Dealing with healthcare waste is a complex challenge. The healthcare sector has a large environmental footprint, and a study calculated that it contributed to 4.4% of greenhouse gases. WHO guidelines provide best practices for dealing with healthcare waste, but these are only recommendations and enforcement of WHO or country-level policies is a challenge. In short, healthcare waste policies are a compromise between competing environmental, public health and financial concerns.
Over the last year and a half, healthcare waste has become an even greater challenge, as the Covid-19 pandemic has increased the use of personal protective equipment (PPE) such as masks, gloves and face shields. Research has found that waste increased an average of 102.2% at public and private hospitals in Iran with the onset of Covid-19. Beyond the pandemic, there are other forms of waste, such as single-use plastics, packaging and pharmaceuticals, which enter and affect the environment when they are disposed or after they have been consumed.
But why is healthcare waste such a challenge? And if it’s such a big, global problem, what can we, as individuals, do to address it?
While it would be useful for healthcare professionals to consider their environmental impact, it is not always their priority. As one cardiologist told the BBC, ‘As doctors, we are required to make patients’ immediate needs and requirements a priority, and that needs to come first.’ Yet, the article goes on to argue, healthcare waste creates a ‘vicious cycle’: healthcare products can negatively impact the environment when they are produced and disposed, which can, in turn, harm human health. Creating sustainable waste management systems is an investment in a healthier future population, and effective waste management can help reduce the number of sick people needing care.
There are different types of healthcare waste, including sharps; infectious waste; pharmaceutical waste, which includes hazardous chemicals and radioactive materials; and general waste, which is like normal household or office waste.
Different disposal methods are better suited to different types of waste. For example, radioactive or hazardous chemical waste should never be disposed in a landfill; according to WHO guidelines it should either be immobilized (trapped in cement blocks) or burned at very high temperatures in a properly built incinerator. General waste, on the other hand, can be sent to a landfill.
Waste segregation, or the separation of different types of waste, is important. As the United Nations Environment Programme found, segregating ‘can dramatically reduce the volume of waste that requires specialized treatment’. A study estimated 50-70% of hospital waste is marked bio-hazardous (or ‘red bag waste’), and that ‘The economic impact of these errors is significant: red bag waste costs up to 10 times more for disposal than municipal solid waste and up to 30 times more than recycling.’
Aligning policy and practice
As a PSA study of pharmaceutical waste disposal found, although countries may have relatively comprehensive policies surrounding the processes for healthcare waste management, that does not mean that these policies are implemented or enforced. One of the challenging aspects of improving the healthcare waste management system is that responsibility for it is dispersed among manufacturers, donors, hospitals and individuals who create or manage the waste. In addition, guidance does not always agree on the best methods. For example, there are differing opinions on whether burning or burying plastics is better for the environment.
Although it may be disheartening, it’s important to recognise that once we are trying to decide what to do with healthcare waste, we have already failed. The best option is always to reduce the amount of waste we produce.
In fact, some healthcare professionals are looking to reduce the amount of materials that are thrown out after one use in an operating theatre. Many of these materials can be regularly and thoroughly sterilized for reuse.
What can I do?
The responsibility does not only lie within the healthcare profession for improving our practices toward healthcare waste. Especially now, with the Covid-19 pandemic, people are producing more healthcare waste, with multiple face coverings and bottles of hand sanitizer. It’s important to educate yourself on the best guidance for disposal and pay attention to any changing recommendations. For example, the UK government recommends reusing masks when possible. In addition, buying products like hand sanitizer in bulk or using refillable bottles for cleaning products reduces the packaging waste.
More generally, it is best to return unused pharmaceuticals to pharmacies, where they can be properly disposed, rather than dispose of them yourself. Flushing medicines can harm the waterways and other aspects of the environment, and burning pharmaceuticals, especially in low temperature fires, releases harmful toxins into the air. Therefore, it’s essential to deal with the healthcare waste that we produce properly.
In addition, it’s worthwhile to educate yourself on how your community deals with waste. Innovative methods for managing healthcare waste are becoming more common as the need increases with the pandemic. Some hospitals in the UK are investing in machines that melt used PPE into plastic blocks, which can then be reused as school chairs and toolboxes.
More than anything, it’s important to recognise that we all share some responsibility for improving the ways that healthcare waste impacts our environment.
Read more about pharmaceutical waste disposal in Africa>