Ask a Doctor: Answering Recyclers’ Questions About Healthcare Plastics
Healthcare Plastics Recycling County (HPRC) has been busy lately, hosting recent roundtables for both hospitals (in conjunction with CleanMed) and recyclers (in conjunction with Re|focus). One of our biggest takeaways has been the barriers created by misconceptions and questions recyclers have about the safety and cleanliness of healthcare plastics.
It is understandable that contamination would be a concern for recyclers, bringing to mind images of employees encountering sharps or blood-contaminated materials. As a result, HPRC decided to ask a physician directly. We were fortunate to find a willing expert with extensive sustainability and recycling experience in a healthcare setting, Ilyssa Gordon, MD, PhD, medical director of the Office for a Healthy Environment at Cleveland Clinic, and HFAB member. Of course, hospital practices can vary, and these answers should not be considered medical or legal advice, but rather a jumping off point for further discussions with your hospital partners.
What parts of a hospital or medical center generate recycling?
Most programs focus exclusively on the Operating Room (OR) as this is the easiest and cleanest location where plastics are generated at significant volume. That’s not to say some hospitals don’t have recycling in other areas as well (labs or patient rooms, for example) but that is far less common and is something that could be agreed upon up front with your partner.
Who sorts the plastics being generated in the OR?
The plastics are prepared and sorted into recycling containers by the nurses who prep the room for the procedure. After unwrapping instruments and supplies, they place all plastics designated for recycling (which would be specific to their hospital’s program) into the recycling container, which may have a color-coded liner, tie that bag off, and remove it from the room before the patient is even brought in.
Are the nurses trained?
Yes. In hospitals where recycling is taking place, staff, including the OR nurses, would be trained in what can be recycled, how it needs to be sorted and where, and how to avoid contamination. In many cases nurses are very passionate advocates of recycling, as they see firsthand how much waste is generated every day, and want to do what they can to minimize it. Nurses are specialized in certain kinds of procedures, so they would be working with the same pool of instruments and packaging time and again, further increasing their familiarity and consistency levels. It can be helpful to compare this process with the level of control and expertise with what you might see in a regular residential stream, where basically anyone could put almost anything into a bin.
What does “contamination” mean to you?
In a hospital setting, “contamination” refers to bodily fluids, chemicals, or potentially infectious material being present where they should not be, whether in a sterile area, on a patient’s body, or in the surrounding environment. This can get confusing when recyclers use “contamination” to refer to items in the waste stream that do not belong (i.e. paper in a plastic stream) but are not necessarily hazardous or infectious. It is important when healthcare professionals are having conversations with recyclers that everyone is clear about which type of “contamination” they are talking about.
Can the material get contaminated in the OR during the sorting process?
This would be very unlikely. The nurses doing the physical sorting would be scrubbed in and wearing face masks, and the room itself would be sterile in preparation for the procedure. All recyclables are “pre-case,” meaning they are removed from the room before the patient is brought in.
What about other bodily fluids, like vomit in a plastic basin?
This kind of situation is generally found in patient rooms, which is one reason why recycling these materials is far less common. In the OR, patients are under anesthesia and would not be using basins, bedpans, etc. All plastic materials are removed from the OR before the patient is brought in, so no contamination from bodily fluids can occur there.
How is hazardous waste handled?
Biohazardous material, also known as regulated medical waste, is subject to very strict protocols in hospitals with a regulatory chain of custody. It is separated into distinctive red bags (and is thus also sometimes known as “red-bag waste”), then taken to a designated section of the facility for autoclave sterilization. It is then picked up by a biohazardous waste service and disposed of in a completely separate landfill from the regular waste stream. Sharps are collected separately in special sharps containers to prevent the risk of puncturing the red bags.
What about the contamination risk to the recycler?
That potential risk is truly shared. Both parties have a strong interest in avoiding dangerous contamination and keeping everyone safe. Hospitals exist to help people and promote community health. Hospitals have an infection prevention specialist on staff, and they are a great resource to consult with as you are discussing the details of a new or expanded program. The relationship between the hospital and the recycler should be direct and open, even when third parties are involved in the recycling process (such as transportation from the hospital to the recycling facility). Trust in the process can be built on both sides.
Would hospitals be willing and able to further separate material streams for their recycler?
While facilities may be willing to do additional sorting, the logistics have proven to be very challenging. One issue that comes up often is space—most hospitals do not have a lot of dock or storage space for sorting or storage of materials. Some have found workarounds to this by partnering with community organizations that handle manual sorting. These programs may still require space at the hospital or be subjected to other local laws and regulations that make setting up the partnership challenging. That’s not to say it cannot be done, but it gives you an idea of what the hospitals are working with. One thing to consider is that as a recycler, it may be best for you to take the mixed plastics and sort them to ensure optimum quality and uniformity of the bales. Perhaps you could even identify new streams of plastic from the mix which you may not have been working with before.
What about only buying certain material mixes of plastics from suppliers in the first place? This would make sorting and recycling much easier.
This is definitely on hospitals’ radars and something many are working on. One way we have already made progress here is through standardizing surgical kits. Rather than every hip replacement surgeon choosing what kit he or she likes best, every surgeon doing that procedure at the hospital uses the same kit. Hospital purchasing can be highly complex (see more here) and medical device packaging is as strictly regulated as the device itself, requiring FDA approval. As a result, change on the procurement side can be slow and gradual.
If there is one overall takeaway, it is not to assume you are speaking the same language or understanding things from the same perspective. Have the conversation! Your foundation for working together will be stronger, your common understanding that much greater, and hopefully your results that much better.