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Australia The business case for tackling Australia's healthcare waste problem

00:07  13 october  2021
00:07  13 october  2021 Source:   abc.net.au

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The Australian healthcare sector's reliance on single-use plastic has never been more visible than during the COVID-19 pandemic — and now frustrated doctors and nurses are fighting back to save both the environment and money.

The healthcare sector has been battling its environmental footprint for years.

Overall, it accounts for 7 per cent of Australia's carbon emissions, with much of that attributed to its supply chains.

Some Australian healthcare workers have long bemoaned a decades-long shift away from washable gowns and surgical items towards prepackaged medical kits and uniforms.

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Doctor Forbes McGain has long been on a war against waste at Western Health's hospital at Sunshine in Melbourne's north, where he's been on the front line of battling the pandemic.

From face shields to PPE, Dr McGain has noticed a lot more plastic during COVID. 

"All of this extra waste is to keep us safe," he says.

"For instance, tens of thousands of gowns are being used daily at Western Health currently. And that's because it's a way of protecting staff and other patients from COVID-19.

"A nurse may go through 30 gowns in one day. That's just standard.

"Every day, we say we're dressed in oil, because they're all petrochemical plant products.

"It's been pretty trying and pretty depressing, like a lot of things about this pandemic."

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What is the pandemic doing to hospital waste streams?

It is difficult to get a national picture of what healthcare waste streams are doing during the pandemic, because this data is not collected at a federal level.

However, Western Health has disclosed its waste figures to ABC News, and they show a microcosm of what's happening, at least in the Victorian context.

In Victoria, the advice is that all healthcare waste from hospitals, COVID-19 clinics, testing and injecting sites must be handled as medical waste. 

Medical waste typically goes into yellow bins. Sunshine Hospital's waste depot is currently heaving with full bins, and has had to significantly ramp up waste collection to deal with this.

Overall, Western Health's clinical waste has risen by 40 per cent during the pandemic, to 375,000kg annually.

"None of it can be recycled, because it's all required to be prescribed waste," Dr McGain says.

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The one silver lining is that Western Health's much smaller PVC waste stream is significantly down. PVC is largely used in tubing during surgery and is recycled by Western Health, thanks to Dr Forbes's ongoing war on waste.

"The reduction on PVC over the last two years we consider relates to the reduction of elective surgery, as usually these processes use PVC content," Western Health's environmental officer, Carlos Machado, says.

"We have actually seen an increase of 13 per cent on our recycling. So that's good."

However, overall its waste streams are up 8.5 per cent from 2.3 million kilograms in 2019 to 2.5 million kilograms this year.

"We have to understand that this is the reality of a pandemic disease, something that we haven't lived before. And we're just making our best effort to try to understand where we need to cut down," Mr Machado says.

The issue is adding costs to healthcare

The Victorian government was asked about its overall official waste figures in the healthcare sector, but it couldn't supply any data after June 2020.

However, an academic who audits hospital waste across the state told ABC News some hospitals had seen waste streams soar by between 25 to 130 per cent during COVID-19.

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"The lower amounts are for smaller hospitals that would rarely have a COVID patient, with the larger amounts at hospitals with COVID wards and patients in ICU," Deakin University's Trevor Thornton says.

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A nurse who works in one of Melbourne's biggest COVID-19 hospital wards shared photos with ABC News of what she generates every day in waste.

"In one shift, it's a new mask three to 10 times a day depending on the patient load. Single-use plastic gowns is probably up to 10. And lord knows how many plastic gloves. Probably 25 pairs. It goes in a rubbish bin," she says.

"I don't think it's the time to be bagging hospitals, as the priority is to firstly keep their patients and us safe. But the waste is obviously a huge issue.

"Everything has the price of what it is. One bag of fluids is $6. I can't reuse anything but I'm so conscious of how much this is costing the system."

Dr Forbes is also concerned about these overheads.

"It's costly. Each gown or each n95 mask that we're wearing is not particularly expensive but it adds up very quickly when we start thinking about it, even if it's just a few dollars per item," he says.

And it's not just the cost of disposable goods. Waste collection is also an expensive process.

"One small regional hospital that also has an aged care facility attached has increased the use of yellow bins from 15 to 25 a week," Deakin University's Trevor Thornton says.

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"One issue is that many facilities are not charged by weight for removal rather than by the bin.

"An approximate rate for clinical waste is $1.50 a kilogram. However, in a 240-litre bin, it may only have 8kg of clinical waste and it's charged at approximately $35. This works out to $4.40 a kilogram."

Why isn't more healthcare waste being recycled?

As well as overarching policies about how medical waste should be handled, one of the main barriers faced by the healthcare industry is finding companies that will even consider recycling the waste.

The recycling and waste industry has been under added pressure since many countries in Asia started refusing to take Australia's excess waste.

In New South Wales, a scheme dreamed up by a nurse at St Vincent's Hospital in Sydney reveals the complexities of recycling single-use plastic waste in the midst of a pandemic.

Rodrigo Fritis-Lamora is also dismayed at all the plastic he's using right now.

"It can be quite sobering to see how much is produced in just from one centre," he says.

St Vincent's Hospital does have a long-running recycling program that includes paper, cardboard, polystyrene, PVC, mattresses, batteries and mobile phones. About 25 per cent of its waste is recycled.

The NSW government was unable to give ABC News figures on exactly what healthcare waste streams are doing during the pandemic. But it does have overarching policies that show how healthcare waste should be treated before being incinerated, sent to landfill or recycled.

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Mr Fritis-Lamora decided to make a point by focusing on a single pandemic waste stream: COVID vaccines.

Every injection involves a range of single-use plastic, including syringe caps and the syringe itself. With tens of millions of doses given, these tiny items add up into tonnes.

Mr Fritis-Lamora's idea to segment and collect these items eventually got going with help from his hospital and a state-government funded body that aims to promote recycling, NSW Circular.

The three-month trial at St Vincent's this year collected 80,000 pieces of plastic waste that weighed 205 kilograms – equivalent to 41,000 plastic bags. The scheme has since expanded to include a COVID-19 vaccination hub in Newcastle, where 170kg of plastic caps from vaccines have been collected in just a few weeks.

The next stage was finding somebody to turn it into new items.

Turning syringe caps into wind turbine parts

The pilot project teamed up with a company in the rural NSW town of Orange that makes plastic parts for manufacturing, AllMoulds Plastic.

AllMould Plastic's founder Scott Cantrill is passionate about reducing his environmental footprint. Half of what he makes is already produced from old waste streams.

He's now turned the 80,000 pieces of plastic from St Vincent's Hospital into parts for roller doors and plastic caps that go on bolts.

"When it comes to the commercial side, it will make more sense as we get more (hospitals) on board and scale this up. One pilot program has obviously cost the company a lot of money, but it's to prove a point," he says.

The plastic caps have a renewable destination — they're being bought by a Sydney-based company Ocycut that makes parts for wind turbines. 

"I could probably get these components from China for half what I'm paying here in Australia," Oxycut's boss Simon Preston says.

But he's absorbing the extra cost because he wants to contribute to a renewable society.

"The fact that AllMould Plastics is using 50 per cent recycled material in their products, and specifically are also using the waste from the recent COVID vaccination program, for us that just worked perfectly," he says.

This all shows the complexities of getting recycling going. But the group that pushed for the pilot program has crunched the numbers and believes there are long-term economic benefits.

"The collection of these two items alone across the NSW public health system could save nearly 70 million pieces of plastic from landfill, amounting to 150 tonnes and generate savings of $150,000 each year," NSW Circular economist Kar Mei Tang says.

"Moving beyond these two items, if the estimated 40 to 60 per cent of recyclable waste currently going into clinical waste streams was recovered, there are potential savings of $2 to 3 million a year across the NSW Health system that could be reinvested into patient care."

What about simply reusing more items?

Back at Sunshine Hospital, Dr Forbes is happy to hear about the efforts of healthcare workers interstate to recycle more goods.

He pushed for the PVC recycling program at his workplace several years ago, and also crunched numbers that show that it's got economic benefits.

But he's passionate about pushing for something even harder than collecting and recycling single-use waste: he wants to transform the sector's culture so it is using more reusable items.

He has already helped bring back reusable anaesthesia equipment at Sunshine Hospital, which is sterilised on site. He says this saves each operating theatre $5,000 per annum, which works out to about $100,000 in savings each year for all of Western Health.

"This becomes a large number when considering all of Australia," he says.

"There are many examples where reusing and washing within a central sterile supply department is still standard of care. It's just that many hospitals have gone to single use, but we haven't.

"And we've certainly have done lots of interesting studies on that sort of area about how to reduce the carbon footprint and save money."

Dr McGain is currently pushing for more hospitals to ditch single-use plastic gowns and go for cloth ones during COVID. 

However, he appreciates that Australia's healthcare system is still very much under crisis, especially with the looming potential of a surge in COVID cases as the country opens back up this summer.

"It's very difficult, especially in a pandemic, to act quickly and deal with it," he says.

He hopes as Australia’s healthcare sector enters a post-pandemic environment, it won’t waste the opportunity to learn about its disposable culture.

“I think there's a number of opportunities where you can save money, and you can actually reduce the amount of waste that you do.

“And it can be so exciting for staff to work as a team to do that.”

Duke and Duchess of Cambridge arrive at Earthshot in electric Audi .
Kate and William, both 39, arrived at Alexandra Palace last night in a car from Audi's e-tron range, which use electric battery powered motors to drive without carbon dioxide emissions. It was revealed yesterday that the Duke has installed an electric car charger at his royal residence in London, as Prince Charles, 72, praised his son for his 'growing commitment to the environment'. © Provided by Daily Mail ( © Provided by Daily Mail ( The couple arrived in the Audi RS e-tron GT, which is built alongside the legendary Audi R8 at the Böllinger Höfe facility in Germany.

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