A Vison for Low Carbon Healthcare Waste Management

Safe processing and disposal of healthcare waste is a vital part of healthcare waste management; as the health needs of an ageing population grow, the quantity of healthcare waste is likely to grow too. This must be managed sustainably as part of society’s commitment to minimise the environmental impact of our activities and so reduce climate change.

Drawing on the input of industry experts and health service waste managers, we have identified how different parts of the healthcare waste management process could change to support a significant reduction in the healthcare sector’s carbon emissions relating to clinical waste disposal.

Minimising the quantity of waste

1. Reduce

Front-line health service staff decide how every item they use should be treated: reused, recycled, treated as general waste or as one of the various types of healthcare waste. Ensuring staff are trained and motivated to classify used items correctly is a fundamental part of effective healthcare waste management and will minimise the quantity of waste disposed of using methods with the greatest environmental impact.

Accurate segregation of waste suffered during the pandemic. In its early stages, when COVID-19 was poorly understood, many healthcare organisations understandably classified a high proportion of waste as potentially infectious. Gradually a better picture emerged of the COVID-19 risks from different types of waste, safely allowing less waste to be classified as infectious. However, some healthcare organisations have yet to modify their classification policies in the light of this new information, meaning more waste than necessary is still subject to disposal using processes with a higher environmental impact.

2. Reuse

As many healthcare products as possible should be re-usable. These include:

PPE: Some NHS trusts have already started using some reusable items of PPE, for instance FFP3 masks with replaceable filters. While these are more expensive to purchase than disposable equivalents, the total cost of ownership is lower as well as the environmental impact. Another advantage is that each member of staff has an individually-fitted mask always ready for use.

Medical devices: an increasing number of what were ‘single use’ devices are now capable of being recovered and ‘remanufactured’ by their makers for re-use, to standards approved by medical device regulators. As more manufacturers invest in these processes, the range of devices which can be reused in this way is likely to expand.

Waste containers: Single use plastic bins are commonly used for sharps waste and certain other waste types such as pharmaceutical and anatomical. They can be sterilised and re-used, rather than being incinerated along with the waste they contain. Stericycle’s BioSystems re-usable sharps containers can be used 600 times before needing to be replaced. Reusable containers are an important part of more sustainable healthcare waste management, and this approach should be extended to all sharps containers and other suitable waste streams.

3. Recycle

It is possible to extract the metal content from some sharps and medical instrument waste and recycle this in new products. This currently takes place on a limited scale and should be done more extensively.

Plastics, glass and paper can also be separated from other waste and recycled. This takes place on a large scale with non-healthcare waste and is currently being piloted with healthcare waste. If the technology proves fit for purpose for healthcare, it should be rolled out more widely.

Further investment in new technologies to recycle the metals, plastics, glass and paper used in healthcare is likely to increase the amount of material which can be recovered, supporting more sustainable healthcare waste management practices.

4. Transportation

Transporting waste from its point of generation to treatment and disposal facilities generates carbon emissions from petrol and diesel-powered vehicles. The waste industry is exploring ways to use electric vehicles and hybrids as extensively as possible to transport waste. Currently, the largest vehicles remain difficult to electrify, although trials are underway to improve the carrying capacity of electric and hybrid fleets. 

There is also potential to use smaller electric vehicles to collect waste around large hospital sites and community healthcare facilities. 

Electric vehicle infrastructure could be rolled out in partnership with healthcare providers, who could support the transition by installing charging points or providing mains electricity connections to power waste-loading equipment without draining vehicle batteries.

5. Waste processing and disposal plants

Processing healthcare waste through incineration creates considerable amounts of heat which can be used directly to provide heating and hot water for nearby facilities, such as the host hospital generating the healthcare waste, or to generate electricity. 

Some treatment facilities already use this recovered energy to power their own operations, including charging electric vehicles, and these innovations should become a key part of low-carbon healthcare waste management wherever practicable.

6. Minimising the environmental impact of waste disposal