. But because we are so in love with disposables, we often dispose items that have an extended shelf life.

Yes, it is so simple just to chuck every thing into the trash. And we also have it in our heads an exaggerated notion of cleanliness. If an item is still sealed, it is still sterile. But no, wait, it’s been at a patient’s bedside. Therefore, it is contaminated, and besides, the patient has already been charged for it. So, into the garbage you go.

Believe it or not, this was the mentality at a hospital that I passed through in Florida. I worked there through a temporary registry, and I was only about two years into my nursing career. But yet, I knew that the infection control policies were off the wall, and the infection control nurse needed to have her brain disinfected and autoclaved.

This was a large county facility, and the unit was newborn intensive care. When an admission would arrive, the baby’s bed was stocked with every imaginable supply, needed or not. Formula, when the baby was breast feeding. IV tubing, even if there wasn’t going to be an IV. And so on. Some of it got used, some was restocked as supplies were used up, but an awful lot of it sat there unused. When discharge came around, everything was thrown out. THROWN OUT.

Items still sealed in sterile packaging from the factory, formula bottles sealed and unopened, expensive supplies that could just be placed back on the shelf or put in a different infant’s bed. Their policy was that once put into the baby’s incubator or bassinet, it had now become “tainted.” Somehow, according to their logic, the germs from the baby were able to make their way through the linens, the mattress, crawl through the metal frame and into the drawers where the supplies were kept, and then gnaw their way into the sterile packaging. An amazing journey, no doubt, and indeed, even more amazing that no one ever published a scientific paper on this phenomenon.

I refused to toss out the supplies. When one of the nurses’ told me that I couldn’t put the supplies back onto the shelf, I took a plastic trash bag and began to pack them up.

She was shocked. “What are you doing?”

“I’m going to give them to the Red Cross,” I told her. “Surely they can find someone to give them to.” I then berated her about the idiocy of their policy, but she defended it. And so did the other nurses who were working there.

They said it was their infection control policy. That once an item left the shelf, it was no longer clean. Interesting, I replied. Then why isn’t the baby’s bed autoclaved after discharge? Sterilized? How can you just put a new admit into a bed that’s been merely wiped down and linens changed?”

Of course, no answer to that one. A lot of steam coming out of their pointed ears, but nothing more. And then I pointed out the illogic of their logic. Infection control, huh. Then according to their bizarre take on things, the items were tainted the second a human hand touched the packaging. That meant that their sterility was gone as soon as someone packed them up for shipping at the factory, and certainly, when someone unpacked them at the hospital and put them on the shelves.

I also pointed out how this was a county facility, and their policy was wasting thousands of dollars every month.

No, I didn’t make a whole lot of friends. But it was one of the worst places that I had ever set foot in, as far as the staff went. It was sort of like being back in junior high, with a bunch of pre-pubescent girls who giggled alot, paired off into little cliques, and concerned themselves with being popular. This bunch was a back stabbing, gossiping group of obnoxious twits who believed that they were God’s gift to healthcare.

It really made one wonder if the hospital purposely recruited staff with the IQ of a moron. How any educated nurse could go along with this type of policy was truly amazing, but yet, not a word of dissent from any of them. Except to diss anyone who disagreed.

I returned to work there several times, and if I had been more experienced, I would have complained about their policy to a higher source. But as it was, there was a lot going on in my life at the time, including my plans to get away from both Florida and a bad relationship, so playing whistleblower was not high on my list.

Anyway, while I’m sure that most facilities aren’t this bad, waste still continues. It’s really sad, from an environmental, an economic, and a humanitarian standpoint.

Another 2.6 million doses of flu vaccine are on their way, although we won’t be seeing them until January. A little late, but better late than never.

Aventis Pasteur, the only company now making flu vaccines for the U.S. market, announced that they would be able to produce another 2.6 million doses, for a total of 58 million doses. Our guys in DC are still talking to the Canadians, about getting another million or so vaccines. But that’s provided that they meet our regulatory standards, and acting FDA commissioner Lester Crawford says that the FDA would inspect the Canadian facilities to see if they meet U.S. standards. Yup, third world countries like Canada certainly couldn’t meet our standards. Just look at all the Canadians dying in the streets from substandard drugs and vaccines.

I know, this is really a pet peeve of mine, that we treat Canada like it is some backwater hole in the ground. Anyway, why don’t they just go there and look at the facility, and buy the damn vaccine already? Those million plus Canadian doses could have already been on their way over here. But all they keep doing is whining, and talking about what they “might do” or are “going to do.” How about just doing it?

I just received an assignment to write an article about biomedical waste management. You know, disposing of trash that is loaded with microbes and potentially lethal critters. I can’t even begin to imagine how many tons of waste are generated each year from medical facilities. In Florida alone, for example, there are an estimated 30,000 biomedical waste generators in Florida. These include hospitals, clinics, nursing homes, laboratories, funeral homes, dentists, veterinarians, and physicians.

But I was thinking of another problem, and that of the unnecesscary waste generated by nurses, doctors and other workers during the course of their average work day. I’d like to think that in this day and age of cost cutting and penny pinching, that maybe things have changed a little. Improved. Then again, since most items are charged to the patient, and not the facility, there is little incentive to curb our wasteful ways.

A Society of Disposables

We love disposables. Use it once, throw it away. Everything from diapers to cameras. In the medical world, some disposables are essential, such as needles. But other items, even though they are labeled as such, as not. Prepackaged trays, to be used for certain procedures, contain a number of reusable items labeled “disposable.” These include perfectly good metal clamps and scissors, which have a long life ahead of them. But according to the package, they are disposable.

Very often, the physician didn’t use half of the equipment in the tray. Still sterile and packaged sutures, sterile syringes, sterile packets of gauze–were all chucked at the end of the procedure. The scissors and clamps were dumped as well. It’s bad enough that hospitals generate so much “real” waste, but do we have to throw out perfectly good equipment and supplies? And besides the environmental factors, there are doctors, clinics, hospitals, schools, etc., all over the world who are desperate for equipment. Shouldn’t we share perfectly good supplies, even if we consider them somewhat tainted?

I happened to read about an operating room nurse who collected unused supplies designated for the trash, and then sent a weekly package to a non-profit organization. She inspired me to do something, other than watch helplessly. I began to wash off used clamps and scissors, the “disposable” kind, and send them downstairs to be autoclaved. I also began collecting the still sterile and wrapped supplies that also could be used.

One of my coworkers then asked me if she could take the now autoclaved clamps and scissors and send them to her nursing school in Chile. They’re always very short on supplies there, she said. Not only did she take those items, but added sutures, gauze packs, and other unused odds and ends. What her school didn’t need, they would give to the local hospital.

After a few months, virtually none of the previously “tainted” items were trashed. Nurses began taking the scissors and clamps and making them permanent bedside items (this was in a newborn intensive care unit). Bottles of formula which were reaching their expiration dates were somehow spirited off to a battered woman’s shelter. Gauze, syringes, sutures, tubing, and so on, were either used in our unit or sent to Chile.

When I went to work at a military facility a few years later, the same system was already in progress. One of the nurses collected whatever she could get her hands on, and sent it to her home in the Philippines. In both these instances, imagine the savings in waste and cost if the hospitals had implemented this throughout the facility. Imagine if all hospitals mandated this? To say nothing of the people who benefitted from our clean trash….

Of course, not every experience was this successful. At a large teaching facility in Florida, not only was waste rampant, but the nurses didn’t see anything wrong with it. Stay tuned for the story of the evil nurses, who were in desperate need of a crash course in infection control.

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