Healthcare waste management: a case study from the National Health Service in Cornwall, United Kingdom

This paper looks at steps taken towards the development of a 10-year strategy for the management of healthcare waste from the National Health Service (NHS) in Cornwall, United Kingdom. The major issues and challenges that affect the management of waste by the NHS, including its organisational structure and collection infrastructure, are outlined. The waste flows of the main acute medical site are detailed, using waste audits of domestic and clinical bags, redundant equipment, bulky waste, and special waste. Some of the common barriers to change, such as staff habits and public perceptions, are also identified. Recommendations are made with respect to improvements in the overall organisational infrastructure and increased localised control. The recommendations also centre around the formation of strategic partnerships, within the site, between sites and at the broader level between the NHS and its surrounding community. An important challenge to be overcome is the need to progress from the concept of "waste management", to one of sustainable decision making regarding resource use, including methods of waste minimisation at the source and recycling. Staff training and awareness underpin several of the short and medium/long term solutions suggested to reduce the waste at the source and recover value from that produced. These measures could potentially reduce disposal quantities by as much as 20-30% (wt.) and costs by around 25-35%.     

Utilizing a 'systems' approach to improve the management of waste from healthcare facilities: best practice case studies from England and Wales.

Changes in environmental legislation and standards governing healthcare waste, such as the Hazardous Waste Regulations are expected to have a significant impact on healthcare waste quantities and costs in England and Wales. This paper presents findings from two award winning case study organizations, the Cardiff and Vale NHS Trust and the Cornwall NHS Trust on 'systems' they have employed for minimizing waste. The results suggest the need for the development and implementation of a holistic range of systems in order to develop best practice, including waste minimization strategies, key performance indicators, and staff training and awareness. The implications for the sharing of best practice from the two case studies are also discussed.     

Realising resource efficiency in the management of healthcare waste from the Cornwall National Health Service (NHS) in the UK

The quantities of waste generated by the healthcare sector in the United Kingdom (UK) have been shown to be amongst the highest in Europe. Based on a case study undertaken within the Cornwall NHS (National Health Service) in the UK, this paper reports on the results of waste minimisation trials. The schemes were able to achieve significant waste reductions in both clinical and domestic waste quantities. Indeed, a reduction in domestic bag waste in the range of 1.6-33.4%, with an average of 14.8% was realised. For clinical waste, the reduction ranged from 1.8% to 38.3%, at an average of 15.7%, with net cost benefits of nearly US$ 25,000 over the period of 1-3 years. The outcomes suggest that significant resource and financial efficiencies can be attained, but due to the many factors involved, there is a need to focus both on containment and logistics, as well as social factors for success.     

Solid waste recycling within higher education in developing countries: a case study of the University of Lagos

To create a truly circular economy requires a shift from the traditional view of waste disposal to one of resource management. This is particularly important in developing countries, where municipal waste generation is increasing, and efficient recovery of economic value from waste is rarely achieved. Conducted in the University of Lagos (UoL), Nigeria, this study investigated the efficiency of a recycling scheme with the goal of making recommendations to improve the process. UoL’s recycling policy centers around source segregation of waste into color-coded bins. Waste audit was carried out using the output method and interviews were conducted with staff from the waste management team to understand practices on campus. Substantial contamination of colored bins with non-target material was observed. Organics (30%), mixed plastics (28%) and paper (24%) were the most abundant materials, hence have the greatest potential for recovery, and income generation, if segregation rates could be improved. Despite its recycling policy and infrastructure, 99% of UoL waste was going to landfill. Poor policy implementation results in low recovery rates. Targeted waste reduction and increased material recovery would enhance efficiency. Improved awareness of recycling benefits, in addition to policy enforcement, could serve as tools to increase stakeholder participation in recycling.

     

Planning for integrated solid waste management at the industrial park level: a case of Tianjin, China

Industrial parks play a significant role in the production and use of goods and services. The proper management of solid waste is a major challenge for industrial parks due to the large quantity of wastes and the variability of waste characteristics from these types of developments. Therefore, integrated solid waste management has become very crucial to the industrial park managers. Such an approach requires industrial park managers to assess the overall use of resources, and to seek waste reduction, reuse and recycling opportunities both at the individual company level and among different tenant companies. The adoption of this method can bring both economic and environmental benefits. This paper introduces the planning efforts of a real case in China. It first presents the basic information on Tianjin Economic Development Area (TEDA), and then introduces its current practices on solid waste management. The main focus of this paper is to describe how to plan an integrated solid waste management system at TEDA. Benefits and challenges are all identified and analyzed. The experiences and methods from this case study should be applied in other industrial parks so as to improve the overall eco-efficiency of the whole industrial park.     

Recovery and recycling practices in municipal solid waste management in Lagos, Nigeria

The population of Lagos, the largest city in Nigeria, increased seven times from 1950 to 1980 with a current population of over 10 million inhabitants. The majority of the city's residents are poor. The residents make a heavy demand on resources and, at the same time, generate large quantities of solid waste. Approximately 4 million tonnes of municipal solid waste (MSW) is generated annually in the city, including approximately 0.5 million of untreated industrial waste. This is approximately 1.1 kg/cap/day. Efforts by the various waste management agencies set up by the state government to keep its streets and neighborhoods clean have achieved only minimal success. This is because more than half of these wastes are left uncollected from the streets and the various locations due to the inadequacy and inefficiency of the waste management system. Whilst the benefits of proper solid waste management (SWM), such as increased revenues for municipal bodies, higher productivity rate, improved sanitation standards and better health conditions, cannot be overemphasized, it is important that there is a reduction in the quantity of recoverable materials in residential and commercial waste streams to minimize the problem of MSW disposal. This paper examines the status of recovery and recycling in current waste management practice in Lagos, Nigeria. Existing recovery and recycling patterns, recovery and recycling technologies, approaches to materials recycling, and the types of materials recovered from MSW are reviewed. Based on these, strategies for improving recovery and recycling practices in the management of MSW in Lagos, Nigeria are suggested.     

Solid waste collection and recycling in Nibong Tebal, Penang, Malaysia: a case study.

The implementation of a suitable solid waste management programme with appropriate methods of recycling as an inherent element is vital to the alleviation of the problems associated with solid waste generation, handling and disposal, environmental conservation, public hygiene, etc. The present work is a case study on solid waste collection and recycling practices in Nibong Tebal town, Penang, Malaysia. The amount and types of domestic waste generated, household participation in recycling, identification of existing problems related to the implementation of the recycling programme, etc. formed the basis of this study. Surveys (interviews/questionnaires) and on-site observations were conducted to gather information on the solid waste collection and recycling practice of the residents. A focus group of 60 individuals was selected and their response to a questionnaire, prepared according to a Likert scale, was obtained and analysed. The majority of the respondents expressed concerns about recycling and wanted more to be done in this regard. Illegal collection, aesthetically displeasing sites and a lack of public awareness were problems of major concern. Issues related to inadequate funding and manpower as well as end market are also addressed and suggestions made.     

Assessing recycling versus incineration of key materials in municipal waste: The importance of efficient energy recovery and transport distances

Recycling of materials from municipal solid waste is commonly considered to be superior to any other waste treatment alternative. For the material fractions with a significant energy content this might not be the case if the treatment alternative is a waste-to-energy plant with high energy recovery rates. The environmental impacts from recycling and from incineration of six material fractions in household waste have been compared through life cycle assessment assuming high-performance technologies for material recycling as well as for waste incineration. The results showed that there are environmental benefits when recycling paper, glass, steel and aluminium instead of incinerating it. For cardboard and plastic the results were more unclear, depending on the level of energy recovery at the incineration plant, the system boundaries chosen and which impact category was in focus. Further, the environmental impact potentials from collection, pre-treatment and transport was compared to the environmental benefit from recycling and this showed that with the right means of transport, recyclables can in most cases be transported long distances. However, the results also showed that recycling of some of the material fractions can only contribute marginally in improving the overall waste management system taking into consideration their limited content in average Danish household waste.     

A review of waste prevention through 3R under the concept of circular economy in China

The large waste generation has become one of the worldwide environmental problems. Circular economy has been seen as a way to tackle its urgent problems of environmental degradation and source scarcity. In recent years, under the concepts of circular economy, waste prevention through “Reduce, Reuse and Recycle” (3R) rules have attracted a broad concern in China. China has made some great achievements on waste management, and at the same time is facing many challenges. It is very necessary to share the management experiences and practices with the scholars and managers in other countries. This review covered the current situation and progress of circular economy development from the perspective of the legal regime and project practices, and the recycling practices of typical waste. The typical household wastes, including municipal solid wastes (MSW), e-waste, and end of life vehicles (ELV), were studied as the typical cases. Based on an examination of the statistical results, we also identified the potential problems and challenges for waste prevention through 3R in China. Finally, we provided some effective measures to further improve the waste management and recycling in China.     

Integrated solid waste management based on the 3R approach

Integrated solid waste management (ISWM) based on the 3R approach (reduce, reuse, and recycle) is aimed at optimizing the management of solid waste from all the waste-generating sectors (municipal, construction and demolition, industrial, urban agriculture, and healthcare facilities) and involving all the stakeholders (waste generators, service providers, regulators, government, and community/neighborhoods). This article discusses the concept of solid waste management (SWM). Initially, SWM was aimed at reducing the risks to public health, and later the environmental aspect also became an important focus of SWM. Recently, another dimension is becoming a critical factor for SWM, i.e., resource conservation and resource recovery. Hence, the 3R approach is becoming a guiding factor for SWM. On the one hand, 3R helps to minimize the amount of waste from generation to disposal, thus managing the waste more effectively and minimizing the public health and environmental risks associated with it. On the other hand, resource recovery is maximized at all stages of SWM. Lately, the new concept of ISWM has been introduced to streamline all the stages of waste management, i.e., source separation, collection and transportation, transfer stations and material recovery, treatment and resource recovery, and final disposal. It was originally targeted at municipal solid waste management (MSWM), but now the United Nations Environment Programme (UNEP) is promoting this concept to cover all waste generating sectors to optimize the level of material and resource recovery for recycling as well as to improve the efficiency of waste management services. The ISWM concept is being transformed into ISWM systems to replace conventional SWM systems. This article further discusses the implementation process for ISWM. The process includes a baseline study on the characterization and quantification of waste for all waste generating sectors within a city, assessment of current waste management systems and practices, target setting for ISWM, identification of issues of concern and suggestions from stakeholders, development of a draft ISWM plan, preparation of an implementation strategy, and establishment of a monitoring and feedback system. UNEP is assisting member countries and their cities to develop an ISWM plan covering all the waste generating sectors within a specific geographical or administrative area such as a city or municipality. This umbrella approach is useful to generate sufficient volumes of recycling materials required to make recycling industries feasible. This is also helpful for efficient reallocation of resources for SWM such as collection vehicles, transfer stations, treatment plants, and disposal sites. UNEP is assisting cities to develop and implement ISWM based on the 3R approach. These experiences could be useful for other countries to develop and implement ISWM to achieve improved public health, better environmental protection, and resource conservation and resource recovery.     

Healthcare waste management practices and risk perceptions: Findings from hospitals in the Algarve region,Portugal

The management of healthcare wastes is receiving greater attention because of the risks to both human health and the environment caused by inadequate waste management practices. In that context, the objective of this study was to analyse the healthcare waste management practices in hospitals of the Algarve region, Portugal, and in particular to assess the risk perceptions of, and actual risk to, healthcare staff. The study included three of the six hospitals in the region, covering 41% of the bed capacity. Data were collected via surveys, interviews, and on-site observations. The results indicate that waste separation is the main deficiency in healthcare waste practice, with correct separation being positively related to the degree of daily contact with the waste. Risk perceptions of healthcare staff show the highest levels for the environment (4.24) and waste workers (4.08), and the lowest for patients (3.29) and visitors (2.80), again being positively associated with the degree of daily contact. Risk perceptions of healthcare staff are related to the difficulties of the correct separation of wastes and the lack of knowledge concerning the importance of that separation. The risk of infection with needlesticks/sharps is higher during patient care than during waste handling, and the frequency of these injuries is related to the daily tasks of each healthcare group (doctors, nurses, and housekeepers). Furthermore, legislative definitions and classifications of healthcare wastes appear to have conditioned the management practices associated with, and the perceptions of risk concerning, healthcare wastes.     

Research on solid waste management system: to improve existing situation in Corlu Town of Turkey

Over the past decades, uncontrolled population growth and rapid urbanization and industrialization have resulted in environmental problems in Corlu Town, Turkey. One of the most important problems is solid waste due to inadequate management practices. Nowadays, increasing public awareness of the environment compels local authorities to define and to adopt new solutions for waste management. This paper presents a general overview of current solid waste management practices in Corlu Town and principles of the recommended municipal solid waste (MSW) management system. In Corlu, 170 tonnes of municipal solid waste are generated each day, or 1.150 kg per capita per day. Approximately one-half of the municipal solid waste generated is organic material and 30% of the MSW consists of recyclable materials. The recommended system deals with maximizing recycling and minimizing landfilling of municipal solid waste, and consists of separation at source, collection, sorting, recycling, composting and sanitary landfilling. This study also analyzed the recommended system with respect to feasibility and economics. To evaluate whether the suggested system is cost effective or not, the operating cost of the recommended system and market prices of recyclable materials were compared, and the results show that the recommended system will reduce required landfill volume up to 27% of compared to the present situation. The profit of the recommended system is estimated to be about 80 million US dollars.     

Paper waste – Recycling,incineration or landfilling? A review of existing life cycle assessments

A review of existing life cycle assessments (LCAs) on paper and cardboard waste has been undertaken. The objectives of the review were threefold. Firstly, to see whether a consistent message comes out of published LCA literature on optimum disposal or recycling solutions for this waste type. Such message has implications for current policy formulation on material recycling and disposal in the EU. Secondly, to identify key methodological issues of paper waste management LCAs, and enlighten the influence of such issues on the conclusions of the LCA studies. Thirdly, in light of the analysis made, to discuss whether it is at all valid to use the LCA methodology in its current development state to guide policy decisions on paper waste. A total of nine LCA studies containing altogether 73 scenarios were selected from a thorough, international literature search. The selected studies are LCAs including comparisons of different management options for waste paper. Despite claims of inconsistency, the LCAs reviewed illustrate the environmental benefits in recycling over incineration or landfill options, for paper and cardboard waste. This broad consensus was found despite differences in geographic location and definitions of the paper recycling/disposal systems studied. A systematic exploration of the LCA studies showed, however, important methodological pitfalls and sources of error, mainly concerning differences in the definition of the system boundaries. Fifteen key assumptions were identified that cover the three paper cycle system areas: raw materials and forestry, paper production, and disposal/recovery. It was found that the outcome of the individual LCA studies largely depended on the choices made in some of these assumptions, most specifically the ones concerning energy use and generation, and forestry.     

The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste

In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total quality management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.     

Medical waste management in Trachea region of Turkey: suggested remedial action.

The main objective of this paper was to analyse the present status of medical waste management in the Trachea region of Turkey and subsequently to draw up a policy regarded with generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal of medical wastes. This paper also presents the results of study about awareness on how to handle expired drugs. Initially all health-care establishments in Tekirda?, Edirne and Kyrklareli provinces in Trachea region were identified and the amounts of hospital wastes generated by each of them were determined. Current medical waste-management practices, including storage, collection, transportation and disposal, in surveyed establishments were identified. Finally, according to results, remedial measurements for medical waste management in these establishments were suggested. Unfortunately, medical wastes are not given proper attention and these wastes are disposed of together with municipal and industrial solid wastes. The current disposal method is both a public health and environmental hazard. When landfill sites are visited, many scavengers can be seen sorting for recyclable materials, a practice which is dangerous for the scavengers. In addition, it was found that some staff in health-care establishments are unaware of the hazard of medical wastes. It is concluded that a new management system, which consists of segregation, material substitution, minimization, sanitary landfilling and alternative medical waste treatment methods should be carried out. For the best appropriate medical waste management system, health-care establishment employers, managers and especially the members of house- keeping divisions should be involved in medical waste management practice.     

The role of intergenerational influence in waste education programmes: the THAW project

Whilst the education of young people is often seen as a part of the solution to current environmental problems seeking urgent attention, it is often forgotten that their parents and other household members can also be educated/influenced via home-based educational activities. This paper explores the theory of intergenerational influence in relation to school based waste education. Waste Watch, a UK-based environmental charity (www.wastewatch.org.uk), has pioneered a model that uses practical activities and whole school involvement to promote school based action on waste. This methodology has been adopted nationally. This paper outlines and evaluates how effective school based waste education is in promoting action at a household level. The paper outlines Waste Watch's 'Taking Home Action on Waste (THAW)' project carried out for two and half years in Rotherham, a town in South Yorkshire, England. The project worked with 6705 primary age children in 39 schools (44% of primary schools in the project area) to enable them to take the "reduce, reuse and recycle message" home to their families and to engage these (i.e. families) in sustainable waste management practices. As well as substantial increases in students' knowledge and understanding of waste reduction, measurement of the impact of the project in areas around 12 carefully chosen sample schools showed evidence of increased participation in recycling and recycling tonnages as well as declining levels of residual waste. Following delivery of the project in these areas, an average increase of 8.6% was recorded in recycling set out rates which led to a 4.3% increase in paper recycling tonnages and an 8.7% increase in tonnages of cans, glass and textiles collected for recycling. Correspondingly, there was a 4.5% fall in tonnages of residual waste. Waste Watch's THAW project was the first serious attempt to measure the intergenerational influence of an education programme on behaviour at home (i.e. other than schools' own waste). It clearly shows that household recycling behaviour can be positively impacted by intergenerational influence via a practical school-based waste education model. However, although the model could potentially have a big impact if rolled out nationally, it will require seed funding and the long-term durability of the model has not yet been fully quantified.     

On achieving the state's household recycling target: a case study of Northern New Jersey, USA

In recent times, the State of New Jersey (USA) has been making attempts at promoting recycling as an environmentally friendly means of attaining self-sufficiency at waste disposal, and the state has put in place a 50% recycling target for its municipal solid waste stream. While the environmental benefits of recycling are obvious, a recycling program must be cost effective to ensure its long-term sustainability. In this paper, a linear programming model is developed to examine the current state of recycling in selected counties in Northern New Jersey and assess the needs to achieve the state's recycling goal in these areas. The optimum quantities of waste to be sent to the different waste facilities, which include landfills, incinerators, transfer stations, recycling and composting plants, are determined by the model. The study shows that for these counties, the gap between the current waste practices where the recycling rate stands at 32% and the state's goal can be bridged by more efficient utilization of existing facilities and reasonable investment in expanding those for recycling activities.     

Architects' perspectives on construction waste reduction by design

The construction, demolition and excavation waste arising in England was estimated at 91 million tonnes in 2003. The current thinking on construction waste minimisation is heavily focussed on several issues relating to physical construction waste and recycling guides. Indeed, much had been published on ways to improve on-site waste management and recycling activities but very few attempts made to address the effect of design practices on waste generation. However, there is a consensus in the literature that the architect has a decisive role to play in helping to reduce waste by focussing on designing out waste. This paper examines previous studies on architects' approach towards construction waste minimisation; and by means of a postal questionnaire, investigates: the origins of waste; waste minimisation design practices in the UK; and responsibilities and barriers within the UK architectural profession. The findings reveal that waste management is not a priority in the design process. Additionally, the architects seemed to take the view that waste is mainly produced during site operations and rarely generated during the design stages; however, about one-third of construction waste could essentially arise from design decisions. Results also indicate that a number of constraints, namely: lack of interest from clients; attitudes towards waste minimisation; and training all act as disincentives to a proactive and sustainable implementation of waste reduction strategies during the design process.     

Medical waste management in Ibadan, Nigeria: obstacles and prospects

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only approximately 3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.