McGain and colleagues [1] highlight the substantial volume of waste arising from the Intensive Care Unit (ICU) and the fraction, (approximately 57%), which may be recycled. Concerns regarding infection risks, logistic and financial barriers, apathy from staff, who show a resistance to change, and technical difficulties in the separation of different plastics wastes, were considered as barriers to effective recycling.

Effective supply chain management can substantially reduce the volumes of packaging waste delivered to clinical areas. This alone may capture almost all cardboard waste, and also reduce the costs of ancillary staff required to deliver packaged goods and collect wastes from clinical areas.  McGain et al consider soft clinical wastes and sharps bins as unsuitable for recycling due to the risk of infection. However, these waste streams are rich in plastics and other recyclables. They also have a high calorific value sufficient for effective waste to energy transfer.

Despite opportunities to reduce the heavy environmental footprint of healthcare activities, progress has so far been limited. The separate collection of recyclables is of value, although practicalities may cause hindrance. In clinical areas, errors in separation may result in hazardous items being disposed into an inappropriate container. Contamination of waste sub-fractions may also occur. However, the infectious fraction of clinical waste need not be lost to recycling. Waste treatments exist to permit the successful recovery of mixed plastics and metals from clinical wastes after processing by high temperature autoclave treatment or other non-burn treatment technologies. This removes any requirement for additional source segregation and permits resource- and environmentally-friendly processing of infectious clinical wastes.

The separation of wastes at the source is often presented as a major barrier to successful waste management, for reasons of practicality and compliance, as noted by McGain et al. Most waste contractors would be delighted to operate post-process waste segregation and recycling of clinical wastes. However, in many jurisdictions, regulatory barriers to waste treatments make this particularly difficult to implement, due to an ideological approach that segregation at source is the sole route to managing waste successfully.

Concerns regarding the presence of pharmaceutical residues in raw clinical wastes, and thus in the residues from any non-burn waste treatment, is used to justify the restriction of waste treatments; in particular. the mandatory disposal of many clinical wastes by incineration, thwarts post-process resource recovery from such wastes. However, no data exist to substantiate these concerns. Sharps bins containing needles and syringes present a substantial plastic resource that is currently lost to recycling. If waste management included post-processing resource recovery, then the need for multiple waste streams may be removed, and this in turn may reduce costs. 

Although in their report, McGain et al confirm that no sharps were noted in non-clinical waste streams arising from anaesthetic practice [2], such errors do occur and may be responsible for sharps injuries amongst ancillary staff, waste handlers and others who will come into contact with these wastes [3]. This suggests that further care is required in waste segregation at the source.  Proposals for more detailed segregation of wastes at the point of disposal are becoming increasingly common. However, this may lead to more errors in segregation, with contamination of individual wastes streams. In addition, waste segregation may place waste handlers at more risk [4].

Healthcare workers must adapt to the environmental pressures and the ‘green revolution’, and develop an improved strategy for waste management. Techniques are available to process wastes in excess of those sought by McGain and colleagues. Post-processing recovery rates of up to 60%, make a valuable contribution to environmental protection, without the need for onerous source segregation. Post-process resource recovery from clinical wastes raises the possibility for further waste stream reduction, and processing non-clinical items from clinical areas.

Those who generate wastes in the anaesthetic room and ICU may help by ensuring the correct disposal of pharmaceutical wastes, and disposing sharps safely e.g.into a suitable sharps bin. This may convince regulators that source segregation of wastes from clinical areas is effective, and enable contractors to deliver environmentally sensitive disposal options, with minimal impact on space and time pressures to healthcare professionals.

Regulators should support developments in recycling from clinical wastes. Waste producers in the NHS may make their contribution to resource recovery of metals and mixed plastics from clinical wastes, by careful selection of their waste disposal options, and ensure that valuable environmental resources are not lost to incineration, or consigned to landfill disposal.

Ian Blenkharn
Blenkharn Environmental, London 

 References

1. McGain F, Story D, Hendel S. An audit of intensive care unit recyclable waste. Anaesthesia 2009; 64: 1299-1302.
2. McGain E, Hendel SA, Story DA. An audit of potentially recyclable waste from anaesthetic practice. Anaesthesia and Intensive Care 2009; 37: 820-3.
3. Blenkharn JI, Odd C. Sharps injuries in healthcare waste handlers. The Annals of Occupational Hygiene 2008; 52: 281-6.
4. Blenkharn JI. Health Service Risk Special Report: Clinical Waste. Croner’s Health Service Risks 2009; 140; 2-7.