What can be done to reduce misplaced waste in regulated medical waste containers?
Clinical Applications
Dr. Schwarzenberger is the former physician editor of DermWorld. She interviews the author of a recent study each month.
By Kathryn Schwarzenberger, MD, FAAD, February 1, 2025
In this month’s Clinical Applications column, DermWorld Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Jenny Murase, MD, FAAD, about her JAAD paper, ‘53319 regulated medical waste reduction in the dermatology clinic.’
DermWorld: Your paper assessed the efficacy of an intervention to reduce misplaced waste in regulated medical waste (RMW) containers. Why did you and your co-authors choose to study this subject?
DermWorld: The intervention consisted of a 30-second informal training for all practice staff that included an overview of appropriate disposal of items in RMW bins. Could you elaborate on the reasoning behind a 30-second training duration?
Dr. Murase: Dermatology clinics and the administrative meetings are often very fast-paced with little down-time for training staff. We wanted to make sure our training was brief, had a lasting impact, and was effective. Moreover, for those who want to implement these changes into their practice, spending 30 seconds is much more practical and likely to affect positive change.
DermWorld: What criteria were used to define an item as suitable or unsuitable for RMW disposal, and were these criteria explained to the staff during the intervention?
Dr. Murase: Defining regulated medical waste itself is an exceptionally complex task within the United States. For instance, the definition of RMW varies from state to state and sometimes even from institution to institution. For our study, we used prior guidelines set in place by the states of Vermont and New York, the latter of which have been utilized by one prior study as well.
These criteria were summarized, and the central, easily palatable points were used to educate staff during our intervention. Essentially, we wanted to provide a balance of written rules while providing visual examples of them. For instance, we highlighted that many items which are not dripping or soaked with blood do not classify as RMW. We then included pictures of both heavily soaked gauze and gauze with only minimal blood absorbed.
DermWorld: You analyzed the contents of both non-RMW and RMW waste containers prior to and following an educational intervention to reduce unnecessary waste. What specific types of materials were most frequently misplaced in the RMW containers before the intervention and how did that change after the intervention?
Dr. Murase: Our study itself did not specifically record which types of materials were most frequently misplaced in the RMW containers. However, our anecdotal data suggest it was most often items associated with minor procedures such as gauze either mildly soaked with blood or not contaminated with blood at all.
DermWorld: What were your findings?
Dr. Murase: We found an overwhelmingly large difference in the amount of RMW properly placed following each intervention (two total). For instance, comparing prior to and after the first intervention, there was a 56.1% increase in the percentage of RMW properly placed in RMW containers.
Our study also analyzed the total waste produced by the dermatology clinic. We similarly found a decrease in the total amount of RMW produced (7.1%) after the first intervention. Our second intervention in both analyses showed further improvements in the amount of RMW properly placed as well as decreases in the total RMW produced.
Finally, our study also performed analyses comparing room types and waste container orientations. We classified rooms as either exam rooms or treatment rooms, with the latter being those reserved for procedures or procedurally oriented physicians. We found treatment rooms had 18.6% more RMW properly placed. For waste container orientation, we either placed containers next to one another or far away from one another, with the former leading to 11.5% more RMW properly placed.
DermWorld: Going forward, what would be the value of conducting routine educational interventions? Would you consider other educational intervention methods such as any visual aids or bin labeling modifications?
Dr. Murase: There would be immense value in conducting routine educational interventions such as ours. Our study found a second intervention just a few days after our first led to more impactful results.
Visual aids or bin-labeling modifications are ideas our research team has already discussed. The AAD-affiliated Expert Resource Group on Climate Change and Environmental Health is currently working on producing and distributing these materials.
Jenny E. Murase, MD, FAAD, is associate professor of dermatology at the University of California, San Francisco, and director of medical consultative dermatology and patch testing at Palo Alto Foundation Medical Group. Dr. Murase does not have any relevant financial and/or commercial conflicts of interest.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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