Summary of Holy Cross Hospital Site Visit

Site:	Holy Cross Hospital

	Silver Spring, Maryland

Date: 		October 31, 2007

Purpose:	To learn about the generation and management of RCRA hazardous
waste in hospitals and their laboratories

Attendees:

U.S. EPA, Office of Solid Waste

Kristin Fitzgerald

Jessica Biegelson

Meg McCarthy

Nick Hilosky

Christina Kager

American Hospital Association

Robyn Cooke, Senior Associate Director, Executive Branch Relations,

Jose Segarra, Operations Manager, American Society for Healthcare
Environmental Services

Holy Cross Hospital Staff

Glenn Anderson, Senior Director, Clinical Services

Jeff Joyner, Vice President, Patient Support Services

David Meeder, Director, Laboratory Services

Richard Parrish, Director, Pharmacy

Mark Bishop, Assistant Director, Pharmacy

Peter McCaffrey, Director, Environmental Services

Beatrice Miller, R.N., Director, Oncology

Jamie Green, R.N., Nurse Manager, Operating Room/Endoscopy

To begin the site visit, staff from Holy Cross Hospital presented
general overview information about their hospital.  We discussed their
current waste practices within the different departments of the
hospital.  We also talked about what types of labs the hospital has and
what lab waste the hospital generates.  

Then we took a tour of the hospital, visiting four areas:

Operating Room

Clinical Laboratory 

Pharmacy

Infusion Center

Pharmaceutical waste appears in all of the hospital’s waste streams,
but hazardous wastes are mainly generated in the ER, intensive care unit
and in the pharmacy.  Hazardous wastes comprise less than 2% of their
pharmaceutical waste (the hospital does not use much epinephrine or
nitroglycerine).  

Problems/questions with RCRA

Inhalers

Partially-used controlled substances

Listing dosage forms- if a drug is on the federal list in one form (i.e.
pills, capsule, liquid, topical, IV), are the other forms considered
listed, too?

Insulin/steroids- medical waste or hazardous waste?

Further complicated if there’s a sharp involved

TPN-intravenous feeding- are these hazardous wastes?  

