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Analyses of the recycling potential of medical plastic wastes
Abstract
This study analyzed the recycling potential of plastic wastes generated by health care facilities. For this study, we obtained waste streams and recycling data from five typical city hospitals and medical centers and three animal hospitals in Massachusetts. We analyzed the sources, disposal costs and plastic content of medical wastes, and also determined the components, sources, types and amounts of medical plastic wastes. We then evaluated the recycling potential of plastic wastes produced by general city hospital departments, such as cafeterias, operating rooms, laboratories, emergency rooms, ambulance service and facilities, and animal hospitals. Facilities, laboratories, operating rooms, and cafeterias were identified as major sources of plastic wastes generated by hospitals. It was determined that the recycling potential of plastics generated in hospital cafeterias was much greater than that in other departments. This was mainly due to a very slight chance of contamination or infection and simplification of purchasing plastic components. Finally, we discuss methods to increase the recycling of medical plastic wastes. This study suggests that a classification at waste generating sources, depending upon infection chance and/or plastic component, could be a method for the improved recycling of plastic wastes in hospitals.
... When waste segregation interventions and educational trainings were introduced on the correct placing of non-hazardous waste within European and American hospitals, the volume of the hazardous waste stream reduced from half [15,16] up to three quarters [17][18][19] found correct identification of infected devices to be the greatest obstacle to establishing recycling within hospitals [19]. It was found that easy access to the correct waste stream bin required was crucial for effective waste segregation [20,21]. ...
... When waste segregation interventions and educational trainings were introduced on the correct placing of non-hazardous waste within European and American hospitals, the volume of the hazardous waste stream reduced from half [15,16] up to three quarters [17][18][19] found correct identification of infected devices to be the greatest obstacle to establishing recycling within hospitals [19]. It was found that easy access to the correct waste stream bin required was crucial for effective waste segregation [20,21]. ...
... Before waste can be considered for the recycling waste stream, it must first be classified as non-infectious, which a previous study found to be the biggest hindrance to a successful recycling initiative [19]. Once this classification has been made, and assuming a recycling bin is present for the healthcare worker to use (again another key issue [3]), further problems are still present to segregate recyclable waste. ...
Within the United Kingdom, most medical waste is incorrectly classified as hazardous and disposed of via incineration or alternative treatment. Currently, no research has been conducted on why such a large quantity of medical waste is erroneously segregated. This pilot study explores the barriers to correct segregation with the aim to decrease the volume of incinerated waste by investigating why medical waste is wrongly identified as hazardous. No previous data are available to compare results, and so this study demonstrates the significance of using qualitative methods (questionnaires and focus groups) to bring awareness to issues faced within medical facilities when segregating waste. The low availability of different bins as well as lack of space and the healthcare workers’ busy schedules were identified as main reasons for poor segregation. Bins were sparsely placed, and staff lacked time to find the appropriate one leading to incorrect segregation of non-hazardous waste. Lack of information around whether a material was recyclable or not led to less recycled waste. When ways to engage with this issue were discussed, most medical staff favoured quick forms of information provision, such as posters, whereas a participant proclaimed longer hands-on style sessions as more effective. The findings of this study provide evidence that governmental strategies focused on sustainable medical waste management should direct their attention to the placement and availability of bins, whilst including ‘on-the-ground’ personnel in their decision making. This pilot study showed the value in using qualitative methods when current data are lacking and can be repeated by other healthcare facilities to collectively grow a greater awareness of the sustainability issues faced by the UK healthcare waste management system.
... In Iran, a significant portion of municipal waste is disposed of in landfills, with only a small percentage recycled 8 . Developing countries increasingly adopt source separation and recycling practices in municipal waste management [10][11][12] . ...
... Plastic waste from laboratories, operating rooms, and hospital cafeterias has been identified as the primary source of plastic waste. According to the literature, segregating and coding at waste source, based on the infection possibility and the type of plastic material can enhance plastic waste recycling in hospitals 11 . ...
... The use of Society of the Plastics Industry (SPI) codes in classifying and analyzing plastic waste can enhance waste recycling. In this context, programs incorporating various recycling processes and techniques such as mechanical crushing, decontamination, washing, and reprocessing are recommended to achieve recycled products 11 . ...
Introduction: Special and infectious wastes are the most significant wastes generated in hospitals, health centers, and similar facilities. Reducing and recycling such wastes at the source pose significant challenges to waste management. Therefore, this study assesses the components of healthcare waste in terms of their recyclability, emphasizing different types of plastic. Materials and Methods: Data collection involved sampling normal and infectious waste in selected hospitals over three months using monthly checklists. The total waste generated in these hospitals was analyzed on a daily basis. Moreover, the average microbial load of infectious waste was determined through microbial strip tests and biological tests following patient companion. Tests were performed with the acceptable performance of safe hospital devices with the destruction of microorganisms. Results: Average waste composition in the selected hospitals included 65-70% general waste and 30-35% infectious waste. The most common generated infectious waste was polyethylene (PE) sets (800 kg/month), while the predominant general waste was nylon bags for polyethylene terephthalate (PETE) packaging (520 kg/month). Hospital 1 had the highest per capita production of recyclable waste, generating 7,900 kg and 2,550 kg of normal and infectious waste per month, respectively. The total revenue generated from selling normal and infectious plastic waste was 1.4 and 0.2, respectively. Conclusion: The mixing of waste can be prevented by properly segregating normal and infectious waste and adequate staff training. Given the escalating disposal costs of health-care waste (HCW) and the shrinking space in landfills, efforts to minimize waste generation are crucial for effective recycling and reuse processes.
... Point source segregation (SS) of wastes (also known as source separation) is very poor in Ayurveda hospitals and the disposal procedures are very poor too since the waste is disposed by means of burial, open dumping and/or open burning (JICA and Kokusai Kogyo Co Ltd, 2003;Kabra et al., 2022;Kumarasekara, 2014;Puri and Pargotra, 2021;Rajan et al., 2019;Saket and Singh, 2022). SS as a good housekeeping practice is an important RECP concept to avoid the formation of unnecessary quantities of hazardous wastes due to cross-contamination of non-hazardous wastes (recyclables and biodegradables) by hazardous wastes (Ali et al., 2017;Kularatne, 2022;Lee et al., 2002Lee et al., , 2004. Furthermore, SS could minimize high disposal costs associated with on-site or off-site disposal facilities (e.g. ...
... Obviously, continuous monitoring of the SS practices (including any health and safety pro-active hazard management strategies adopted) is needed along with regular awareness and training of all employees including nurses and janitorial staff (Gupta and Boojh, 2006;Kumarasekara, 2014;Kularatne, 2022;Lee et al., 2002;Prüss et al., 1999;WHO, 1997). Table 7 describes the recommendations of the WHO, Sri Lankan and Indian standards for SS of hazardous and non-hazardous wastes. ...
... (a) Usage of reusable items made of glass, plastic and metals to the extent possible that can be easily disinfected (except for catheters, needles, syringes, scalpels, Vasti yantras, Salaka and any other invasive medical item) (Kularatne, 2022;Lee et al., 2002;Prüss et al., 1999). (b) Reducing the number of pre-sterilized single-use items would be useful. ...
Ayurveda hospitals generate biomedical wastes (BMW). However, details on composition, quantities and characteristics are very scarce, details which are important to formulate a proper waste management plan for subsequent implementation and continual improvement. Therefore, this article presents a mini review of the composition, quantities and characteristics of BMW generated from Ayurveda hospitals. Additionally, this article presents some best possible treatment and disposal procedures. Most of the information was gleaned from peer-reviewed journals, although some information was collected by the author and from grey literature available to the author; 70-99% (by wet weight) of the solid waste is non-hazardous; biodegradables contributing to 44-60% by wet weight due to more used Kizhi (medicinal bags for fomentation) and other medicinal/pharmaceutical wastes (excluding waste medicated oils, which is 12-15% of the liquid medicinal waste stream and are not readily biodegradable) largely derived from plants. The hazardous waste component includes infectious wastes, sharps, blood as pathological wastes (from Raktamoksha - bloodletting), heavy metal containing pharmaceutical wastes, chemical wastes and heavy metal rich wastes. Quantities of infectious wastes followed by sharps and blood form a major portion of hazardous wastes. Most of the infectious waste material contaminated with blood or other body fluids and sharps from Raktamoksha are very similar (appearance, moisture content and bulk density) to what is generated from hospitals practicing Western medicine. However, hospital-specific waste studies are required in future to better understand the sources, areas of generation, types, quantities and characteristics of BMW, and hence to formulate more accurate waste management plans.
... It ensures that medical equipment is contaminant-free, thereby protecting patients, healthcare providers, and the broader public from infection. Additionally, plastic packaging facilitates the safe and efficient transportation of medical items [9]. However, after its brief use in hospitals, this packaging is typically disposed of in landfills or incinerated [10]. ...
... Despite the scale of this issue, recycling programs for healthcare waste are strictly regulated due to the high risk of infection transmission, which limits the recycling of potentially valuable plastic materials. The primary method of medical waste disposal remains incineration [9], a practice that significantly contributes to global warming, ecotoxicity, and the depletion of fossil fuels, placing both the environment and human health at greater risk [13]. ...
... Traditional disposal methods, such as landfills or incineration [8], have raised concerns due to poorly designed incinerators and improper landfill disposal. Even recycling, touted as a potential solution, faces challenges, with low recycling rates contributing to the growing plastic waste crisis [3,9,10]. Improper plastic disposal methods release harmful environmental pollutants, posing severe health risks to populations. ...
... Dioxins, furans, and hydrogen chloride are pollutants affecting soil, groundwater, and air quality [11][12][13]. Medical plastic waste disposal's environmental and health ramifications have become a public concern, necessitating urgent attention [3]. Recycling medical plastics has been proposed as a sustainable approach, but challenges, including public perception of infectiousness and the quality of recovered materials, must be addressed [14,15]. ...
Medical plastic waste threatens the environment and human health if not properly handled and disposed of. This study used field visits, multi-criteria decision analysis, material testing, and data analysis to assess the feasibility of recycling medical plastic waste. The study identified medical plastic products (syringes, intravenous bags, and infusion sets) with high recyclability potential and proposed targeted recommendations for improving waste management practices. Medical plastic waste generation rates in kg/bed/day were 0.486 and 0.428. 55 kg/day and 5 kg/day of recyclable medical plastic waste are generated at KATH and KNUST hospitals, respectively. The contextual relevance of this research extends beyond the Ghanaian healthcare system, with implications for waste management practices in low and middle-income countries by contributing to the advancement of sustainable waste management practices.
... Within healthcare facilities, operating theatres are particularly energy-intensive, and their emission rate is estimated at three to six times more than that of other hospital departments. This is especially due to air conditioning requirements, ventilator and biomedical equipment use, and consumption factors such as medical supply production and waste disposal [3][4][5][6]. ...
... A noteworthy finding was the high impact of the arthroscopy and scrubbing and draping processes. This can be attributed to the disposable nature of the draping used, as well as the high energy requirements of the arthroscopy tower components [4][5][6]. At 8.36 kg of CO 2 eq, the disposable single-use drape set represents the process with the highest environmental impact of the entire LCA. ...
Purpose
Environmental sustainability in medicine is a growing concern. Determining the carbon footprint of medical procedures may aid in selecting a less impactful technique moving forward. The purpose of this study was to understand the environmental impact of different anterior cruciate ligament reconstruction techniques, for which there is no consensus in terms of optimal graft.
Methods
A life cycle analysis of different anterior cruciate ligament reconstruction techniques was performed. These included quadrupled semitendinosus graft, bone-patellar tendon-bone graft, iliotibial band augmented with gracilis graft, doubled semitendinosus and doubled gracilis graft, and quadriceps tendon graft. All procedures were systematically paired with a lateral extra-articular procedure. The study was conducted in a specialised centre using surgeon preference cards, with the help of a dedicated organisation for calculation according to the ISO 14044 standard. The primary outcome measure was the carbon footprint of each of the five techniques. Secondary outcomes included other environmental impact indicators, including human carcinogenic toxicity and mineral resource scarcity, among others, based on the ReCiPe 2016 midpoint guideline. The analysis had three scopes, each encompassing varying numbers of processes: graft implantation, full procedure, and entire environmental impact, from medical prescription to patient discharge. Results were reported as percentage increases compared to the graft technique with the lowest environmental impact.
Results
It was demonstrated that the surgical procedure itself accounted for <40% of the life cycle, with arthroscopy being 88% of surgery's GHG emissions, and scrubbing and draping contributing 39% to the carbon footprint. The iliotibial band augmented with gracilis tendon technique had the lowest carbon footprint (0.199 Kg Co2 eq), and the least impact in most categories at all scopes of the life cycle analysis. Using this technique as a reference, in terms of graft implantation, it was determined that extensor mechanism grafts had the highest carbon footprint (300% higher than the reference). Greater scopes showed a similar trend, with percentage differences decreasing significantly, reaching 1–3% when considering the entire environmental impact for most categories. Nevertheless, among the aforementioned factors of the ReCiPe 2016 guidelines, the semitendinosus graft paried with a lateral extra-articular procedure displayed greater difference in human carcinogenic toxicity and mineral resource scarcity (6% and 10% respectively) compared to the reference. The individual processes with the highest impact were also highlighted.
Conclusions
In the institution where the study was conducted, the studied iliotibial band graft option was found to have the lowest environmental impact. Such analyses of standardised procedures can be replicated in individual institutions in order to determine their environmental impact. Identification of procedures with comparable results and differing environmental consequences may influence the future decision-making process.
... Considering all available reports, the recommended first step to successful recycling of biomaterials is segregation by the type of material (polymer, metal, or ceramic) (Kheirabadi and Sheikhi, 2022;Yadav et al., 2020), specific composition (Lee et al., 2002;Joseph et al., 2021), waste source (Attrah et al., 2022;Lee et al., 2002), and infection chance (Kheirabadi and Sheikhi, 2022;Yadav et al., 2020). Figure 1 illustrates an exemplary composition of biomaterials waste, highlighting the chemical diversity of the materials. ...
... Considering all available reports, the recommended first step to successful recycling of biomaterials is segregation by the type of material (polymer, metal, or ceramic) (Kheirabadi and Sheikhi, 2022;Yadav et al., 2020), specific composition (Lee et al., 2002;Joseph et al., 2021), waste source (Attrah et al., 2022;Lee et al., 2002), and infection chance (Kheirabadi and Sheikhi, 2022;Yadav et al., 2020). Figure 1 illustrates an exemplary composition of biomaterials waste, highlighting the chemical diversity of the materials. ...
Biomaterials undergo a transformative journey, from their origin as renewable resources to the manufacturing plants where they are processed and stored, until they fulfill their intended therapeutic or diagnostic purposes and become medical waste. However, during this life cycle, biomaterials can be susceptible to contamination and subsequent degradation through various mechanisms such as hydro-mechanical, thermal, or biochemical processes in water, soil, or air. These factors raise significant concerns regarding biological safety. Additional complexities arise from the potential amalgamation of biomaterials with other materials, either of the same kind or different types. Use of biomaterials influences their porosity, surface chemistry, and structural strength, and these factors affect biomaterials’ reusability. Given the multitude of materials, processing parameters, sustainability requirements, and the limitation of natural resources, the recycling of biomaterials becomes necessary. Unfortunately, this topic has received limited attention thus far. In this context, this perspective provides a brief overview, analysis, and classification of reports on biomaterials recycling, aiming to initiate a discussion on this frequently overlooked subject. We highlight the challenges related to energy consumption and environmental pollution. However, the lack of established protocols and reporting on biomaterials recycling prevents a comprehensive understanding of these challenges and potential solutions. Nevertheless, addressing these issues can lead to more efficient resource use and reduced environmental impact in the field of biomaterials.
... 7 The ORs of a single hospital can produce over 100 tons of waste per year, with a 30% proportion of plastics. 8 The need for sterility in the OR encourages the use of disposable devices and materials sealed in plastic packaging. 1,[9][10][11] Waste disposal costs for an OR were estimated to be USD 45,000 per year. ...
... 1,[9][10][11] Waste disposal costs for an OR were estimated to be USD 45,000 per year. 8 Single-use devices contribute to resource consumption and waste generation. 12 Reusing medical devices is a favorable circular economic strategy 13 that can greatly reduce the environmental impact of surgery 14 and can even reduce costs. ...
Purpose
Operation rooms have a large environmental impact. Single-use staplers (SUS) are widely used surgical instruments that contribute to resource consumption and waste generation, whereas multi-use staplers (MUS) can greatly reduce the environmental impact of surgery. The staple lines are often reinforced with buttressing material to prevent leaks and bleeding. We explore current clinical practice and environmental concerns regarding stapling and buttressing, as well as the environmental impact of staple line buttressing in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, we extend this analysis by taking packaging material and the lithium in power supplies into consideration.
Materials and Methods
A survey of bariatric surgeons was conducted to assess stapler and buttressing use in clinical practice. We deconstructed and analyzed the product and packaging composition of a commonly used SUS with separate staple line reinforcement (Echelon Flex™ with Echelon Endopath™, Ethicon) and MUS (Signia™ with Tri-Staple™ reinforced reloads, Medtronic), where the buttressing material was delivered separately or already incorporated in the reload cartridge, respectively. Both systems were compared regarding total waste generation, resource use (determined as total material requirement), and greenhouse gas emission caused by their lithium content.
Results
60 mm cartridges were most frequently used in bariatric surgery, and 67% of surveyed surgeons applied staple line reinforcement. MUS with pre-attached buttressing resulted in a reduction of waste, material consumption, and greenhouse gas emissions compared to SUS with separate buttressing: they reduced product waste by 40% (SG and RYBG), packaging waste by 60% (SG) and 57% (RYGB), resource consumption by more than 90%, and greenhouse gas emissions related to the lithium in the batteries by 99.7%. Preloaded buttressing produced less waste than separate buttressing per stapler firing.
Conclusion
The environmental impact of surgery can be greatly reduced by using MUS with pre-attached buttressing rather than SUS with separate buttressing.
... The possibility of recovering and reusing both their components is a solution not only economic solution, but also ecological (environmental protection). In the papers by Swain [2] and Lee et al. [3], pharmaceutical blisters are defined as the largest plastic waste in pharmaceutical industry and their recycling is indicated for environmental reasons as well as for financial savings. The pharmaceutical blisters are well known to provide an effective protection against moisture, light, and oxygen. ...
... A view through the observation window of the tank for separation of pharmaceutical blisters: a) the pharmaceutical blisters before separation into components: a mixture of powdered blisters in the separation liquid (1), b) the pharmaceutical blisters after separation into components: PVC (1), separation liquid(2), aluminium(3) ...
In this paper, the separation technology of components of waste pharmaceutical blisters and its adaptation to the industrial scale are described. It involved, among others, taking advantage of the phenomenon of difference in the density of the individual phases that were contained in the separation tank, i.e., the separating mixture, PVC plastics, and aluminium. As a result, the directions of movement of the separated blister components were opposite. All components of the separating mixture feature a similar surface tension ( γ > 20 mN/m) which facilitates the penetration of the liquid between the blister component layers. After separation, the full-value products, i.e. polyvinyl chloride (PVC) and aluminium are obtained. The resulting products can be further processed and the entire technological process is a waste-free. PVC can be melted and processed into other products e.g. plastic components for the construction industry. Pure aluminium is a metal sought after and widely used in industry due to its low specific weight. An additional element supplementing the technology is the separation tank of our design in which the separation process of the blister components takes place. The advantage of the separation tank is that the separation process can be repeated many times with the same separating mixture until it is exhausted. Both separated blister components are directed to filtering followed by air drying without a mixing PVC plastic with aluminium.
... plastics collected out of the total volume of medical wastes generated imparted a major contribution to MSW (Lee et al., 2002). The most commonly used plastics used in medical application includes high density polyethylene (HDPE), low density polyethylene (LDPE), polypropylene (PP), polystyrene (PS), acrylonitrile-butadiene-styrene terpolymer (ABS), etc. (Lee et al., 2002). ...
... plastics collected out of the total volume of medical wastes generated imparted a major contribution to MSW (Lee et al., 2002). The most commonly used plastics used in medical application includes high density polyethylene (HDPE), low density polyethylene (LDPE), polypropylene (PP), polystyrene (PS), acrylonitrile-butadiene-styrene terpolymer (ABS), etc. (Lee et al., 2002). The most common management techniques being adopted in India include incineration/deep burial incineration, autoclaving, microwaving, and disposal by deep burial, including recent techniques like Plasma Pyrolysis, Waste Sharps dry heat sterilization, and encapsulation and shredding cum chemical disinfection to avoid contamination and infection (ENVIS, 2014). ...
This work reports the thermo-catalytic conversion of medical plastic wastes to fuel oil using the detergent grade Zeolite A as the catalyst. The effect of catalyst on the pyrolysis is ascertained from the kinetic data obtained from thermogravimetric analysis assuming it to be a first-order reaction. A significant reduction in activation energy of the thermal degradation reaction is found in presence of the Zeolite A catalyst. The pyrolysis runs were performed at different temperatures from 400–550 °C in a stainless-steel batch reactor system to obtain an optimum condition for suitable waste to energy process. The highest oil yield of 79% was obtained at 500 °C with 10% catalyst concentration. The thermogravimetric analysis and the batch pyrolysis experimental result indicated a promising effect of the catalyst in terms of the enhanced rate of reaction and conversion. The oil fraction obtained in the optimum condition of catalytic pyrolysis was analysed for its composition and fuel properties. It confirmed the presence of branched alkane and alkene with composition C10–C18. Again, the fuel properties of the oil such as specific gravity (0.793), viscosity (3.75Cst@ 30 °C), and flash point (<11 °C) resemble that of the petro fuels. Neural Networks (NNs) are used to recognize patterns, and relationships in data and validate the experimental results of this reaction and the results indicate that the use of ANN in thermo-catalytic degradation of medical waste to fuel oil is a feasible option that should be considered for real-time applications.
... The value of its application has been demonstrated by Chauhan et al. [40] through exploring the economic benefits gained from the resource-based treatment of medical waste. Several scholars have investigated the technological pathways for the implementation of resource-based disposal, including the reuse of packaging, plastic, and metal particles in other production areas [41][42][43][44], and the conversion of medical waste into energy such as electricity [45]. Moreover, some studies have examined the efficiency of existing resource-based disposal programs for medical waste, for example, evaluating the contribution of electricity and district heating generated by waste-to-energy plants in some countries [46][47][48]. ...
... In this case, the high cost of resource-based disposal may add to the budgetary burden of disposal enterprises, leading them to disagree with expanding their resource-based operations in order to maintain maximum revenue. Finally, medical institutions are only responsible for the sorting and temporary storage of medical waste, with cost and risk minimization being their main objectives [42]; therefore, the resource-based disposal of medical waste is not the primary choice for medical institutions. Just as Glew et al. [67] and Costa et al. [68] demonstrated the role of government subsidies and supervision on the efficiency of waste reuse in symbiotic systems in other fields, the simulation results of this study suggest a positive impact of government subsidies and supervision on the promotion of symbiosis among multiple subjects in resourcebased medical waste disposal projects. ...
In the post-pandemic era, the continuous growth in the rate of medical waste generation and the limited capacity of traditional disposal methods have posed a double challenge to society and the environment. Resource-based disposal is considered an efficient approach for solving these problems. Previous studies focused on the methods of medical waste disposal and the behavior of single stakeholders, lacking consideration of cooperation among different stakeholders. This study establishes an evolutionary game model of the resource-based disposal of medical waste to analyze the behavioral decision evolution of governments, medical institutions, and disposal enterprises. This study also explores the influencing factors in the achievement of the symbiotic state and investigates the conditions that participants need to meet. The results show that joint tripartite cooperation can be achieved when the subsidies and penalties from governments are sufficient, as well as the efficiency of resource-based disposal, which can effectively promote the evolution of the three subjects from the state of “partial symbiosis” to the state of “symbiosis”. However, the resource-based classification level cannot directly change the symbiotic state of the system due to the goal of minimizing cost and risk. When evolutionary subjects have reached the state of “symbiosis”, the improvement in the classification level can enhance the willingness of disposal enterprises to choose the resource-based classification strategy. Under such circumstances, governments reduce their corresponding level of intervention. At this time, the whole system is in a more idealized symbiotic state.
... Plastics are not only ubiquitous in everyday lives but also form a core part of medical equipment. A vast amount of medical equipment used in the general hospital environment is either made from plastic or comes in plastic wrapping (Harding et al., 2021;Lee et al., 2002;McGain et al., 2008). The SARS-CoV-2 (COVID-19) pandemic also resulted in increases in personal protective equipment usage, predominantly made from plastics (Harding et al., 2021). ...
... To attempt to relate the MPs observed to sources, the data available on plastic composition and waste in operating theatres can be used. A large retrospective study including five hospitals in Massachusetts, U.S. A, identified that the operating theatres contributed to 33.2 tons per year of plastic waste representing 21 % of the total plastic waste for the whole hospital (Lee et al., 2002). Focusing on the two most detected MP polymers, PET represented 38 % of the MP content with a mean concentration of 451 MP m − 2 day − 1 . ...
Atmospheric microplastics (MPs) have been consistently detected within indoor and outdoor air samples. Locations with high human activity are reported to have high MP levels. The aim was to quantify and characterise the MPs present within the surgical environment over a one-week sampling period. MPs were collected in samplers placed around an operating theatre and adjoining anaesthetic room at 12 hour intervals. Particles were filtered onto 0.02 micron membranes and analysed using micro-Fourier-transform infrared spectroscopy. The number of MPs identified during the working day sampling period varied, with a mean of 1,924 ± 3,105 MP m⁻² day⁻¹ and a range of 0 – 9,258 MP m⁻² day⁻¹ observed in the theatre, compared with a mean of 541 ± 969 MP m⁻² day⁻¹ and a range of 0 – 3,368 MP m⁻² day⁻¹ for the anaesthetic room. Across both rooms and at all sampling points, an increase in levels with a decrease in MP size was observed. Identified particles consisted of mainly fragment shaped MPs (78%) with polyethylene terephthalate (37%), polypropylene (25%), polyethylene (7%) and nylon (13%) representing the most abundant polymer types. MPs were not detected in the theatre during non-working hours. The results provide novel information on defining polymer levels and types, in a room environment where the use of single plastics has been regarded as beneficial to practice. These results can inform cellular toxicity studies, investigating the consequences of human MP exposure as well as represent a potentially novel route of exposure for humans for this emerging contaminant of concern, via surgery.
... Notably, operating rooms (ORs) are responsible for approximately 21% of this waste. 2 Given that infectious waste requires specialized handling, such as incineration and chemical treatment, misclassification and improper management can exacerbate environmental damage. ...
... Due to their sensitivity to humidity and oxidation during storage, dried vegetables pose a special challenge for food safety; as a result, it is essential to choose the absolute best packing material to stop these undesired physicochemical processes [22]. Red pepper paste packaged on polyethylene plastic was reported to have an extended shelf life compared to other types of plastic [23]. Shelled walnuts packed on polyethylene, as opposed to polyethylene pouches, had a longer shelf life and less microbiological development [24]. ...
After harvesting, cowpea leaves have high moisture content which exposes them to microbial growth. Drying is used to reduce the moisture and extend the shelf life. However, dried foods are susceptible to spoilage resulting from many microbial, biological, chemicals and physical reactions. After drying packaging materials used by farmers also expose the dried product to a range of microorganisms due to their different moisture retention capacity. This study aimed at prolonging the keeping quality of the dried cowpea leaves for use during off- season and coming up with information on the best and affordable packaging material that would ensure safety of dried leaves. Data was collected on fungal, bacteria and coliforms. The data was subjected to variance using Statistical Analysis System 9.2 edition and significantly different means separated using LSD at 5%. The combination of harvesting stage, drying method and packaging material significantly (p<0.05) influenced microbial load (bacterial and fungal), however no coliforms were observed. Open sun-dried cowpea leaves at 21 DAS, packaged in woven and aluminium foil reported a high number of bacterial and fungal counts compared to the kraft packaging. Oven dried cowpea leaves, harvested at 49 days after sowing (DAS), and in kraft paper resulted in the least bacterial and fungal contamination compared to those packaged in woven and aluminium foil. Sun drying and harvesting time after at 21, 35 and 49 DAS contained the highest bacterial and fungal contamination followed by solar drying and the least was recorded in oven drying method. This research shows that correct harvest stage, adoption of oven and solar drying methods and use of correct packaging material will prolong the shelf life of dried cowpea leaves therefore enhancing food security and food safety.
... Employing a dynamic material flow analysis of urban stocks, they find that Japan, the U.S., and Europe could substantially increase their recycled aluminum consumption and therefore drastically reduce their dependence on primary-use aluminum. Lee et al. [24] examined the recycling potential of medical plastic waste streams. They found that the origin and level of contamination risk play a major role in determining the recycling potential of medical waste. ...
Recovery and re-utilization of materials are regarded as key strategies for reducing greenhouse gas emissions in the built environment. Within those end-of-use scenarios, recycling is one of the widely used tactics, demonstrated by established infrastructure and developed supply chain networks in many geographic locations. While recycling is an increasingly common practice in the built environment, accurately defining recycling quality in order to compare technologies and material types remains methodologically contested. This is mainly due to the vast spectrum of scenarios that typically fall under the term ‘recycling’. Remanufacturing, downcycling, upcycling, and even direct reuse are all referred to as types of recycling in non-scientific circles, depending on the sector they occur in. The main challenge in assessing the material recovery quality of those solutions is that they exist on a continuum without clear divisions. Within that context, this article presents and compares four methods for assessing recyclability. The featured methods measure recycling potential from different perspectives: economic dimensions of the recycling industry; patterns of resource depletion; the energy cost of recycling; and the carbon intensity of recovery processes. The scientific foundations of the four methods are presented and a range of widely used construction materials are tested. The performance of materials is then compared across the four assessment methods to note observations and gain insights. Some of the materials are found to consistently outperform others, whereas some materials perform well on one method while performing poorly on others. This comparative study is followed by a discussion that looks at the limitations of each approach and reasons, or lack thereof, for the adoption of one method over the others in industry and academia. Lastly, the article looks at future research trajectories and examines the path ahead for recycling in the construction industry.
... 2641 tons, are used every day (Idrees et al., 2022). Furthermore, the manufacturing of single-use medical items presents a significant challenge when it comes to recycling (Lee et al., 2002). These products, designed for a one-time use, are typically composed of high-quality materials that offer essential functionalities and ensure the safety of medical procedures (Saini et al., 2022;Ivanović et al., 2022). ...
This study explores the challenge of recycling single-use medical items due to their non-recyclable nature and associated environmental concerns. To align with the circular economy principles, we propose thermochemical recycling, specifically steam gasification, for carbon atoms recovery. Face masks, plastic syringes, non-woven gowns, and nitrile gloves were tested at different temperatures (700 • C, 750 • C, and 800 • C) in a lab-scale reactor. A significant portion of the carbon in the feedstock could be effectively recovered as valuable chemical building blocks (i.e., olefins, ethane, and BTXS species), enabling their direct application in the chemical industry and reducing reliance on fossil resources. At 700 • C, carbon recovery percentages were approximately 79 % for face masks, 82 % for plastic syringes, 38 % for nitrile gloves, and 76 % for non-woven gowns. Higher temperatures led to reduced recovery due to secondary cracking reactions. Overall, this study highlights the circularity potential of single-use medical waste contributing to sustainable waste management in healthcare.
... Studies looking at the impact of various operations, such as cataracts, hysterectomies, and dermatologic procedures, have identified common sources of high emissions; particularly, single-use surgical tools, energy needed for ventilation and heating/cooling, and anaesthetic gas use [3,21,22] . Moreover, studies show that operating theatres (OTs) are 3-6 times more energy-consuming than the rest of the hospital and are responsible for 21-30% of hospital waste [3,[24][25][26] . Since OTs often have their own supply chains, represent a physical area of the hospital under separate managerial control, and are operated by defined professional groups, strategies targeting environmentally sustainable behaviours could be most impactful within healthcare. ...
Background
The health sector contributes significantly to the climate crisis. Operating theatres in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. We systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in operating theatres, categorising these using the Theoretical Domains Framework (TDF).
Materials and methods
Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 – June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines.
Results
Twenty-one studies were selected for analysis and assessment (seventeen surveys and four interview studies) comprising 8286 participants, including surgeons, nurses and anaesthetists. Eighteen themes across ten TDF domains were identified. The most common barriers to adoption of green behaviours in operating theatres were in domains of: ‘knowledge’ (N=18) e.g. knowledge of sustainable practices; ‘environmental context and resources’ (N=16) e.g.‘personnel shortage and workload and inadequate recycling facilities; ‘social influences’ (N=9) e.g. lack of leadership/organisational mandate or support; ‘beliefs about consequences’ (N=9) e.g. concerns regarding safety. Intention was the most common facilitator, with eleven studies citing it.
Conclusions
Despite intentions to adopt sustainable practices in operating theatres, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff’s knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the Hospital and Trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise operating theatres.
... Medical garbage has substantially higher percentage of plastic content (20-25 wt. %) as compared with the municipal solid waste (Lee et al. 2002). The greatest impediment to the establishment of medical waste recycling systems has been the danger of infection transmission and incorrect medical waste classification (Aljabre 2002). ...
Plastic recycling reduces the wastage of potentially useful materials as well as the consumption of virgin materials, thereby lowering the energy consumption, air pollution by incineration, soil and water pollution by landfilling. Plastics used in the biomedical sector have played a significant role. Reducing the transmission of the virus while protecting the human life in particular the frontline workers. Enormous volumes of plastics in biomedical waste have been observed during the outbreak of the pandemic COVID-19. This has resulted from the extensive use of personal protective equipment such as masks, gloves, face shields, bottles, sanitizers, gowns, and other medical plastics which has created challenges to the existing waste management system in the developing countries. The current review focuses on the biomedical waste and its classification, disinfection, and recycling technology of different types of plastics waste generated in the sector and their corresponding approaches toward end-of-life option and value addition. This review provides a broader overview of the process to reduce the volume of plastics from biomedical waste directly entering the landfill while providing a knowledge step toward the conversion of “waste” to “wealth.” An average of 25% of the recyclable plastics are present in biomedical waste. All the processes discussed in this article accounts for cleaner techniques and a sustainable approach to the treatment of biomedical waste.Graphical abstract
... Finally, the massive number of phlebotomy tubes used can cause huge environmental impacts. A study by Lee et al. has shown that the phlebotomy tubes contribute up to 70% and 19% of plastic waste from all laboratories and hospitals, respectively [13]. Due to biosafety regulations, all the plastic waste from phlebotomy tubes cannot be recycled and must be incinerated, causing additional emission of greenhouse gases and pollution [14]. ...
Background and objectives:
Overutilization of phlebotomy tubes at healthcare facilities leads to iatrogenic anemia, patient dissatisfaction, and increase in operational costs. In this study, we analyzed the phlebotomy tube usage data at the Zhongshan Hospital, Fudan University, to show potential inefficiencies with phlebotomy tube usage.
Methods:
Data of 984,078 patients with 1,408,175 orders and 4,622,349 total phlebotomy tubes were collected during years 2018-2021. Data of different patient types were compared. Furthermore, we assessed the data from subspecialty and test levels to explore the factors influencing the increase in phlebotomy tube usage.
Results:
We observed an overall 8% increase in both the mean number of tubes used and blood loss per order over the past 4 years. The mean blood loss per day for intensive care unit (ICU) patients was 18.7 ml (maximum 121.6 ml), which was well under the 200 ml/day threshold. However, the maximum number of tubes used reached more than 30 tubes/day.
Conclusions:
The 8% increase of phlebotomy tubes over 4 years should alarm laboratory managements, as tests offered are expected to increase in the future. Importantly, the whole healthcare community needs to work together to solve this problem with more creative solutions.
... Since recycling primarily depends on the product's components, the recycling eligibility of medical products varies (Kane et al. 2018). According to Lee et al. (2002), it is estimated that 20-25 per cent of medical waste consists of recyclable materials. Nevertheless, as mentioned earlier, the existence of infectious waste impedes the potential for recycling, since the strict regulatory framework in most countries necessitates employing specific methods for disposal of contagious waste. ...
... In fact, only 10-25% of all HCWs are infectious [45,48]. However, to overcome this problem, HCW could be classified as nonclinical waste (unregulated HCW can also be defined as general waste) and clinical waste (special waste, regulated waste) [32,49]. Nonclinical waste is defined as any waste presenting no risk to human health or the environment. ...
b> Introduction: Healthcare activities are generally associated with the production of healthcare waste, a large part of which is assimilated to household waste (packaging, kitchen waste, green waste, etc.) and another category of waste which may have a risk to health and the environment given its nature and typology. This category of waste at risk includes waste at risk of infection such as stinging, sharp waste (needles, blade, scalpel, etc.), and waste at chemical risk. Poor management of hospital waste is a problem in most countries and especially in developing countries. We aimed to determine the health and environmental impacts of the poor management of healthcare waste. Methods: We carried out a systematic review of the French and English literature on the scientific research sites Medline/PubMed and Embase. This research was carried out over 3 months (April–June 2020). The search strategy was used by combining keywords and Boolean operators: Health, Health impact assessment, Hospitals, Medical waste, Waste disposal facilities, Environment, Environment/Epidemiology, Hospital waste, impact, workplace, Environment hazards, Healthcare works, Waste management. Results: It has been clear that the current management of healthcare waste is not capable of adequately preserving human health and environmental contamination from infection. The surveys analyzed showed that if incineration is properly treated, it would be an appropriate treatment method to deal with healthcare waste. However, exposure to pollutants produced by the incineration is still a public health problem. If incineration is seen as a practical solution for dealing with healthcare waste, low-temperature incinerators should be banned and replaced by modern incinerators equipped with air pollution control units. These problems are typical for any developing country which does not have the means to purchase incinerators which are more protective for the environment and equipped with the latest technologies. Conclusions: Thus, autoclaving and microwaves are considered better alternatives for treating healthcare waste. However, these methods are generally not adequate for the disposal of pathological, radioactive, laboratory, and chemotherapy wastes. Therefore, the specific management of healthcare waste is a major concern due to the potentially high risks for human health and the environment.
... Researchers have explored the potential of recycling medical plastic waste at least since the early 2000s, a decade before the European Commission launched its first action plan on the circular economy [24]. In 2002, Lee et al. analyzed the possibilities of recycling medical waste and highlighted the difficulties associated with the risk of infection [25]. ...
Hospitals generate huge amounts of nonwoven residues daily. This paper focused on studying the evolution of nonwoven waste generated in the Francesc de Borja Hospital, Spain, over the last few years and its relation to the COVID-19 pandemic. The main objective was to identify the most impacting pieces of nonwoven equipment in the hospital and to analyze possible solutions. The carbon footprint of the nonwoven equipment was studied through a life-cycle assessment. The results showed an apparent increase in the carbon footprint in the hospital from 2020. Additionally, due to the higher annual volume, the simple nonwoven gown used primarily for patients had a higher carbon footprint over a year than the more sophisticated surgical gowns. It can be concluded that developing a local circular economy strategy for medical equipment could be the solution to avoid the enormous waste generation and the carbon footprint of nonwoven production.
... The healthcare sector is responsible for roughly 4.6 percent of global greenhouse gas emissions as a result of resource-intensive facilities and, indirectly, the supply chain of medical products and procedures (Beloeil and Albaladejo, 2021;MacNeill et al., 2020). While there are several studies that have focused on global greenhouse gas emissions generated by the healthcare sector Lenzen et al., 2020;Rasheed et al., 2021) and waste management recommendations (Fletcher et al., 2021;Lee et al., 2002;Patrício Silva et al., 2020), few publications focus on the production and use phases of plastic (Johansen et al., 2022). ...
Plastic single-use devices (SUDs) are favoured by healthcare facilities, especially surgical departments, for their convenience, sterility, and single-use quality assurance. Medical facilities are responsible for generating large amounts of CO2 emissions due to resource-intensive processes and reliance on single-use plastic products, among other factors. Currently, there are knowledge gaps in literature about specific types and amounts of plastic products generated by hospitals, and more specifically, operating theatres. Existing relevant research focuses mostly on waste management solutions, negating the potential solutions further up the value chain. While considerations that focus on waste management and end-of-life are important, those that span the rest of the value chain, including the circular economy and the waste hierarchy, are inherently important. This study addresses this knowledge gap by quantifying these fractions and making recommendations to reduce them. Observations, polymer analysis, and surveys with medical staff were conducted at two hospitals in Denmark. Results suggest that the current design of medical products and packaging does not consider the end-of-life fate of the product, making current sorting and recycling options impossible. Recommendations from this study highlight external responsibilities such as those of producers and manufacturers to include consideration of the end-of-life fate of the product within the design phase. These are in addition to internal responsibilities such as the use and sorting of these fractions.
... It would require boiling water which could be an energy or cost-intensive process [55]. Limited healthcare clinical plastic product types have been identified for the base polymers present [56] (Table 2). Used clinical plastic products with low to moderate hazard levels, which rarely cause diseases and do not lead to lethal conditions, are suitable to recycle through a system configuration, shown in Figure 1. ...
Over 5.5 million tons of plastic waste are generated globally from the research sectors. A university laboratory, e.g., pathology, can generate 250 tons of clinical plastic waste annually. The UK National Health Service (NHS) generates 133 kilotons (kt) of clinical plastic waste annually. Healthcare facilities in the US generate 1.7 million tons of clinical plastic waste annually. In addition, 95% of the clinical plastics are single-use plastics derived from fossil resources, i.e., crude oils. These single-use clinical plastic wastes are incinerated, contributing to global warming, or go to the landfill, contributing to resource depletion. Plastic leakage is a major threat to the environment. This linear plastics economy model, take-make-dispose, must be replaced by a circular plastics economy, i.e., sort plastic wastes, wash, decontaminate, recover materials, blend with bio-based compounds as necessary and circulate recyclate plastics, for holistic systemic sustainability. While there are multi-faceted environmental drivers for a circular plastics economy, there are many uncertainties in the economic attributes, electricity price, labor cost and chemical cost being the primary ones influencing the cost of production of secondary or recyclate plastics, requiring government and policy support, such as a gate fee on plastic waste by the generators to the recyclers. An essential macroeconomic condition for techno-economically (or micro-economically) feasible plastic waste recycling is low oil and gas prices that influence the recyclate plastics and electricity prices. It is essential to de-fossilize the economy by decoupling renewable electricity generation from natural gas consumption and fossil-independent biopolymer productions displacing fossil-derived plastics to stimulate the circular economy. This study shows a comprehensive and robust technoeconomic analysis of mechanical recycling of clinical plastic wastes into secondary plastics recovery.
... Face masks make up a considerable part of the medical waste (MW), especially after the massive increase in use due to COVID-19 and mandatory face mask-wearing regulations. According to the findings of a recent study that included seven hospitals and medical centres in the state of Massachusetts, USA, along with three veterinary hospitals [6], plastic waste accounted for~30% of the total wastes produced by hospitals. Non-woven polyurethane, polypropylene, or polyacrylonitrile fabrics are used to produce face masks. ...
Many nations struggle with the collection, separation, and disposal of medical waste. However, extra caution is required to avoid the risk of injury, cross-contamination, and infection; thus, healthcare workers and individuals responsible for waste management must follow the mandatory safety procedures. In this review, a classification of the various types and categories of medical waste and its treatment methods are discussed. Due to the fact that medical waste can be contaminated and hazardous, it must be managed and processed using complex steps and procedures. In many countries, the primary medical/hospital waste treatment method is incineration, which is regarded as a highly polluting process that emits numerous pollutants that degrade air quality and pose a threat to human health and the environment. As case studies, medical waste treatment and disposal practices in Germany, China, USA, and Egypt were compared, and the legislations and laws enacted to regulate medical waste in each of these countries are reviewed and discussed.
... Results show that recycled polypropylene wrapping can be used as raw material for production of new medical devices [24]. A study conducted in hospitals in Massachusetts (USA) shows that IV bags and syringes have great potential for recycling [25]. Another study conducted at the Royal Sussex County Hospital in Brighton (UK) found that recycling hospital waste could save 30% of a hospital's annual budget. ...
The growing population in urban areas generates large volumes of hospital waste which
intensifies the problem of hospital waste management in developing countries. This study is designed to evaluate environmental impacts associated with hospital waste management scenarios using life cycle assessment (LCA) approach. Two scenarios were designed to describe the current practices: (scenario A) and an integrated approach (scenario B), which includes segregation and recycling of hospital waste. Data were collected from five public hospitals located in the district of Sheikhupura, Pakistan. The collected hospital waste was quantified and categorized on a daily basis for five consecutive months (October 2020 to February 2021). The functional unit was defined as one tonne of hospital waste. System boundaries for two scenarios include segregation, transportation, treatment and disposal of hospital waste. After defining functional unit and system boundaries, LCA was conducted using the IGES-GHG simulator. The scenarios were evaluated using common parameter, i.e., greenhouse gas (GHG) emissions. Scenario A and scenario B resulted in net GHG emissions of 1078.40 kg CO2-eq. per tonne of waste and 989.31 kg CO2-eq. per tonne of waste, respectively. Applying an integrated approach, it would be possible to mitigate GHG emissions of 37,756.44 kg CO2-eq. per tonne of waste annually and to recover some materials such as glass, paper, plastic and metals. Therefore, implementing an integrated approach for the management of hospital waste will progress the entire system towards sustainability. The findings of this study can be used for future research and policymaking.
Background
Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products.
Results
A total of 30 staff members responded to the survey. Overall, 90% of respondents were either satisfied/very satisfied (80%) or neutral (10%) when asked about their satisfaction with the reusable drapes, while 10% were unsatisfied/very unsatisfied; 87% of staff responded that reusable drapes were either as effective or more effective than disposable drapes. Reusable drapes showed very high levels of staff satisfaction in terms of durability (87%), fluid protection (70%) and provision of a sterile field (80%). There were no staff who did not support the ongoing use of reusable surgical drapes.
Conclusion
There is extremely high staff satisfaction with reusable surgical drapes.
In the advancements-driven environment, the developing setting of healthcare in information and communication technology (ICT) is representing a transformative change in nursing practice. Nurses, known as critical in attaining Sustainable Development Goals (SDGs), are poised to influence new technologies for patient care delivery, mainly in developing nations. There is need to incorporate electronic health records (EHR), mobile apps, big data analytics, and artificial intelligence (AI) in nursing care across various positions. The chapter focuses on the implementation of AI in hospital settings for better patient outcomes. The building blocks of smart hospitals and their challenges are also highlighted. It is necessary to train the workforce in tech-related operations from time-to-time in order to have seamless operations.
The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste.
A systematic search of several global academic databases was conducted in mid‐2022 (articles from 1992 to 2022) for peer‐reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room.
The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of “first do not harm”, ingrained in surgeons’ practices, in prioritising single‐use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels.
We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro‐sustainability behavioural change.
Microbiology laboratories are pivotal hubs for exploring the potential of microorganisms and addressing global challenges. Particularly, Environmental Microbiology facilities hold substantial influence in advancing knowledge and capabilities crucial for achieving the United Nations Sustainable Development Goals. This raises the imperative of integrating sustainable practices to mitigate the environmental impact of research activities and foster a culture of responsibility. Such an approach not only aligns with global sustainability objectives but also catalyses innovative, eco-conscious methodologies in scientific research aimed at tackling pressing environmental issues. Concerns regarding the environmental footprint of laboratory practices have stimulated innovative improvements within the scientific community, ranging from resource-efficient initiatives to the management of essential commodities like water and energy. This perspective discusses specific areas where microbiology laboratories can enhance their sustainability efforts, drawing on reports and case studies of pioneering groups. Additionally, it explores potential collaborators to support these endeavours and emphasises the pivotal role of early career researchers in driving this transition. By initiating discussions and sparking curiosity within the environmental microbial community, this commentary seeks to propel the microbial ecology field toward a greener future, starting from within the laboratory environment.
Polymers are applied extensively in the healthcare sector and enable a variety of different applications. In addition to packaging and personal protective equipment, a large number of medical devices are also coated with or consist of polymers. Today's medicine is therefore inconceivable without these materials. However, the huge challenge is to design these polymers more sustainable and to find new possibilities for the future of medicine with polymers. This study therefore highlights potential ways, in how polymers applied in the healthcare sector and in particular in hospitals can be utilized in a circular manner, but also indicates what risks and challenges this entails.
Objective
Climate change has been described as the ‘biggest global health threat of the 21st century’ and NHS England has set out its plans to develop a ‘net zero’ NHS by 2040. This is a target of completely negating the amount of greenhouse gases produced by healthcare in the United Kingdom, currently estimated at 4% of the UK total carbon emissions. We need to consider as a community of endourologists how we can make sustainable choices.
Methods
Recommendations for sustainable surgery in the United Kingdom have been considered and applied to the field of Endourology. There is a relatively little published evidence on this evolving area.
Results
Areas for making sustainable choices in Endourology can broadly be divided into ‘Prevention and Education’, ‘Pre-operative’, ‘Planning’, ‘Operative’ and ‘After Care’. While reducing waste in theatre is clearly important, there are many other decisions we can make with our patients to create a lower carbon journey.
Conclusion
Sustainability in Endourology strongly parallels GIRFT recommendations and the concept of realistic medicine. We should all make personal and professional choices to reduce our carbon footprint with the shared goal of Net zero in 2040.
Level of evidence
4
The COVID-19 pandemic has led to an enormous rise in biomedical waste and plastic trash production. The sudden increase in the production of waste vehicles carrying the same for disposal presented major challenges for the current waste disposal systems, particularly in developing countries. Due to the COVID-19 health emergency, the significance of appropriate waste management has become more evident. This review aims to showcase all aspects of biomedical waste, including its management, safe disposal approaches, the risks associated with improper waste management, and other hazards from hospitals, labs, and the environment. The focus has been laid on the possible role of laboratories in hospitals, research, and academic institutions directly and indirectly involved in handling biomedical items. It is pertinent to mention that policies relating to biomedical waste management must be renewed periodically for updates and to incorporate new research and system development points. In the present review, establishing collaboration among hospitals, laboratories, and research staff is vital for proper waste management in healthcare facilities. The review demonstrates the contemporary directions in biomedical waste treatment and safe disposal methods, especially incineration, autoclaving, chemical disinfection, and land disposal. Good laboratory practices and techniques for destroying needles, shredders, encapsulation, and inertization are also covered. The significance of biomedical waste management policies in promoting environmentally responsible and safe practices and amendments to these policies has been emphasized.
Introduction: The blood collection for laboratory tests has been frequently performed due to evidence-based medicine. We aimed to conduct a survey on phlebotomy among phlebotomists and patients and to reduce unnecessary blood loss by using small-volume blood collection tubes. Materials and Methods: A survey among phlebotomists and patients was conducted to gather their opinions. Phlebotomists received training on the importance of the preanalytical process. The blood volume required for laboratory tests was reduced by 33.3%-50.0% in children and adults, and 63.0%-84.0% in newborns. Following this intervention, we investigated its effects on the blood transfusion ratio in the neonatal and adult intensive care unit (NICU and ICU) and the amount of laboratory medical waste generated. Results: A majority of phlebotomists (91.8%) reported difficulties in drawing blood from newborns, pediatric, oncology, hematology, and geriatric patients. Additionally, 68.9% of phlebotomists and 57.1% of patients expressed an opinion for reduced blood volume. Despite an increase in the number of laboratory tests (28.4%) and samples (15.7%), we observed a 17.8% reduction in the amount of laboratory medical waste. Although the number of patients in NICU increased statistically significant, the increase in transfusion rates was not significant. Although the number of patients in ICU increased, transfusion rates decreased, but neither was found to be statistically significant. Discussion: Post-graduation, phlebotomists should be educated regularly about the preanalytical process. Based on the opinions of both phlebotomists and patients, using small-volume tubes in patients with difficult blood collection may increase their satisfaction. Generally, laboratory medical waste may be reduced.
Günümüzde sağlık kuruluşlarında tek kullanımlık malzemelerin yaygın olarak kullanılması sonucu atık miktarları belirgin bir şekilde artış göstermektedir. Sağlık kuruluşlarında üretilen atıkların çevresel ve ekonomik açıdan bir değeri bulunmaktadır. Hemşireler, sağlık sunumu sırasında oluşan geri dönüştürülebilir atıkların farkına vararak ve bu atıkları kaynağında ayırarak bu değerin şekillenmesine katkı sağlayabilirler. Bu derlemede sağlık kuruluşlarında geri dönüşümün faydaları, geri dönüştürülebilecek tıbbi malzemeler, başarılı uygulama örnekleri, geri dönüşüm uygulamalarında engeller ve çözüm önerileri, geri dönüşüm uygulamalarında hemşirenin sorumlulukları incelenmiştir. A green practice for nurses in health facilities: recycling Today, as a result of the widespread use of disposable materials in health institutions, the amount of waste increases significantly.The wastes produced in health institutions have an environmental and economic value.Nurses can contribute to the shaping of this value by recognizing the recyclable wastes generated during health care and separating these wastes at their source.In this review, the benefits of recycling in health institutions, recyclable medical materials, examples of successful applications, obstacles and solution suggestions in recycling applications, nurses' responsibilities in recycling applications are examined. Keywords: Environment, recycling, nurse, health facilities, green practice.
Background and Aim
Greenhouse gas emissions are the fundamental cause of global warming, with CO 2 being the most contributive. Carbon reduction has been widely advocated to mitigate the climate crisis. The endoscopy unit is the third highest waste‐generating department in a hospital. The awareness and acceptance of the practice of green endoscopy among healthcare workers is unclear.
Method
An online survey was conducted over a 5‐week period from July to August 2023 in the Asia‐Pacific region, which targeted endoscopists, nurses, and other healthcare professionals of the endoscopy unit. The primary outcome was the agreement to adopt green endoscopy. The secondary outcomes included views on sustainable practices, factors associated with increased acceptance of green endoscopy, the acceptance of different carbon reduction measures, and the perceived barriers to implementation.
Results
A total of 259 valid responses were received. Overall, 79.5% of participants agreed to incorporate green endoscopy into their practice. Nevertheless, existing green policies were only reported by 12.7% of respondents. The level of understanding of green endoscopy is the only significant factor associated with its acceptance (odds ratio 3.10, P < 0.007). Potential barriers to implementation include healthcare cost increment, infection risk, inadequate awareness, and lack of policy and industrial support.
Conclusion
Green endoscopy is well accepted among healthcare workers but not widely implemented. The level of understanding is highly associated with its acceptance, highlighting the importance of education. A reliable assessment tool is needed to quantify the environmental impact of endoscopy. Further studies are needed to ascertain its benefit and cost effectiveness.
The COVID-19 pandemic has increased the demand for life-saving devices known as ‘ventilators,’ which help critically ill patients breathe. Owing to the high global demand for ventilators and other medical equipment, many Indian nonmedical equipment companies have risen to meet this demand. This unexpected demand for ventilators during the COVID-19 pandemic, similar to that for other EOL electronic medical devices, has become a severe problem for the nation. Consequently, the healthcare industry must efficiently handle EOL ventilators, which can be outsourced to 3PRLPs. 3PRLPs play a vital role in a company’s reverse logistics activities. This study emphasises the 3PRLP selection process as a complex decision-making problem and the optimisation of order allocation to qualified 3PRLPs. As a result, this study proposes a two-phase hybrid decision-making problem. First phase combines the two multi-attribute decision-making methods to select 3PRLPs based on their assessed SPS and Second phase, the evaluated SPS was utilised as one of the objectives of a multi-objective linear programming model to allocate orders to the selected 3PRLPs. To solve the proposed model, both classical and modern approaches were used. The results show that the proposed framework can be successfully implemented in the current scenario of the healthcare industry.
Recently, the main polymers present in the health‐care waste (HCW) of a Brazilian university hospital were identified, revealing a composition of polypropylene (85%), high‐density polyethylene (6%), polystyrene (5%), and cellulose (4%). Recognizing the potential for these materials to generate energy through pyrolysis, this study aimed to assess the thermal degradation of the HCW polymers and their respective polymer mixture using thermogravimetric analysis. Thermalgravimetric analysis encompassed three heating rates (5, 10, and 20°C min⁻¹). The kinetic parameters of thermal degradation were estimated using the first‐order reaction model. Friedman differential isoconversional method, as well as Ozawa, Flynn–Wall–Ozawa, and Kissinger–Akahira–Sunose integral isoconversional methods, were applied to obtain the kinetic parameters, which can predict the thermal degradation kinetics of the polymers in thermal conversion process. Through statistical evaluation of the parameter estimation, it was demonstrated that the proposed methodology yielded fitted models for the experimental data on HCW. These models may be implemented in designing pyrolysis reactors that convert these polymers into energy, thereby mitigating environmental pollution.
Abstract
The objective of this paper is to minimize the total cost of vaccine storage and
distribution operations at centralized distribution centers (DCs) and at clinics so that
clinics are provided with vaccines in a timely fashion while under resource and
environment-protection constraints. A non-linear mathematical programming model is
developed to improve the efficiency of large-scale influenza vaccination programs. The
suggested model is tested and justified through computational experiments with real-life
data from a Clalit HMO influenza vaccination case study. The investments in green
(environment-protecting) activities recommended by the optimal plan are smaller than the
expected monetary benefits associated with their effects. A possible application of this
research is for optimizing vaccination plans for different subpopulations and various
HMOs. Our vaccine supply chain model includes the costs of disposal, recycling, and
utilizing clean technologies (i.e., low-pollution gas heating/cooling, electric transportation
cars, energy saving policies). It integrates the operational cost/benefit parameters of
vaccination programs with the costs/benefits of green activities.
Microplastics (MPs) are ubiquitous in the environment, in the human food chain, and have been recently detected in blood and lung tissues. To undertake a pilot analysis of MP contamination in human vein tissue samples with respect to their presence (if any), levels, and characteristics of any particles identified. This study analysed digested human saphenous vein tissue samples (n = 5) using μFTIR spectroscopy (size limitation of 5 μm) to detect and characterise any MPs present. In total, 20 MP particles consisting of five MP polymer types were identified within 4 of the 5 vein tissue samples with an unadjusted average of 29.28 ± 34.88 MP/g of tissue (expressed as 14.99 ± 17.18 MP/g after background subtraction adjustments). Of the MPs detected in vein samples, five polymer types were identified, of irregular shape (90%), with alkyd resin (45%), poly (vinyl propionate/acetate, PVAc (20%) and nylon-ethylene-vinyl acetate, nylon-EVA, tie layer (20%) the most abundant. While the MP levels within tissue samples were not significantly different than those identified within procedural blanks (which represent airborne contamination at time of sampling), they were comprised of different plastic polymer types. The blanks comprised n = 13 MP particles of four MP polymer types with the most abundant being polytetrafluoroethylene (PTFE), then polypropylene (PP), polyethylene terephthalate (PET) and polyfumaronitrile:styrene (FNS), with a mean ± SD of 10.4 ± 9.21, p = 0.293. This study reports the highest level of contamination control and reports unadjusted values alongside different contamination adjustment techniques. This is the first evidence of MP contamination of human vascular tissues. These results support the phenomenon of transport of MPs within human tissues, specifically blood vessels, and this characterisation of types and levels can now inform realistic conditions for laboratory exposure experiments, with the aim of determining vascular health impacts.
Introduction:
The use of disposable plastics and their subsequent environmental impacts are topics of increasing concern in modern society. Medical, including veterinary, sectors are major contributors to plastic waste production. While there is an existing body of literature on the use and reduction of disposable plastics in the human medical sector, few studies, if any, have specifically investigated the use of plastics within the veterinary field. The overall aim of this pilot study was to investigate Australian veterinarians regarding their attitudes toward the ways in which they use disposable plastic in their work and personal lives.
Materials and methods:
Seven veterinarians were interviewed, representing a range of demographics and professional backgrounds from multiple states. Thematic qualitative analysis was employed to organise the data into several major themes encompassing many smaller nodes.
Results:
The dataset revealed that most, if not all, veterinarians interviewed agree that disposable plastic is used in excess in veterinary medicine, but that veterinarians will never be able to avoid using plastic entirely. Participants supplied differing opinions with respect to the best strategies for reducing plastic waste production within the veterinary field, including recycling, replacing disposable items or improving education.
Discussion:
Despite different participants suggesting conflicting ideas, most, if not all, of the ideas presented have support in the scientific literature. This supports a hybrid approach involving refining recycling systems, reducing plastic consumption and improving education on plastic waste production. A hybrid top-down-bottom-up approach must include encouraging cooperation among stakeholders, both within and outside the veterinary sector, as this will be a major contributor to progress. In a broader context, this hybrid approach to inciting change at all levels of the veterinary sector will require engagement from many interdependent entities; as such, this study should act as a starting point for an ongoing process of cooperative change. Recommendations for future research include life cycle analyses of reusable versus disposable veterinary materials; exploring ways to expand sustainability education within and beyond the veterinary sector, and examining methods of improving technology and infrastructure.
Incineration sterilizes and detoxifies medical waste and converts it to innocuous ash, reducing its weight and volume by 90 to 95 percent. However, there is concern about pollutants emitted into the air during the incineration of medical waste, especially acid gases, heavy metals, and dioxins. There is also concern about potentially toxic substances that remain in the ash residues. These pollutants are derived from the waste feed material and generally change in form during the combustion process. The concern increases as hospitals use larger quantities of disposable plastics. In addition, existing incinerator stacks are often short and located close to other buildings.
In the management of medical wastes, a management plan should be established to ensure protection of public health and the environment. The plan should incorporate a cradle-to-grave approach to infectious medical wastes. This includes the adoption of standard operating procedures (SOPs) to address: the generation of wastes, segregation of wastes, containerization and storage of wastes, waste treatment, waste handling and transportation, waste disposal, and contingency planning. Current treatment techniques for medical waste are discussed and include: steam sterilization; incineration; thermal inactivation; gas/vapor sterilization; irradiation sterilization; chemical disinfection.
A new sorbent, `Diox-Blok', has been developed to prevent the formation of dioxins in waste incinerator flue gases. Fly ash normally serves as the dioxin `factory' for the adsorption and conversion of the organic precursors of dioxins. By preferentially adsorbing the pre-dioxin compounds before they can be adsorbed by the fly ash, `Diox-Blok' accomplishes two things: (a) the fly ash is `starved' of organic precursor reactants, and (b) the inert `Diox-Blok' prevents conversion of its adsorbed precursors to dioxins. `Diox-Blok' has been used for over four years in several 20 tonne/day U.K. regional medical waste incinerators Stack tests have consistently shown PCDD/F emissions at levels of 0.006 ng/dscm, toxic equivalents (TEQ), barely above the detection limit. Details of the process chemistry which are accountable for these results, are reviewed.
The terms medical wastes, hospital wastes, and infectious wastes are often used interchangeably. In this paper, the term 'medical wastes' refers to all types of wastes produced by a medical facility; 'hospital wastes' refers to all wastes produced by a hospital; and 'infectious wastes' refers to that portion of a medical or hospital waste that has the potential to transmit disease. Currently, most medical waste generators designate between 10 to 15% of it as infectious. This paper discusses infectious waste management and transportation, as well as Environmental Protection Agency regulations.
Common sense suggests that work is organized in accordance with plans that are created by designers who reflect on the work setting and manipulate representations of the work process in order to determine new and efficient organizational structures. Or, even if “outside” designers are not involved, the reorganization of work is normally attributed to the conscious reflection by members of the work group itself. A detailed examination of the response of a real-world group to a sudden and unexpected change in its informational environment shows that these common sense assumptions may be quite misleading.
While entering a harbor, a large ship suffered an engineering breakdown that disabled an important piece of navigational equipment. This paper considers the response of the ship's navigation team to the changed task demands imposed by the loss of this equipment. Following a rather chaotic search of the space of computational and social organizational alternatives, the team arrived at a new stable work configuration.
In retrospect, this solution appears to be just the sort of solution we would hope designers could produce However, while some aspects of the response appear to be the products of conscious reflection, others, particularly those concerning the division of cognitive labor, are shown to arise without reflection from adaptations by individuals to what appear to them as local task demands. It is argued that while the participants may have represented and thus learned the solution after it came into being, the solution was clearly discovered by the organization itself before it was discovered by any of the participants.
The report is the most recent in a series of reports released by the EPA to characterize Municipal Solid Waste (MSW) in the United States. It characterizes the national waste stream based on data through 1988 and includes: information on MSW generation from 1960 to 1988; recovery for recycling, composting, and combustion from 1960 to 1988; characterizing MSW by volume as well as by weight; projections for MSW generation to the year 2010; projections for MSW combustion through 2000; and projections (presented as a range) for recovery and recycling through 1995.
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The internet to track recycling options
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