A green bill of health
Can hospitals cut down on single-use plastic without endangering patients? Madeleine Rojahn investigates.
Imagine the life cycle of a sterile plastic water bottle, used in a hospital theatre. Oil is extracted from the ground, shipped to a plastics refinery and transformed into plastic. It is moulded, transported to a supplier, bought by a hospital, picked up by a nurse, opened and used.
Then it is thrown in the recycling bin and (hopefully) recycled – although, globally, only 9% of plastics are recycled, according to a research article in Science Advances. Of the rest, 12% is incinerated – often disseminating harmful toxins into the atmosphere – and 79% goes to landfill. Our obsession with plastic has left it piling up all over the planet.
Hospitals are lagging behind in the fight against plastic: the use of single-use and disposable plastics is growing as they seek to cut costs and maximise infection control and convenience. Hospital plastics take many forms, such as excessive packaging, oxygen masks and various containers, including petri dishes and bedpans.
According to a 2018 NHS report, the NHS produced just over 58,000 tonnes of landfill waste in 2017-18 – costing £11.7m. Incineration disposal cost another £25.6m for 74,700 tonnes of waste.
The procurement question
On a more positive note, the NHS has actually committed to reduce the waste it creates. The NHS Sustainability and Development Unit (SDU) has made a series of commitments to the environment, including a commitment to reduce landfill by improving recycling systems and relationships with waste suppliers.
Bureaucracy, however, can be tough to surmount – especially when sanitation standards must be met. Clare Topping, energy and sustainability manager at Northampton General Hospital, says that in order to push greener procurement, one needs to first source a reusable device, understand the exact situations in which it can be used, find the capacity to clean it efficiently, and get clinical ‘buy-in’ – meaning understanding and agreement from prospective users. One problem, she says, is that people find more comfort in recycling; reuse is sometimes “more effort than someone is willing to go to”.
“When patient safety is always top of the agenda, do they spend their time on something that’s directly related to patient safety, or on trying to prove something’s okay from an environmental perspective?” she asks.
Ruth Stringer, policy coordinator for the international organisation Health Care Without Harm, says infection control should not be a significant barrier to achieving greener practices: “It is a lazy argument, I don’t think it is backed by evidence.” She believes infection control risks are often overestimated, and that, with proper management, infection can be minimised along with environmental concerns.
The World Health Organisation’s (WHO) Blue Book states that, generally, between 75% and 90% of waste produced by healthcare facilities is non-hazardous, and between 10% and 25% is identified as hazardous, thus requiring careful disposal.
Cheap and toxic
Due to a focus on lowering costs, cheaply made plastics such as polyvinyl chloride (PVC) are prevalent in many medical devices, particularly IV lines and bags. “IV lines are necessarily single use, but they need to be made of non-toxic materials that are readily recyclable,” says Stringer.
The WHO identifies PVC as the most difficult plastic to recycle, as it contains an array of additives, and recommends it is “avoided wherever possible” in healthcare because of concerns over toxicity. Latex, polyethylene and silicone are safer and easier to recycle materials suitable for replacement of PVC medical equipment, although they are more expensive. Some European states are currently phasing out PVC due to its harmful nature.
Procuring potentially harmful plastics that are harder to recycle or non-recyclable is appealing, due to their low-cost – but why are these materials so inexpensive? According to Stringer, it’s because nobody pays the environmental cost: “Manufacturers make all this stuff disposable and it creates problems downstream. We need extended producer responsibility initiatives to put the cost back onto manufacturers, who need to be part of making sure that functioning recycling facilities exist.”
Management of sustainability aspects varies throughout hospitals and trusts within the NHS, which Topping sees as a weakness: “I think it can be a problem that there is a lot of variety in management levels of sustainability. The Sustainability and Development Unit has recently put out a lot of guidance, but it’s only a small team.”
Thanks to this lack of capacity, she says, there is not much focus on efforts that do not directly benefit the hospital. “If you look at the whole picture, most emphasis will be on energy savings, justified from a financial perspective. Waste is not as high a priority because the spend isn’t high, and if you put it in a business case, it’s more difficult to make investments.”
However, studies have been done to show how green action can benefit hospitals in the longer term. A case study by Global Green Hospitals found that at the Renal Dialysis Centre of the Newcastle upon Tyne Hospitals NHS Trust, the implementation of two new pieces of recycling equipment saw an additional 90 tonnes of materials recycled, saving £7,000 in annual disposal costs and just under 50 tonnes of carbon dioxide.
When you imagine the extensive amount of energy used throughout the life-cycle of that single sterile water bottle, one may wonder how, today, we consider it more strenuous to simply wash an item and reuse it.
Madeleine Rojahn is a freelance journalist