Environmental waste in health care

In the linked analysis article (doi:10.1136/bmj.b609), Hutchins and White describe an audit of anaesthetic waste collected from six theatres in one teaching hospital in the United Kingdom and identify potential improvements in the management of such waste.1 Around 540 kg of solid anaesthetic waste was produced (about 2300 kg per theatre per year), 40% of which was potentially recyclable paper, card, plastic, and glass. Analysis of five sharps bins found that only 4% by weight was true sharps waste (needles and broken glass)—57% was glass and 39% was “other” (packaging, plastic, metal, and fluid).

Last year’s World Health Assembly adopted a powerful resolution on climate change, which not only warned of the stark consequences for human health but also identified how the health sector should respond to the profound changes taking place in the global ecosystem.2 The direct contribution of the health sector to environmental degradation is however less well analysed and debated. It is clear that the scale of carbon reduction needed to limit the effects of global warming cannot be achieved without the health sector playing its part.

Analysis of the carbon footprint of the NHS in England gave surprising results.3 About 18% of the NHS carbon footprint came from staff and patient travel, 22% from energy usage, and 59% from procurement, including equipment and pharmaceuticals. This is unlikely to be an atypical finding, and in countries such as the Netherlands and Denmark, with a less car based transport system, the proportion attributable to procurement may be higher.

To tackle the problem, medical industries will need to review their processes and supply chains and adapt their purchasing approaches to make carbon reduction a priority. In some areas of health care, such as pharmaceuticals, the avoidance of unnecessary prescribing or treatment will help. But in other areas, including where single use devices are common, reducing, reusing, reprocessing, and recycling waste will cause intense debate.

The World Health Organization estimates that 20% of the total waste arising from healthcare activities is potentially hazardous.4 Concerns about transmission of agents such as the prion responsible for variant Creutzfeldt-Jakob disease and viruses that can spread via body fluids have driven much of the recent growth in single use equipment and the consequent increase in waste classified as potentially hazardous. However, evidence shows that items intended for single use are often reused without sterilisation.4

The WHO reports that worldwide about 16 million hepatitis B infections, 4 million hepatitis C infections, and 160 000 HIV infections occur annually from improper reuse of syringe needles.4 Concern about injecting practices has led some countries to advocate a shift back to reusable glass syringes. From the perspective of carbon reduction, the importance of tackling the volume of clinical waste is reinforced by the estimated high fossil carbon content of clinical waste compared with general municipal waste.5

The importance of reducing healthcare waste is heightened by the steadily reducing landfill capacity in many countries and the sometimes vociferous opposition to the construction of incineration plants. Healthcare systems need to embrace a holistic approach to minimising waste but also encourage commitment and innovation among healthcare professionals in individual specialties. Hutchins and White’s audit of waste is an example of how healthcare professionals can take into account the environmental consequences of their work and minimise the amount of clinical waste while recognising that patient safety is paramount.5 Their approach is valuable and would make a substantial contribution if it became the norm. To be fully effective it must however be linked to rigorous procurement practices that have environmental concerns at their heart. If they operate in an organised manner, clinicians are well placed to become environmentally discerning customers and demand clinical supplies that are much less wasteful.

Healthcare professionals are no different from other members of society, and many are making the necessary changes in their homes to reduce their ecological footprint. They should be encouraged to bring the same concerns into play in their professional lives. Thomas Berry, the American theologian, has said that you cannot have well humans on a sick planet.6 The goals of healing people and healing the planet will increasingly need to go hand in hand.