Clinicians should lead the way on 'greener' healthcare

Clinicians have an important role to play in reducing hospital waste and should not be discouraged by lack of knowledge or the threat of legal liability, according to a paper published on bmj.com.

In 2005-6, the NHS produced 408,218 tonnes of waste, 29% of which was clinical waste, and spent nearly £73m (€80m; $103m) on its disposal. Concerns about the risk of prion transmission and sterility have also led to large increases in both the amount of anaesthetic packaging and the use of disposable devices over the past 5-10 years.

Concerned by these figures, David Hutchins and Stuart White carried out a two-week audit of the waste produced by six operating theatres at their hospital, the Royal Sussex County Hospital in Brighton.

The results were striking: a total of 540kg of anaesthetic waste was produced (about 2,300 kg/theatre/year), 40% of which was potentially recyclable paper, card, plastic and glass.

Sharps waste (needles and broken glass) accounted for 54kg, but analysis of the contents of five sharps bins found that only 4% by weight was true sharp waste. The rest was made up of glass, packaging, plastic, metal, and fluid.

With around seven million operations performed each year in England and Wales, the authors suggest that clinical anaesthesia accounts for between 10 and 20,000 tonnes of NHS solid waste annually.

They also estimate that recycling anaesthetic waste across the hospital trust would save £21,000 per year (about 30% of the hospital's annual budget for disposing of clinical waste), although with waste disposal and landfill costs expected to rise, this sum could increase.

They discuss the social, logistical and legal barriers to improving waste management within the NHS, and suggest that clinicians are central to countering these.

Hospitals need government support to change current waste management strategies, while new NHS hospitals must incorporate recycling facilities, they write. Professional bodies and medical publishers also have an important role to play in the spread of ideas and solutions.

Medicine has a considerable environmental impact, they say. Increases in landfill and incineration costs, together with financial recycling incentives and our social and moral responsibilities, should encourage clinicians to improve clinical waste management, as long as the quality of patient care remains unaffected.

Over the past 60 years, the NHS has set a worldwide example in free high quality healthcare at the point of contact. It should continue to set an example by developing and integrating a national medical waste management policy to reduce its environmental impact, they conclude.