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  • Paul Rivers

Hospital Sustainability, Part 3

Updated: Aug 29, 2023

Red Bag Waste (RBW)

Prior to 2005, at Green Medical Center (our fictitious hospital which is based on an actual Philadelphia-area hospital), all waste generated in every patient room was handled and treated as infectious waste. The waste was placed in a single large infectious waste container. Additionally, all waste generated in each bathroom was also handled and treated as infectious waste. With the cooperation of Epidemiology, Administration, Environmental Services and Nursing, the Green Team set a goal to reduce red bag waste (RBW) to less than 25% of the total waste stream. Eight-gallon, step-on lidded red bag waste containers were purchased for all medical/surgical patients’ rooms so staff could “source-separate” waste at the patient bedside. Within one year, RBW was reduced from over 50% of the total hospital waste to less than 35% of the total waste stream.


RBW can cost approximately $480 a ton to process in comparison to municipal waste costing approximately $25 per ton. One benchmark for measuring RBW is by pound per adjusted patient day (APD). APD is a general measure of combined inpatient and outpatient days. Best practices suggest that hospitals can reduce waste down to about one to three pounds per patient day or less than 10% of their total waste.


The Hospital Green Team wanted to reduce RBW to less than 25% of the total waste. The team had to ensure that there were sufficient step-on receptacles in the Emergency Trauma Center (ETC), Labor and Delivery Floors to allow these departments to participate in the program. The hospital staff was trained to dispose of items soiled with blood as RBW. Labels were placed on top of the lidded containers informing staff of what is and what is not infectious waste. Receptacles in bathrooms were changed to regular trash containers. Soon, RBW decreased to less than 25% of total waste and the goal was reached. Still, there was room for improvement…..


Critical Care Units and the Operating Rooms had not been included in the program. These units produce significant quantities of RBW. Prior to rollout in these units, Nurse Managers trained their staff on RBW source separation. Step-on lidded, RBW receptacles were placed in these areas. Staff began source separating and RBW tonnage plummeted. “Green Rounds” were implemented as a teaching tool. Green Team Members were assigned a floor or unit and they used a checklist to monitor compliance. Green rounds were effective at reducing RBW even further while increasing recycling efforts.


About this time, the non-critical areas piloted a program to remove the red bag receptacles in favor of small red bags available at the patient bedside. Soon all medical surgical floors followed. Now the medical surgical rooms feature one large municipal waste container with back-up small red bags, as needed. Today, RBW stands at less than 15% of the total waste or about 2 pounds per adjusted patient day. Green Medical Center achieved best practices and saved approximately $200,000 in cost avoidance per year.


We respond to all questions or comments posted here. What have been your experiences with Red Bag Waste?


The next post in this series will cover environmentally preferable purchasing and reprocessed medical devices, so visit us again on Friday.


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