Presentation
From Red Bin to Green Impact: Human-Centered Approach to Reducing a Hospital's Regulated Medical Waste
DescriptionBackground: The World Health Organization has called climate change “the single biggest health threat facing humanity.” Ironically, the U.S. healthcare industry is responsible for a disproportionate amount of greenhouse gas (GHG) emissions, which exacerbate the accelerating climate crisis and worsen human health. We need to build environmentally sustainable health systems. Human Factors Engineering (HFE) can help by aligning human needs, capabilities, and limitations with sustainable practices that benefit people, organizations, and the environment.
Problem: Regulated medical waste (RMW) is a category of waste generated in healthcare settings that poses the risk of infection, injury, or environmental contamination if not handled and disposed of properly. In hospitals, RMW is typically discarded in red biohazard bags or bins. Due to resource-intensive sterilization and transport to processing facilities, RMW disposal incurs far more GHG emissions than standard waste. At our large tertiary care pediatric hospital, the Environmental Services Department (ESD) noticed that most RMW bins in the emergency department (ED) and the pediatric intensive care unit (PICU) were filled with inappropriate content, which was unnecessarily increasing our financial and environmental costs of care delivery. At that time, all patient rooms in those units contained RMW bins next to standard waste bins. Notably, RMW disposal for our hospital costs 8 times more than standard waste disposal. ESD brought these concerns to the hospital’s Sustainability Council, and a quality improvement (QI) team was formed. The multidisciplinary QI team submitted a consult to the Human Factors (HF) team in September 2024 to help evaluate and implement a new waste disposal system that would meet the needs of end users.
Human Factors Assessment: Our initial HF assessment prioritized understanding the barriers faced by clinical staff and patients/families during the waste disposal process. RMW bins (red) were often identical in size to general waste bins (white) and placed side-by-side in patient rooms. This made it difficult for users—especially those moving quickly or distracted by healthcare needs— to distinguish which bin to use. The lack of size differentiation also reduced opportunities for users to pause and make a correct disposal decision. The amount of general waste generated in ED and PICU rooms is much higher than the amount of RMW; HF and QI stakeholders agreed that such large RMW bins were unnecessary and were possibly encouraging over-utilization.
The proposed intervention was to remove the large red RMW bins from patient rooms and replace them with wall-mounted dispensers containing pull-down rolls of RMW bags. Clinicians can access bags as needed and dispose of them in centrally located soiled utility rooms. Recognizing that this represented a significant change in practice for our hospital, we chose to pilot the intervention on a small scale before implementing it more broadly. In an effort to decrease inappropriate RMW, we chose to test two small-scale interventions: 1) smaller size RMW bins in less convenient locations in the patient rooms, to encourage users to engage in a deliberate thinking process before waste disposal, and 2) replacing RMW bins with easily accessible wall-mounted RMW bag dispensers, to make RMW disposal a more conscious action while also freeing up floor space in crowded rooms. Comparing waste audit data and user feedback from both interventions will help identify the most convenient and acceptable option for users — without making RMW disposal too difficult (which could risk safety violations by inadvertently steering users toward only utilizing the general waste bin).
The signage on the original large RMW bins also presented significant usability challenges. It depicted a long, text-only list of acceptable items. It violated several of Nielsen’s design heuristics like, “Recognition over Recall” and “Error prevention.” The design relied on a recall-heavy process that required users to compare each waste item with the list on the sign. The addition of images/icons would make recognition easier. The sign could also do more to prevent inappropriate RMW utilization by adding examples of common items that are not biohazardous, like gloves and plastic containers.
Objectives: We aimed to decrease the proportion of rooms with inappropriate RMW in our ED and PICU from 89% and 77% (respectively) in December 2024 to ≤50% inappropriate by July 31, 2025. We planned to improve the usability of the overall RMW disposal process for users.
Methods: The initial assessment led to the formation of a multidisciplinary quality improvement (QI) team involving ESD, Facilities, Human Factors engineers, safety & quality specialists, physicians, nurses, and resident trainees. To evaluate the current state, RMW bins in the ED and PICU were audited September-December 2024. Additionally, >240 staff members completed a current state survey, and dozens more were informally interviewed during audits. This current state analysis helped identify root causes, which informed the selection of interventions. In the PICU, the team decided to trial smaller red bins in less convenient locations. In the ED, wall-mounted RMW bags would replace floor-based RMW bins. These interventions were chosen based on the amount of RMW generated and patient acuity levels. The team also tested interventions aimed at improving staff awareness and understanding of proper RMW sorting. So far, we have tested six PDSA (Plan-Do-Study-Act) cycles in the ED and seven in the PICU. The primary outcome measure is the proportion of audited rooms found to contain inappropriate content in RMW receptacles.
Results: Baseline audits of >1,100 waste bins (Sep-Dec 2024) revealed that, on average, 89% of ED rooms and 77% of PICU rooms contained mostly or entirely inappropriate RMW. Survey data revealed that only 32% of respondents felt that current RMW signage was clear and helpful. Meanwhile, only 35% understood the financial impact of RMW disposal, and only 37% understood the environmental impacts.
In the PICU, the combination of smaller red bins and staff education decreased inappropriate RMW from 77% to 54%, and then down to 32% by April 2025 following additional outreach interventions. Without sustained education, though, RMW levels settled at 42% inappropriate. In the ED, initial educational interventions only generated a slight improvement to 71% inappropriate. However, the implementation of wall-mounted RMW bags decreased inappropriate RMW to 11%.
New, user-friendly signage was developed using visual design principles and clear icons to show what should and should not be discarded as RMW. This new design was incorporated into educational materials and screensavers throughout the units. All communication materials used framing effects to effectively convey the immediate financial and environmental costs of inappropriate RMW disposal, rather than distant climate impacts that users may not relate to. Communications included specific data such as the percentage of inappropriate RMW and its cost, to make the message more tangible.
Application: The smaller RMW bins did help decrease inappropriate RMW in the PICU, but the initial success waned over time without persistent staff education and reminders. The wall-mounted RMW bag system proved to be a more effective intervention by increasing user intentionality. For this reason, our QI team is planning to implement the wall mount system in the PICU. Currently, we’re determining the ideal wall mount locations in PICU rooms to optimize user accessibility and physical ergonomics. As in the ED, we will ensure that PICU staff fully understand the new wall mount process prior to implementation, and we will collect ongoing quantitative and qualitative feedback after implementation.
Problem: Regulated medical waste (RMW) is a category of waste generated in healthcare settings that poses the risk of infection, injury, or environmental contamination if not handled and disposed of properly. In hospitals, RMW is typically discarded in red biohazard bags or bins. Due to resource-intensive sterilization and transport to processing facilities, RMW disposal incurs far more GHG emissions than standard waste. At our large tertiary care pediatric hospital, the Environmental Services Department (ESD) noticed that most RMW bins in the emergency department (ED) and the pediatric intensive care unit (PICU) were filled with inappropriate content, which was unnecessarily increasing our financial and environmental costs of care delivery. At that time, all patient rooms in those units contained RMW bins next to standard waste bins. Notably, RMW disposal for our hospital costs 8 times more than standard waste disposal. ESD brought these concerns to the hospital’s Sustainability Council, and a quality improvement (QI) team was formed. The multidisciplinary QI team submitted a consult to the Human Factors (HF) team in September 2024 to help evaluate and implement a new waste disposal system that would meet the needs of end users.
Human Factors Assessment: Our initial HF assessment prioritized understanding the barriers faced by clinical staff and patients/families during the waste disposal process. RMW bins (red) were often identical in size to general waste bins (white) and placed side-by-side in patient rooms. This made it difficult for users—especially those moving quickly or distracted by healthcare needs— to distinguish which bin to use. The lack of size differentiation also reduced opportunities for users to pause and make a correct disposal decision. The amount of general waste generated in ED and PICU rooms is much higher than the amount of RMW; HF and QI stakeholders agreed that such large RMW bins were unnecessary and were possibly encouraging over-utilization.
The proposed intervention was to remove the large red RMW bins from patient rooms and replace them with wall-mounted dispensers containing pull-down rolls of RMW bags. Clinicians can access bags as needed and dispose of them in centrally located soiled utility rooms. Recognizing that this represented a significant change in practice for our hospital, we chose to pilot the intervention on a small scale before implementing it more broadly. In an effort to decrease inappropriate RMW, we chose to test two small-scale interventions: 1) smaller size RMW bins in less convenient locations in the patient rooms, to encourage users to engage in a deliberate thinking process before waste disposal, and 2) replacing RMW bins with easily accessible wall-mounted RMW bag dispensers, to make RMW disposal a more conscious action while also freeing up floor space in crowded rooms. Comparing waste audit data and user feedback from both interventions will help identify the most convenient and acceptable option for users — without making RMW disposal too difficult (which could risk safety violations by inadvertently steering users toward only utilizing the general waste bin).
The signage on the original large RMW bins also presented significant usability challenges. It depicted a long, text-only list of acceptable items. It violated several of Nielsen’s design heuristics like, “Recognition over Recall” and “Error prevention.” The design relied on a recall-heavy process that required users to compare each waste item with the list on the sign. The addition of images/icons would make recognition easier. The sign could also do more to prevent inappropriate RMW utilization by adding examples of common items that are not biohazardous, like gloves and plastic containers.
Objectives: We aimed to decrease the proportion of rooms with inappropriate RMW in our ED and PICU from 89% and 77% (respectively) in December 2024 to ≤50% inappropriate by July 31, 2025. We planned to improve the usability of the overall RMW disposal process for users.
Methods: The initial assessment led to the formation of a multidisciplinary quality improvement (QI) team involving ESD, Facilities, Human Factors engineers, safety & quality specialists, physicians, nurses, and resident trainees. To evaluate the current state, RMW bins in the ED and PICU were audited September-December 2024. Additionally, >240 staff members completed a current state survey, and dozens more were informally interviewed during audits. This current state analysis helped identify root causes, which informed the selection of interventions. In the PICU, the team decided to trial smaller red bins in less convenient locations. In the ED, wall-mounted RMW bags would replace floor-based RMW bins. These interventions were chosen based on the amount of RMW generated and patient acuity levels. The team also tested interventions aimed at improving staff awareness and understanding of proper RMW sorting. So far, we have tested six PDSA (Plan-Do-Study-Act) cycles in the ED and seven in the PICU. The primary outcome measure is the proportion of audited rooms found to contain inappropriate content in RMW receptacles.
Results: Baseline audits of >1,100 waste bins (Sep-Dec 2024) revealed that, on average, 89% of ED rooms and 77% of PICU rooms contained mostly or entirely inappropriate RMW. Survey data revealed that only 32% of respondents felt that current RMW signage was clear and helpful. Meanwhile, only 35% understood the financial impact of RMW disposal, and only 37% understood the environmental impacts.
In the PICU, the combination of smaller red bins and staff education decreased inappropriate RMW from 77% to 54%, and then down to 32% by April 2025 following additional outreach interventions. Without sustained education, though, RMW levels settled at 42% inappropriate. In the ED, initial educational interventions only generated a slight improvement to 71% inappropriate. However, the implementation of wall-mounted RMW bags decreased inappropriate RMW to 11%.
New, user-friendly signage was developed using visual design principles and clear icons to show what should and should not be discarded as RMW. This new design was incorporated into educational materials and screensavers throughout the units. All communication materials used framing effects to effectively convey the immediate financial and environmental costs of inappropriate RMW disposal, rather than distant climate impacts that users may not relate to. Communications included specific data such as the percentage of inappropriate RMW and its cost, to make the message more tangible.
Application: The smaller RMW bins did help decrease inappropriate RMW in the PICU, but the initial success waned over time without persistent staff education and reminders. The wall-mounted RMW bag system proved to be a more effective intervention by increasing user intentionality. For this reason, our QI team is planning to implement the wall mount system in the PICU. Currently, we’re determining the ideal wall mount locations in PICU rooms to optimize user accessibility and physical ergonomics. As in the ED, we will ensure that PICU staff fully understand the new wall mount process prior to implementation, and we will collect ongoing quantitative and qualitative feedback after implementation.
Authors
Event Type
Oral Presentations
TimeMonday, March 2311:00am - 11:30am EDT
LocationMurray Hill West
Hospital Environments