Intended for healthcare professionals

Rapid response to:


Coming round to recycling

BMJ 2009; 338 doi: (Published 11 March 2009) Cite this as: BMJ 2009;338:b609

Rapid Response:

Green shoots of recycling

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.


1. Hutchins DCJ, White SM. Coming round to recycling. BMJ

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
(accessed 27 March 2009)

Ian Blenkharn

Blenkharn Environmental

18 South Road


London W5 4RY

Competing interests:
None declared

Competing interests: No competing interests

27 March 2009
Ian Blenkharn
Environmental & Healthcare Microbiologist
Blenkharn Environmental