Waste management for healthcare facilities

Waste management is poorly practiced. While standard domestic waste separation is now reasonably well understood and is followed in principle by most dialysis units, structured, innovative waste management remains an ‘undiscovered continent’.

If properly managed, waste management has the potential to leave a far smaller environmental impact than is currently the case.

A simple and quick way to implement general waste recycling in dialysis units is to follow the recycling programs established by your local council/area for:

  • Paper and Cardboard
  • Plastic and Glass

For medical waste consider implementing a program similar to the Vinyl Councils PVC recycling program used in Australia.

PVC Recyling in Hospitals.

Thinking outside the box

In the PVC recycling initiative described above, most hospital waste – and all dialysis waste, barring packaging – is regarded as ‘infectious waste’.

As such, it is either incinerated – with potentially appalling air pollution consequences – or is buried as ‘toxic’ landfill. The latter risks water table pollution, as well as having ongoing infective implications and/or risks.

It does not need to be so…

A number of waste-management systems now exist that:

  1. Render all waste non-infectious by point-of-generation steam sterilization by autoclave, effectively killing any/all potential bacterial and viral contamination.
  2. The steam-sterilized conglomerate can then be shredded or compacted into discs of solid, sterile waste for easier disposal.
  3. If coupled with innovative waste separation practices, the resulting selective plastic waste product could then potentially be suitable for re-use – even for on-sale – to the secondary plastics industry.
  4. These sterilizing systems and practices are in current use – though not routinely so in dialysis units – and can accept and process all plastic, metal (including sharps), glass, packaging, and other waste.

An example of this system is:

The Sterishred 250™ is a Swiss system that similarly autoclaves the waste to a ‘non-infectious’ state then, rather than compacting to a disk for landfill, shreds the sterile material to a confetti-like ‘shreddate’. While this latter system also accepts all/any waste, if waste inclusion is limited to plastics, the shreddate format potentially offers an on-sale opportunity to the plastics industry for separation into plastic ‘types’. Reuse may then be feasible (e.g. for the manufacture of ‘secondary’ plastic items such as road bollards).

See: www.sterishred.com

Other systems are also available. In Europe, Fresenius Medical Care is currently trialing a Hungarian system, the Celitron™, in one of their dialysis units.

See: celitron.com

A further similar system, the Meteka™, has also been recently released.

See: www.meteka.com

While these waste management systems are not cheap – the quoted cost (July 2011) to purchase, import, install and train staff to use the Sterishred 250™ was €58,000 (then ≈A$75,000) – it seems reasonable to undertake a pilot study of their applicability.

Finally, it is tempting to dream of eco-loop ‘closure’, by integrating RO RW (for steam generation), and solar-assisted power (for autoclave operation) and to fully test the eco-waste management hypothesis – particularly if on-sale and/or re-use of the plastic shreddate is an end result.