HEALTHCARE & SUS TAINABI L I T Y
new plastic container or covering offers a sterile environment: that is why clinicians cover themselves and everything they use in plastic. Yet for all the ways that plastic has revolutionised the medical industry, over the past century, it is now being scrutinised for what happens after it has done its job. Various products such as single-use plastic and disposable items contribute to the mountains of hospital waste which end up being incinerated in landfill or as sewage. The sheer scale of the issue is graphically illustrated by the just one fact i.e. the NHS uses 1.4 billion examination gloves in any one year.5
Plastic waste management All plastic waste management technologies (including incineration, co-incineration, gasification, and pyrolysis) result in the release of toxic metals, such as lead and mercury, organic substances (dioxins and furans), acid gases, and other toxic substances to the air, water, and soils. All such technologies lead to direct and indirect exposure to toxic substances for workers and nearby communities, including through inhalation of contaminated air, direct contact with contaminated soil or water, and ingestion of foods that were grown in an environment polluted with these substances.
Plastic and health
Once plastic reaches the environment in the form of macro- or microplastics, it contaminates and accumulates in food chains through agricultural soils, terrestrial and aquatic food chains, and the water supply.
This environmental plastic can easily leach toxic additives or concentrate toxins already in the environment, making them bioavailable again for direct or indirect human exposure. Microplastics entering the human body via direct exposures through ingestion or inhalation can lead to an array of health impacts, including inflammation, genotoxicity, oxidative stress, apoptosis, and necrosis, which are linked to an array of negative health outcomes including cancer, cardiovascular
diseases, inflammatory bowel disease, diabetes, rheumatoid arthritis, chronic inflammation, autoimmune conditions, neurodegenerative diseases, and stroke.5 Coronavirus has made plastic waste more visible than ever and the ubiquitous presence of PPE inside and outside hospitals has ironically raised the profile of plastic in the public conscience along with the redoubtable Sir David Attenborough and the iconic BBC Blue Planet programmes, as well as numerous others.
While the enormous PPE use, to mitigate against COVID-19, is essential, with the advent of a number of vaccines offering the real prospect of a normalisation of life as we know it, now is the time to begin thinking about the mechanisms for turning the tide of the Tsunami of plastics in the NHS. However, in order to succeed, it is worth recognising that addressing the environmental impact of healthcare, from plastics to fossil fuel reliance, can quickly become a charged debate. After all, when it comes to saving lives, the patient in front of the doctor or the nurse is always the first concern. The clinical response is often: ‘It is very good in theory to talk about healthcare and its environmental impact but, as healthcare professionals, we are required to make the patient’s needs and requirements a priority and that needs to come first’. Actually the argument isn’t as simple or binary as that because sustainability is also about helping patients or rather preventing patients from having to go to hospital in the first place. The focus should be on educating and challenging assumptions. Unbeknown to the vast majority of healthcare professionals, according to the World Health Organization, 85% of hospital waste is non infectious, the bulk of which is recyclable. This 85% of waste is not much different from the waste we generate at home or at work as it might include food containers, packaging materials, or gloves worn to inspect a non-infectious patient. It is this non-infectious waste where the reductions must come from. Sadly, only a small fraction of that waste enters
the recycling stream, most of it is landfilled or burned contributing significantly to the emissions and plastics problem.
Ignorance
In fairness to most healthcare professionals, the biggest hurdle is ignorance and inertia. While being immersed in caring for patients is what they do with great vigour and passion, it is easy to assume that most hospital waste is not recyclable. In 2018, a survey conducted across four Mayo Clinic locations, across the US, found that 57% of the staff surveyed didn’t know which items could be recycled and 48% had a lack of knowledge about recycling. I daresay that is an underestimate.6
The widespread lack of an efficient medical recycling system represents a part of the bigger problem within the healthcare industry as a whole. It is clear that environmental sustainability is an unappreciated dimension of quality healthcare as traditional assessments in the success or failure in the healthcare system as a whole have yet to factor in the cost of pollution from resource extraction to disposal management.
What can be done Senior clinical leaders should start to work with their teams to begin identifying the simple changes that can be made that will promote efficiencies and ensure better outcomes for our patients and the environment both now and in the future. With the advent of the vaccine to be deployed worldwide in the next few months and despite the current state of the pandemic the number of cases will begin to slow down, perhaps around the middle of 2021.
Now is the time, therefore, to raise the awareness and test ideas that can be rolled out the other side of the pandemic. One illustrative example of how raising the awareness can lead to a quick but very substantial change is below:
The NHS bought at least 163 million plastic cups, 16 million pieces of plastic cutlery, 15 million straws and 2 million plastic stirrers last year.
If the NHS cut its use of catering plastic in half it could mean over 100 million fewer items each year end up polluting the oceans or in landfill. In an organisation notoriously slow to change, it has been the pandemic that has ironically shown the way i.e. when the need is there, change can be achieved efficiently and safely and, while COIVD-19 is clearly an acute Global health emergency, the Tsunami of plastic is now a decades old health and environmental emergency. I am a consultant paediatric intensivist and I work in the Leicester Children’s Hospital and East Midlands Congenital Heart Centre, which is a 140-bedded
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WWW.CLINICALSERVICESJOURNAL.COM MARCH 2021
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