Healthcare waste management is an area of high impact within scope 3 emissions, designed to reduce the risk of infection and exposure to hazardous material. We must ask, is the current state of play really servicing healthcare as efficiently or sustainably as it should? The NHS (National Health Service) Health Technical Memoranda outlines offensive waste and infectious waste as being very similar, with the distinction being if the waste has come into contact with either known or suspected infectious patients. Focussing specifically on infectious and offensive waste categories, within healthcare it is outlined and legislated that infectious waste (e.g. dressings, swabs, and medical devices) must be placed into infectious bags and waste of a similar nature, that is not infectious but healthcare related, be placed into offensive bags. Whilst this is a clear directive, our research has shown us that there is a huge amount of confusion within healthcare about correct segregation.
The data tells us segregation of waste into the correct categories is largely unsuccessful. Even when healthcare workers are able to follow these guidelines, patients and visitors are unaware of the concept of different bag types for different waste. This results in far more material being incinerated, leading to unnecessarily high costs and emissions, and an extremely low level of recycling.
During the COVID-19 pandemic, offensive waste from patient care was disposed of into infectious waste bins as a precaution to not potentially further spread the virus. At end of life, infectious waste is autoclaved before going through low temperature incineration. This process, although effective in sterilisation, has a great environmental impact even when used as energy from waste (EfW). A study has shown that the process emits an estimated 569kg CO2e/t waste.
The pandemic left over-cautious waste disposal practices, as well as an increased volume of infectious waste bins where offensive waste bins would be more appropriate. The ‘just-in-case’ mentality has caused numerous items to be disposed of incorrectly into more expensive waste streams with a higher environmental impact, despite the IPC guidance stating that it is unnecessary. More IPC training focussed on waste management, ‘nudges’ by bins to drive behaviour, and a reduction of infectious waste bins through only positioning them where appropriate and replacing them with offensive waste bins, are just a few methods of reducing unnecessary expenditure whilst still adhering to IPC guidelines.
So, following the pandemic how infectious is our waste and are we becoming overcautious and thus not correctly segregating waste? A recent internal study showed that more than 60% of waste segregated as infectious or offensive was not in fact infectious at all. Huge proportions of general waste are not going to landfill or being recycled as it is being disposed of incorrectly in offensive and infectious waste. Due to contamination, once waste enters the wrong bag it is destined for incineration, so how do we drive segregation and change?
The impact of costs, emissions, and the volume of recycled material is dependent upon waste segregation. The management of infectious and hazardous waste has largely been in the hands of waste management companies, who will charge a premium for collection and management of this material. We know however, research is being done to recover waste materials for repurposing, such as the recovery of plastics. This allows for waste management contractors to keep the state of play the same with the hospital, charging high rates for waste handling but also benefiting again from the processing and potential sale of this resource later down the line.
There are however various on-site sterilisation models that are effective in infection control and remove the necessity for incineration. It is our understanding and expectation that onsite sterilisation, for a reasonable proportion of sites, is a viable option for the waste management of offensive and infectious waste categories. There are several devices in the UK and more across the globe that allow the hospital to transform their infectious or offensive waste to sterile material, which has the potential to be utilised as a raw material later down the line. Not only does this reduce scope 3 emissions via the diversion of waste form incineration, it reduces costs and puts control of the resources in the hands of the hospital. From the perspective of IPC this is also hugely beneficial should there be a situation, such as a pandemic, whereby infectious waste was seen piled up outside hospitals with drivers unable to collect the waste as efficiently as required. This being the perfect medium to spread infection and a huge risk factor. This problem would be eradicated as waste could be treated and left as a sterile material onsite, until it is can be collected. There is also growing concern about the emissions from the incineration of this waste along with the utilisation of waste being used for EfW, generating heat from the incineration.
The combination of on-site sterilisation, education and marketing campaigns would be extremely effective in managing infection control in waste management, whilst reducing costs and environmental impact.
Our recommendation is for healthcare facilities to seek agility in their next steps, before signing traditional waste management contracts, given that there is so much technology available to change the way waste is managed; from increasing autoclaving capacity, small scale microwave sterilisation devices right through to larger onsite or close proximity machines for on location management. This would give autonomy back to the hospital, allowing them to manage costs and scope 3 emissions using the right tech and on the right scale for their site. Using a modular approach when planning medical waste treatment facilities allows for each element of the solution to work independently, making it easier to scale up or down solutions as and when needed. It also makes it simpler to replace outdated components that are no longer fit for purpose. Having this flexibility, allows a medical waste management system to adapt to potential outbreaks or pandemics more proficiently. Consequently, this will aid for better infection control when volumes of waste greatly increase. Sustainability in infection control is complex due to the breadth of considerations that must be applied, from pooling resources, adapting to uncertainty and coordinating services whilst considering social, environmental and economic performance.