BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/New_York X-LIC-LOCATION:America/New_York BEGIN:DAYLIGHT TZOFFSETFROM:-0500 TZOFFSETTO:-0400 TZNAME:EDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0400 TZOFFSETTO:-0500 TZNAME:EST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20260715T161119Z LOCATION:Murray Hill West DTSTART;TZID=America/New_York:20260323T110000 DTEND;TZID=America/New_York:20260323T113000 UID:HFESHCS_2026 International Symposium on Human Factors and Ergonomics i n Health Care_sess114_LEC304@linklings.com SUMMARY:From Red Bin to Green Impact: Human-Centered Approach to Reducing a Hospital's Regulated Medical Waste DESCRIPTION:Sweta Parmar, David Keifetz, Megan Pluymers, Meghan Orr, Daisy Carter, Stefanie Rosanova, John Breslin, Kathryn Lipinski, Anna Chen, Aku a A. Appah-Sampong, May Shum, and Mark McShane (Children's Hospital of Phi ladelphia)\n\nBackground: The World Health Organization has called climate change “the single biggest health threat facing humanity.” Ironically, th e 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 sustaina ble health systems. Human Factors Engineering (HFE) can help by aligning h uman needs, capabilities, and limitations with sustainable practices that benefit people, organizations, and the environment.\n\nProblem: Regulated medical waste (RMW) is a category of waste generated in healthcare setting s that poses the risk of infection, injury, or environmental contamination if not handled and disposed of properly. In hospitals, RMW is typically d iscarded in red biohazard bags or bins. Due to resource-intensive steriliz ation and transport to processing facilities, RMW disposal incurs far more GHG emissions than standard waste. At our large tertiary care pediatric h ospital, the Environmental Services Department (ESD) noticed that most RMW bins in the emergency department (ED) and the pediatric intensive care un it (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 standar d waste bins. Notably, RMW disposal for our hospital costs 8 times more th an standard waste disposal. ESD brought these concerns to the hospital’s Sustainability Council, and a quality improvement (QI) team was formed. Th e 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.\n\nHuman Factors Assessmen t: 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 user s—especially those moving quickly or distracted by healthcare needs— to di stinguish 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 tha n the amount of RMW; HF and QI stakeholders agreed that such large RMW bin s were unnecessary and were possibly encouraging over-utilization. \nThe p roposed intervention was to remove the large red RMW bins from patient roo ms and replace them with wall-mounted dispensers containing pull-down roll s of RMW bags. Clinicians can access bags as needed and dispose of them in centrally located soiled utility rooms. Recognizing that this represente d 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 int erventions: 1) smaller size RMW bins in less convenient locations in the p atient rooms, to encourage users to engage in a deliberate thinking proces s before waste disposal, and 2) replacing RMW bins with easily accessible wall-mounted RMW bag dispensers, to make RMW disposal a more conscious act ion while also freeing up floor space in crowded rooms. Comparing waste au dit data and user feedback from both interventions will help identify the most convenient and acceptable option for users — without making RMW dispo sal too difficult (which could risk safety violations by inadvertently ste ering users toward only utilizing the general waste bin). \nThe signage on the original large RMW bins also presented significant usability challeng es. It depicted a long, text-only list of acceptable items. It violated se veral of Nielsen’s design heuristics like, “Recognition over Recall” and “ Error prevention.” The design relied on a recall-heavy process that requir ed users to compare each waste item with the list on the sign. The additio n of images/icons would make recognition easier. The sign could also do mo re to prevent inappropriate RMW utilization by adding examples of common i tems that are not biohazardous, like gloves and plastic containers.\n\nObj ectives: We aimed to decrease the proportion of rooms with inappropriate R MW 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 o f the overall RMW disposal process for users.\n\nMethods: The initial asse ssment led to the formation of a multidisciplinary quality improvement (QI ) team involving ESD, Facilities, Human Factors engineers, safety & qualit y 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 st ate analysis helped identify root causes, which informed the selection of interventions. In the PICU, the team decided to trial smaller red bins i n less convenient locations. In the ED, wall-mounted RMW bags would replac e floor-based RMW bins. These interventions were chosen based on the amoun t of RMW generated and patient acuity levels. The team also tested interve ntions 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 o f audited rooms found to contain inappropriate content in RMW receptacles. \n\nResults: Baseline audits of >1,100 waste bins (Sep-Dec 2024) reveale d that, on average, 89% of ED rooms and 77% of PICU rooms contained mostl y or entirely inappropriate RMW. Survey data revealed that only 32% of res pondents felt that current RMW signage was clear and helpful. Meanwhile, o nly 35% understood the financial impact of RMW disposal, and only 37% unde rstood the environmental impacts. \n\nIn the PICU, the combination of smal ler red bins and staff education decreased inappropriate RMW from 77% to 5 4%, and then down to 32% by April 2025 following additional outreach inter ventions. Without sustained education, though, RMW levels settled at 42% i nappropriate. 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%. \n\nNew, user-fr iendly signage was developed using visual design principles and clear icon s to show what should and should not be discarded as RMW. This new design was incorporated into educational materials and screensavers throughout th e units. All communication materials used framing effects to effectively c onvey the immediate financial and environmental costs of inappropriate RMW disposal, rather than distant climate impacts that users may not relate t o. Communications included specific data such as the percentage of inappro priate RMW and its cost, to make the message more tangible.\n\nApplication : The smaller RMW bins did help decrease inappropriate RMW in the PICU, bu t the initial success waned over time without persistent staff education a nd reminders. The wall-mounted RMW bag system proved to be a more effectiv e 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 optimi ze user accessibility and physical ergonomics. As in the ED, we will ensur e that PICU staff fully understand the new wall mount process prior to imp lementation, and we will collect ongoing quantitative and qualitative feed back after implementation.\n\nTrack: Hospital Environments\n\nSession Chai r: Gabriel Segarra (Medical University of South Carolina)\n\n END:VEVENT END:VCALENDAR