Case study: WASTE Reduction

Module: SUSTAINABLE HEALTHCARE
Chapter: Climate Solutions

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The Problem

Medicine tends to be a very wasteful practice and there are many areas for improvement. For example, in the ICU of a major BC hospital, all medical supplies in a patient’s room are discarded when a patient is discharged. This is an important piece of infection control to prevent any materials that may have been inoculated with microbes from spreading to another patient. However, there are many gaps and inefficiencies in the process that leads to unnecessary waste.

The project

Intensive Care Unit, Tertiary Care Center, British Columbia

Two students, Iman Baharmand and Alec Yu, were involved in a project to limit the amount of waste produced in the ICU unit. An initial audit was conducted and the cost of throwing out unused materials was calculated to be about $140 – $170 per patient. [5]

Some potential solutions for waste reduction were identified:

  • Grab and go carts for items not stocked in rooms

  • Nursing server carts kept outside of room

  • Optimized ordering system (also reduced amount of expired medical equipment)

  • Price tags added to shelves to communicate expenses of items used

  • Reusing items after appropriate decontamination

  • Recycling of non-medical waste

To help guide the program, a national Canadian survey [5] was conducted on critical care units to identify best practices and barriers.

The Initiative

Waste exhibit. Image courtesy of Iman Baharmand and Alec Yu.

Waste exhibit. Image courtesy of Iman Baharmand and Alec Yu.

The following waste reduction initiative was designed and implemented:

  • An exhibit showing discarded unused equipment from 5 beds was presented to educate nursing staff on the amount of waste being produced (image).

  • A new nursing stocking list was created in collaboration with staff to remove excess and typically unused items.

  • Small baskets of equipment were assembled for patients with short lengths of stay in lieu of larger nursing carts.

 
Amount of unused waste generated before (right) and after (left) implementation. Image courtesy Iman Baharmand and Alec Yu.

Amount of unused waste generated before (right) and after (left) implementation. Image courtesy Iman Baharmand and Alec Yu.

The Result

After implementing the initiative, unused equipment waste declined by 80%. This was projected to result in a decrease of 16,190 kg of carbon dioxide equivalents and annual savings of $140,000 CAD.

Benefits of waste reduction. [3]

 

Reduced environmental footprint.

  • Reducing waste entering the landfill will subsequently reduce the carbon emissions associated with production, distribution and disposal of materials.

Increased conservation of resources.

  • A decrease in waste, especially of unused materials, will limit inefficiencies in the current consumption of goods, whereby more resources are being taken from the environment than are actually being used.

Reduced costs. [4]

  • Decreased disposal of unused or expired items will lead to a decrease in spending by the hospital to acquire items to replace the ones wasted.

  • Mitigation strategies could also focus on the proper separation of biohazardous waste, which is an expensive disposal process.

Improved health.

  • Improper disposal of pharmaceutical products can lead to leakage into the environment.

  • Incineration of medical waste increases air pollution, contributing to respiratory diseases.

  • Burns and other work related injuries often occur during the disposal of the waste.

Considerations for implementation. [2]

The goal of a waste initiative is to ensure the compliance of staff and patients/visitors so that a program can truly make an impact in decreasing healthcare’s footprint.

 

Focus on patient safety.

  • Infection control is a central part of waste disposal and therefore must be taken into account for successful approval of an initiative.

Examine the logistics of a waste program.

  • It is important to think about factors that contribute to ease of use including waste bin sizes, proper signage and consistency across departments.

Provide staff education and incentives.

Audit waste to track progress.

[1] Baharmand, I., Duan, N., & Yu, A. (2020). First, do no planetary harm: Perspectives on medical waste and sustainability initiatives. UBC Medical Journal, 12(1), 30–32. https://med-fom-ubcmj.sites.olt.ubc.ca/files/2020/09/UBCMJ-Volume-12-Issue-1.pdf 

[2] Church, R., Briggs, D., & Tran, V. (2019). Climate emergency: Towards a greener emergency department. Emergency Medicine Australasia, 31(2), 274–275. https://doi.org/10.1111/1742-6723.13269

[3] The Canadian Coalition for Green Health Care. (n.d.). Waste. Retrieved May 22, 2020, from https://greenhealthcare.ca/waste/ 

[4] World Health Organization. (2018, February 8). Health-care waste. https://www.who.int/en/news-room/fact-sheets/detail/health-care-waste 

[5] Yu, A., & Baharmand, I. (2021). Environmental Sustainability in Canadian Critical Care: A Nationwide Survey Study on Medical Waste Management. Healthcare Quarterly, 23(4), 39–45. https://doi.org/10.12927/hcq.2020.26394