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Rapid Responses: Rapid Responses published:
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Green shoots of recycling
- Ian Blenkharn (27 March 2009)
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token recycling
- Ivan P Hudecek (31 March 2009)
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Ian Blenkharn, Environmental & Healthcare Microbiologist Blenkharn Environmental
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Despite opportunities to reduce the heavy environmental footprint of the NHS, progress so far has been limited. Reduction in consumption and elimination of waste can afford substantial savings though successes have so far been limited. The separate collection of recyclables including food, paper and cardboard, glass and some metals is of proven value though the logistics may be troublesome. In clinical areas, errors of segregation may result in hazardous items being disposed into an inappropriate container, or of confidential documents discarded without attention to the necessary data security. Hutchins and White discount the possibility for recycling of clinical wastes and imply that these wastes must be considered ‘lost’ to resource recovery.1 Though not yet widespread, this waste fraction can be processed for recycling after treatment to render it safe using non-incineration treatments such as commercial autoclave processing. Valuable high grade metals from single-use instruments can be recovered using magnetic extraction. Other separation techniques permit recovery of hard plastics, while the high calorific value of the treatment residues allows use as a fuel for cement kiln operation. Though current regulatory pressures seeks to frustrate recycling initiatives and divert clinical wastes directly to landfill or to high temperature incineration with no obligation to energy recovery, post- processing recovery rates up to 60% make a valuable contribution to environmental protection without the need for ever more onerous source segregation that are generally troubled by space and time constraints, by segregation errors, and by the vastly increased manpower and logistics costs. With clinical waste production across the UK exceeding 1,400 tonnes per annum, technologies that enable resource recovery from clinical wastes, and biogas production from vast quantities of sanitary and offensive waste fractions that are separately collected, offer an invaluable environmental advantage that as yet to be fully realised. Scally is correct is his assertion that NHS procurement must ensure that decisions are informed by awareness of material and packaging composition as key determinants in recovery and recycling.2 Indeed, this approach forms part of the WHO strategy for healthcare waste management that includes, for example, the production of all syringe components made of the same plastic to facilitate recycling.3 Inevitably, this would carry a heavy financial burden for manufacturers who may be unwilling to fund the redesign and re-approval of their products. However, there are already green shoots appearing from the treatment of NHS wastes teams, though these may be hidden to most healthcare professionals. Regulators should applaud and support developments in recycling from clinical wastes, though presently the approach is largely obstructive and sits uncomfortably with a substantial weight of published and technical evidence. In their part, NHS waste producers can make their contribution to resource recovery of metals and mixed plastics from clinical wastes by thoughtful selection of their waste disposal options to ensure that valuable environmental resources are not lost to incineration, or consigned to landfill disposal. References 1. Hutchins DCJ, White SM. Coming round to recycling. BMJ 2009;338:b609 2. Scally G. Environmental waste in health care. BMJ 2009;338:b1129 3. World Health Organization. Policy paper – Safe health-care waste management. Accessible from http://www.who.int/water_sanitation_health/medicalwaste/en/hcwmpolicye.pdf (accessed 27 March 2009) Ian Blenkharn Blenkharn Environmental 18 South Road Ealing London W5 4RY blenkharn@ianblenkharn.com Competing interests: None declared |
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Ivan P Hudecek, Consultant Anaesthetist Manor Hospital,Walsal,WS2 9PS
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Clinicians might decrease the environmental impact of medical practice by drinking tea from china cups. Sounds far fetched? Not according to Dr. White and Mr. Hutchins, who in their article dish out this and plenty of similarly original advice. They however do not adhere to one of their own suggestions (to save paper): extra pages are required so we can be treated to two(!) pictures of a box full of Petri dishes and one of a yellow bag. From my point of view as an anaesthetist, I was especially interested which disposables would Dr. White dispose with (sorry for the pun) and which packaging he would simplify. As someone who started practicing during the non disposable era, I am more than convinced that the introduction of plastic single use items must have been one of the biggest contributions to the quality and safety of anaesthesia. I shall give just two examples: Ventilator tubing used to be manufactured from heavy black rubber. Thus ventilator (or spontaneous breathing circuits) disconnections were a constant hazard and did occur not infrequently - sometimes with disastrous consequences. Endotracheal tubes were manufactured from red rubber – a nasty irritating compound. These tubes constantly kinked, obstructed and their cuffs leaked. I have also spent six months working as an Anaesthetic Assistant and thus had the “pleasure” of cleaning masks, airways, endotracheal tubes etc. using various toxic solutions – not an enviable task. As for the packaging - Dr. White’s article is misleading. Virtually all packaging of anaesthetic disposables is single layer. Where it is double, like spinal or epidural packs, then the inner layer serves as cover for a trolley. Recycling of packaging is impracticable as it consists of both plastic and paper and cannot be viably separated. Anyway packaging gets frequently contaminated as it serves as a receptacle for equipment. Are we supposed to do some form of sorting during our clinical work? Shall we have one box for syringes; one box for “true” sharps; several boxes for glass according to its colour etc. (the list seems to be endless)? All this to achieve (at best) the savings of £ 40 (the top price for a ton of waste paper) per year per theatre? PS: Perhaps next time the BMJ publishes yet another environmental article, the editors should ask the authors also to declare their carbon footprint. Competing interests: None declared |
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