How the healthcare sector can solve its waste problem

Poorly managed healthcare waste already harms the environment and human health – and the volumes are growing. New methods and policies and increased capacity to process and recycle it are urgently required, writes Nick Wilson.

If the global healthcare sector were a country, it would be the fifth largest emitter of greenhouse gasses on the planet. A growing contributor to the size of the industry’s carbon footprint is the waste it generates.

This insight is one of many included in a major update to guidance on waste management that Mott MacDonald has recently completed for the UK’s National Health Service (NHS). The best practice document, ‘Health Technical Memorandum: Safe and Sustainable Management of Healthcare Waste’, has been revised to reflect the lessons learnt from the COVID-19 pandemic, as well as the drive to net-zero.

Healthcare waste management has become a major international issue. In 2020 the World Health Organization (WHO) published ‘Global progress report on WASH in health care facilities: Fundamentals first’, estimating that one in three healthcare facilities worldwide did not manage their wastes safely, and a similar number failed to segregate different waste streams. COVID-19 has both drawn attention to the problem, and exacerbated it, by increasing the volumes of healthcare waste being generated.

Healthcare waste can be complex and varied. It can include hazardous waste, such as infectious material, dangerous chemicals, contaminated sharps, pharmaceuticals, and even limited quantities of radioactive material, as well as a wide variety of non-hazardous waste including confidential paperwork.

A study modelling the carbon impact of several waste streams and treatment methods found that the associated level of CO2 varied significantly, with recyclable waste generating the least, and waste requiring incineration generating the most. Besides climate change, these waste streams also contribute to broader environmental issues, such as antimicrobial resistance, and can impact public health through direct or indirect exposure.

The WHO estimates that roughly one third of the global population still lacks universal health coverage. As access to healthcare increases, waste will become a growing problem. Without effective management strategies, healthcare waste will create additional environmental and public health impacts. A variety of measures at local, national and international level are needed to improve healthcare waste management.

Use data to understand waste streams and volumes

Accurate data on healthcare waste is vital to planning infrastructure, devising long-term strategies, and finding solutions. Yet very few countries have an open, centralised system data collection.

The UK is one of those that does, via the Estates Returns Information Collection system. It promotes transparency and accountability, and allows the NHS to monitor performance, compare in-house and contracted services, and identify exemplar service providers. It also enables improvements in service provision and adoption of best practices.

Improve education and guidance

Skills and capacity must be built to develop and implement strategies for minimising waste and handling it safely. The WHO’s ‘Safe management of waste from healthcare activities’ (widely known as the ‘Blue book’) provides a useful foundation for education programmes. In London, Great Ormond Street Hospital’s The gloves are off! campaign shows what is possible with focused and intensive engagement. In 12 months, it successfully eliminated more than 21t of PPE waste by reducing the unnecessary use of latex gloves and other protective equipment.

If healthcare waste streams can be segregated at source, it avoids contamination of recyclables and ensures that only waste that must be incinerated is disposed of that way. Incineration is approximately six times more energy-intensive than municipal energy to waste. Currently, materials that could readily be recycled and returned to use end up as waste because they are mixed with hazardous and ‘offensive’ waste (soiled but non-hazardous). The volume of offensive waste greatly exceeds that of hazardous waste.

In the UK, the NHS has been promoting the correct segregation of offensive waste. Training staff to correctly identify this waste stream, and keeping it separate from hazardous and clinical wastes which require incineration or treatment at a specialist facility, allows it to be sent to a municipal energy from waste site at much lower cost, and with a much smaller environmental footprint.

But such success stories are scarce. Studies have suggested that despite guidance being available, current levels of education around healthcare waste management are still low in many parts of the world, with one study published by the Journal of Humanities and Applied Social Sciences finding that in Karnataka, India, only 43% of healthcare staff could correctly segregate waste, and 54% of staff had received no training on healthcare waste management at all.

Guidance for managing healthcare waste is available in many languages but is mainly general. It rarely addresses specific waste streams and treatment technologies. Meanwhile, the range of healthcare products making their way into the waste stream is continually expanding, bringing new risks, while new treatment technologies are becoming available, creating new opportunities. Work is required to regularly update guidance and to adapt it to local contexts and different audiences, including non-technical ones.

Invest in better infrastructure

Improved infrastructure solutions include facilities for remanufacturing disposable polypropylene, microwave-based waste treatment systems (popular in the developing world due to their relatively low cost), and the expansion of municipal facilities.

Better systems include the adoption of schemes to take back containers and packaging for reuse and reverse logistics networks – both of which are becoming more common among medical manufacturers.

Ideally, every site should have a bespoke waste management strategy, tailored to the kinds of healthcare provided, materials used and management solutions available.

If we invest now in the right infrastructure, systems and education, we can strengthen the long-term sustainability of healthcare.

Nick Wilson

Waste management consultant, Mott MacDonald

Changing attitudes and practices

Waste management will be helped if healthcare providers, their supply chains and the waste management industry speak the same language. Work is required to standardise classifications, terminology and practices, and encourage the collecting and sharing of data. Ideally, a worldwide agreement should be negotiated – there is currently no international convention on healthcare waste – but organisations can help by collaborating to find ways in which waste can be minimised or designed out of systems.

Governments have a key role to play by implementing national policies, developing integrated waste management strategies for cities and regions, using regulation as a driving force to implement change, and working with the public and healthcare and waste management stakeholders.

Improving the sustainability of healthcare

Without action to reduce healthcare waste, it is set to become a growing problem, harming the environment and undermining gains in human health.

The implementation of circular economy principles into the design of healthcare products, equipment and consumables will help to minimise the quantity of waste generated, reduce the environmental footprint of the sector, and make sustainable healthcare a reality. Mott MacDonald has worked with NHS senior managers to develop procurement guidelines to improve product design and packaging that make it easy to reuse, recycle and recover. Similarly, we have written technical guidance for The Global Fund’s procurement partners and national waste management strategies for government bodies that have informed policies on requirements such as labelling to assist in product reuse and recycling.

We understand that solutions will need to vary internationally, based on local resource availability, the existing level of infrastructure and organisation, and the specific needs of individual communities. However, if we invest now in the right infrastructure, systems and education, we can strengthen the long-term sustainability of healthcare and enable it to play a key role in creating a greener society.

This article was first published by Circular Online, the daily news and insights website of the Chartered Institution of Wastes Management.

Our experts authored ‘Health Technical Memorandum: Safe and Sustainable Management of Healthcare Waste’, a major update to guidance on waste management best practice within the NHS. It reflects key principles in sustainable healthcare waste management and specifically in relation to the circular economy, environmental protection, improved social outcomes, and reduced carbon emissions.

We have developed and are currently updating guidance on Sustainable healthcare waste management for The Global Fund to Fight AIDS, Tuberculosis and Malaria.