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:

token recycling

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?

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

Competing interests: No competing interests

31 March 2009
Ivan P Hudecek
Consultant Anaesthetist
Manor Hospital,Walsal,WS2 9PS