Medical Device Waste: Who is Responsible?

What can I responsibly do with it?

Preamble: Australia is part of the worldwide healthcare community, with medical devices providing a platform for healthcare delivery. The medical device community faces challenges not only in the environmentally responsible production of medical devices, but also in the lifecycle of those devices, including disposal of medical device waste. Organisations such as the Healthcare Plastics Recycling Council www.hprc.org  in the USA, the EU, governments and private healthcare consumers have recognised that medical waste is a significant challenge, which is the first step towards a solution.  The majority of effort is currently being expended in resource recovery, recycling or downcycling of materials currently used.

The scope of the problem is broad, due to the multiple materials used in device manufacture, as well as the fact that medical device waste is a complex subset of a larger industrial waste problem.

There is little evidence that widespread progress is being made in materials research that would be beneficial for reducing medical device waste, beyond Post Consumer Recycled (PCR) and Post industrial Recycled (PIR) packaging. However, some medical device companies, such as those in the field of dialysis have implemented some encouraging waste management initiatives.

Baxter has chosen the product stewardship route for the recycling of its PVC products, which means that they take responsibility for the end of life of the product by collecting and recycling the PVC into other products such as playground equipment and garden hoses.

Fresenius Medical Care Australia have undertaken several pilot projects for the recycling of the waste produced by their locally manufactured plastic products which are PVC free (https://www.greendialysis.org/healthcare-professionals-and-health-authorities/waste)

These examples are significant, considering that one dialysis patient may consume 5 to 7 bags per day, every day.   

The incorporation of waste disposal into product design represents a significant opportunity for product development and at a minimum, is likely to assist in material separation at the disposal end, as well as offering a commercial advantage to pioneers in the field.

The purpose of this document is to highlight what practices of medical waste disposal are currently in use in Australia, to assist members of the MTAA and their customers in the responsible disposal of medical device product waste.

There are four main types of medical waste. They are:

  1. General Medical Waste
  2. Hazardous Medical Waste
  3. Infectious/Clinical Medical Waste
  4. Radioactive Medical Waste

1. General Medical Waste

  • General Medical Waste includes, but is not limited to:
  • Electronics (E-waste)
  • Plastic
  • Sterile packaging
  • Blue polyethylene wrap (Kimgard)
  • PVC
  • Unused plastic components of procedure packs
  • Used and contaminated single-use items of varying materials
  • Obsolete or broken metal devices including surgical instruments, metal trolleys, metallic transport equipment, e.g., wheel chairs, beds
  • Food waste
  • Paper

 

Electronics/E-Waste

Electronic waste includes everything from TVs, computers and mobile phones to batteries, printer cartridges and kitchen appliances. E-waste can be recycled to extract non-renewable resources such as plastic and precious metals including gold, silver, platinum, nickel, zinc, aluminium and copper.  Due to the National Television and Computer Recycling Scheme, there are many e-waste recycling options available. There are four organisations that recycle computers and computer accessories under the scheme:

Other E-Waste recycling options include:

 

Plastic

Research has found that only 15% of medical waste is hazardous even though up to 90% of the waste is incinerated, and the majority of the rubbish and waste that can be recycled in hospitals were plastic materials.

 

Sterile Packaging

Uncontaminated sterile packaging can be disposed of as non-hazardous waste; however the majority currently goes to landfill. Sterile packaging can be made into Process Engineered Fuel which is used to substitute for fossil fuels in cement manufacture. However, this is a“least worst” option as while it does reduce the demand for fossil fuels, its use as a fuel still contributes to global warming.

There are other technologies in development such as chemical recycling of plastics into fuels and plastic feedstocks (www.licella.com.au, www.nexusfuels.com) but not yet available in Australia.

Process Engineered Fuel: Cleanaway ResourceCo

 

Blue polyethylene wrap

Blue polyethylene wrap (Kimgard/Halyard) sterilisation wrap One of the current barriers to economically viable plastics recycling is the uniformity of the waste, and the cost of recycling to new plastic feedstock vs the lower cost of newly manufactured plastic feedstock.

Blue wrap can be recycled/downcycled to plastic pellets, but the process of removing the sterilisation activation tape, which is required to indicate that a sterilisation cycle has been completed –reduces the cost effectiveness of recycling. Some healthcare facilities remove the tape and compress the uniform waste into bales to make it more cost effective for recycling.

 

Unused plastic components

Unused plastic components (kidney dishes, hollow ware etc) of procedure packs Unused and uncontaminated products can be donated for use in veterinary clinics. Selective donation for foreign aid is possible for technologically appropriate products, though the waste disposal problem is transferred as well.

Alternatively, like products can be stacked for increased density to make transportation and recycling more efficient, and sent for recycling. 

Foreign Aid: Save our Supplies

Rotary Medishare 

Recycler: Cleanaway Daniels, SUEZ

 

PVC

Global Recycling states that Australia generates 15 tonnes of PVC medical waste per annum. PVC waste comes in the form of IV bags, oxygen tubing and face masks and represents 5-10% of the total waste produced annually in the healthcare sector. Vinyl Council of Australia estimates this total at 26,000 tonnes of PVC per annum. Only 25,000 tonnes is recycled locally and the rest is incinerated or exported overseas for further reprocessing.

Baxter has been a pioneer in the product stewardship of PVC, facilitating the collection and recycling of its PVC bags for fluids.

 

Metal devices including surgical instruments and stainless steel trolleys

These can be accumulated and sent to metal recyclers because recycled metal has sufficient value to warrant doing so. 

 

EPS  (Expanded Polystyrene)

EPS is plastic material which consists of small hollow spherical balls and is typically used in packaging. EPS is a growing concern for many businesses as the volume of EPS waste increases each year. Reducing EPS to landfill is now a priority concern for local councils and governments – as the Australian Packaging Covenant mandates to remove packaging waste from landfill by 2025. EPS is up to 98% air, and as little as 2% plastic. As a result, it is quite difficult to transport and recycle efficiently and economically. However, EPS is uniquely recyclable and can be fully reprocessed, which diverts waste from landfill and helps reduce demand on petroleum from which polystyrene is derived.  Expanded Polystyrene Australia (EPSA) has established a National Collection Network with recycling centres located in Melbourne, Sydney, Brisbane, Adelaide, Perth and Canberra.  Produce boxes are accepted free of charge.

Although lightweight, bulky EPS waste takes up significant space in a bin or skip – meaning that true disposal costs are often hidden in a company’s general waste removal costs.


2. Hazardous Medical Waste

Hazardous medical waste consists of sharps waste, mercury, lead paint and solvents. Most medical waste cannot be disposed of in a landfill due to the high level of contaminants in the rubbish. Because of this, they must be disposed of by an incinerator that has been licensed by the state environmental regulator. It was initially believed that burning medical waste destroyed the known pathogens however new research suggests that contaminants in the form of microscopic particulates are exposed via the incineration process.

Other: Safety equipment, medicine blister packs and masks can also be recycled via Terracycle Zero Waste Box.


3. Infectious/Clinical Waste

Clinical Waste is material which has the potential to cause infection or disease. Infectious clinical waste includes surgical waste, bandages, human, tissue or body parts, bodily fluids and swabs. As a general principle, no waste that is classified as Infectious/Clinical Waste is recycled.  Transport and disposal of it is regulated and it is ultimately incinerated. However, there are some new processes which sterilise and shred some clinical waste allowing it to go to landfill rather than being incinerated. SUEZ offers such as service for clinical waste including disposable metal and plastic instruments.


4. Radioactive waste

Radioactive waste includes radiotherapy machines, radium in tubes and needles. This is regulated by federal and state agencies and disposed of accordingly.

For further information or assistance with device waste, recycling, downcycling, upcycling and/or resource recovery, please contact Gordon Stenning at gstenning@nstenning.com.au.