We need to tackle the medical waste mountain

Mounting levels of medical waste were a concern before coronavirus added piles of personal protective equipment to the problem. Now scientists are hurrying to find a solution to keep patients and the planet safe

Even before anyone had even heard of coronavirus, the issue of medical waste was being recognised as an increasingly urgent problem with global consequences.

To highlight the extent of the problem we need only look at the city of Wuhan, which before the disease was discovered there was generating between 40 and 50 tonnes of medical waste a day; three months later, on March 1, that figure had spiked to 247 tonnes a day.

Personal protective equipment (PPE) would have, understandably, made up for a large proportion of the increase. The World Health Organization (WHO) estimated at the time that PPE supplies would need to increase by 40 per cent monthly to protect frontline workers.

Although increased PPE demand might have significantly added to the amount of single-use plastic discarded daily, its usage was already sky high in medical settings because for hospitals and their surgeons, plastic offers the chance to work with tools that are cheap, durable and, most importantly, sterile.

Indonesia bearing the brunt of medical waste

The environmental and human cost of this wastage was demonstrated dramatically in Indonesia, a country which had been generating unprecedented amounts of its own medical waste as it struggled to get to grips with the highest death toll from COVID-19 in Southeast Asia.

Combine this with the fact that Indonesia’s landfills are the final resting place for a significant amount of Europe’s medical waste and you have a recipe for the disaster that occurred at Cipeucang landfill, on the outskirts of Jakarta. In May, the facility suffered a major wall breach and sent 100 tonnes of waste landsliding into the nearby Cisadane River, covering the river flow and putting the lives of riverside communities at risk.

It’s unlikely to be a coincidence that the event happened after Indonesia’s government revealed that 1,480 tonnes of COVID-19 medical waste was produced in the country between March and June.

So how do we square environmental responsibility with the public duty to keep high-risk hospital personnel safe while they test and treat patients for COVID-19 and other pre-existing life-threatening conditions?

The search for alternatives

There has been a lot of attention around a process called pyrolysis, or chemical recycling at high temperatures, after a research group from the University of Petroleum and Energy Studies in India suggested it could be used to degrade polypropylene, a main ingredient in N95 protective respirators, surgical masks and single-use gowns.

However, this is now being seen as a false dawn as many experts agree that we can’t chemically recycle our way out of the problem.

One of those experts is Professor Judith Enck, president of Beyond Plastics, who explains: “Chemical recycling is not a viable option. It doesn’t have a proven track record, can rarely exist without massive public subsidies and doesn’t scale up. Instead, a much more reliable and economical approach is to look for innovative alternatives to single-use plastics in medical settings, finding reusable alternatives to N95 respirators and other forms of reusable PPE.”

We need innovative alternatives to single-use plastics, and reusable alternatives to N95 respirators and other forms of reusable PPE

An alternative could be elastomeric half-face respirators (EHFRs), which are commonly used in manufacturing and construction. A 2020 study from Baylor College of Medicine in Houston found that EHFRs rivalled N95 respirators in performance and fit testing and, most significantly, can be safely reused by hospital staff.

“I think the reason we haven’t seen elastomeric respirators often used in healthcare, prior to COVID-19, was because the issue had never been pressed,” says Dr Stella Hines, a pulmonologist at the University of Maryland School of Medicine, who has led a study looking at reusable PPE. “EHFRs are clearly effective, they protect the healthcare worker and validated cleaning and disinfection protocols exist that can be modified to suit the needs of the healthcare setting.”

Cleaning up the waste streams

There is also increasing awareness that while we continue to find ways to reuse infectious waste, we also need to address the management of the non-hazardous material that is generated by healthcare activity.

According to WHO, these benign products make up 85 per cent of all medical waste and include items like the ubiquitous surgical blue wrap, a sheet of polypropylene that covers sterilised tools before surgeries. Many hospitals are already experimenting with replacing the wrap with reusable sterilisation containers.

So could the answer to slowing the growth of the medical waste mountain be similar to the measures adopted to deal with domestic waste, whereby households were asked to audit and realign their habits on reuse and recycling?

Sonia Roschnik, international climate policy director at Health Care Without Harm, believes it could be. She says: “Just as it’s now incumbent on the individual to cut back on single-use plastics, recycle and reduce their environmental footprint, so it’s incumbent on hospitals and clinicians to try and do the same. I think the healthcare sector can and needs to improve its segregation and hence its waste management for reduced environmental impact.”

Roschnik, who is also the former director of the NHS Sustainable Development Unit, highlights some successful schemes that are already up and running, including one operating at the Queen Victoria Hospital in East Grinstead, which brought in a new waste scheme and immediately saw a reduction in clinical waste of between 10 and 15 per cent compared to the previous whole-year figures.

With schemes like this being introduced, it’s possible the pandemic can catalyse thinking on medical waste so environmental and medical ethics don’t have to clash, and doctors don’t have to face the stark choice between patient and planet.