The financial and environmental impact of unopened medical supplies discarded in the emergency department.

BACKGROUND: Inefficient supply chain management within the US healthcare industry results in significant financial and environmental impact. Unopened medical supplies may routinely be discarded in the Emergency Department (ED), contributing as a source of unnecessary medical waste. OBJECTIVES: Quantify the financial and environmental impact of unopened medical supplies that are routinely discarded in two EDs. METHODS: The study utilized a waste audit of collection bins targeting unopened medical supplies that would have otherwise been discarded. Associated financial cost was calculated using data from the purchasing department and from an online search. End-of-life (EOL) environmental impact was calculated using the M+ Wastecare calculator. A lifecycle analysis was performed on a supplier-packaged intubation kit, which the study identified as a significant source of waste. RESULTS: High volumes of unused, unopened supplies (143.48 kg) were collected during the study period with a yearly extrapolated value of 1337 kg. Purchasing costs over 44 days at Hospital A and 37 days at Hospital B for these items amounted to $16,159.71 across both sites with a yearly extrapolated value of $150,631.73. Yearly extrapolated EOL impact yielded 5.79 tons per year of CO2eq. Components from supplier-packaged intubation kits were found to contribute to 45.2% of collected items at one site which purchased them. Lifecycle analysis of an intubation kit yields 23.6 kg of CO2eq. CONCLUSION: This study demonstrates that the disposal of unopened medical supplies contributes a significant source of financial and environmental waste in the ED setting. The results continue to support the trend of procedure kits generating significant environmental and financial waste.

Waste management in the operating theatre.

INTRODUCTION: Poor clinical waste management and its effect on the environment is an increasingly recognised concern for global healthcare systems. Approximately two thirds of waste produced in healthcare is from the operating theatre. In the Republic of Ireland, an estimated 580,977 tonnes of hazardous waste was produced in 2019. The cost of incineration of this hazardous waste is approximately €2,125 per tonne and €935 per tonne for sterilisation. Pollution from incineration is substantial and harmful. METHODS: A literature review was performed on the topic of hospital waste management, specifically looking at the Republic of Ireland. A comparison could then be drawn between Ireland, Europe and the United States of America. Observation of our current operating theatre environment and practices were carried out. DISCUSSION: An increased focus towards sustainability and reusable equipment means that there is potentially a decreased amount of waste for disposal, but an increase in the process of sterilisation. Approximately 66% of healthcare related waste is inappropriately contaminated, meaning that significant savings are possible if correct segregation and recycling were to occur. An increase in the amount of bins, identification labels above bins and education of staff results in an increased likelihood of successful segregation of waste. Clear and concise hospital guidelines of what is considered hazardous versus non-hazardous waste will decrease the amount of inappropriately disposed items.

Can pyrolysis handle biomedical wastes?: Assessing the potential of various biomedical waste treatment technologies in tackling pandemics.

Globally, COVID-19 has not only caused tremendous negative health, social and economic impacts, but it has also led to environmental issues such as a massive increase in biomedical waste. The biomedical waste (BMW) was generated from centralized (hospitals, clinics, and research facilities) and extended (quarantine camps, COVID-19 test camps, and quarantined homes) healthcare facilities. Many effects, such as the possibility of infection spread, unlawful dumping/disposal, and an increase in toxic emissions by common BMW treatment facilities, are conjectured because of the rise in waste generation. However, it is also an opportunity to critically analyze the current BMW treatment scenario and implement changes to make the system more economical and environmentally sustainable. In this review, the waste disposal guidelines of the BMW management infrastructure are critically analyzed for many functional parameters to bring out possible applications and limitations of individual interventions. In addition, an investigation was made to select appropriate technology based on the environmental setting.

A study of the stabilization and solidification of heavy metals in co-vitrification of medical waste incineration ash and coal fly ash.

Medical waste incineration ash (MWIA) has significant concentrations of heavy metals, dioxins, and chlorine that, if handled incorrectly, might cause permanent damage to the environment and humans. The low content of calcium (Ca), silicon (Si), and aluminum (Al) is a brand-new challenge for the melting technique of MWIA. This work added coal fly ash (CFA) to explore the effect of melting on the detoxication treatment of MWIA. It was found that the produced vitrification product has a high vitreous content (98.61%) and a low potential ecological risk, with an initial ash solidification rate of 67.38%. By quantitatively assessing the morphological distribution features of heavy metals in ashes before melting and molten products, the stabilization and solidification rules of heavy metals during the melting process were investigated. This work ascertained the feasibility of co-vitrification of MWIA and CFA. In addition, the high-temperature melting and vitrification accelerated the detoxification of MWIA and the solidification of heavy metals.

Experimental and modeling study of medical waste based on plasma gasification.

Plasma gasification melting (PGM) provides reliable disposal of toxic medical waste with a low heating value, which is capable of converting waste into energy. This study investigates the performance of experiments on plasma gasification for the treatment of chemical-pharmaceutical medical waste (CPMW) with an air medium. A comparative analysis is performed for gasification characteristics at three reactor temperatures (1000, 1400, and 1800 °C). Moreover, a thermodynamic equilibrium model is developed to assess performance features such as syngas yield, high heating value, and cold gas efficiency in the gasification temperature range of 1000-1800 °C. A comparison of the experiment and computational outcomes shows a good agreement. The results show that the quality of syngas and heating value is improved by increasing the temperature of the plasma gasifier so that at 1800 °C, H2, CO, and higher heating value (HHV) are obtained as 41 %, 37 %, and 10 MJ/Nm3, respectively. The obtained syngas is a clean fuel with low sulfur-containing and nitrogen-containing. The experimental results provide an extensive comprehension of CPMW gasification in a plasma reactor and consider a possibility for hydrogen and energy production.

Does Reusable Instrumentation for Four-Anchor Rotator Cuff Repair Offer Decreased Waste Disposal Costs and Lower Waste-Related Carbon Emissions?

INTRODUCTION: Orthopaedic surgery is culpable, in part, for the excessive carbon emissions in health care partly due to the utilization of disposable instrumentation in most procedures, such as rotator cuff repair (RCR). To address growing concerns about hospital waste, some have considered replacing disposable instrumentation with reusable instrumentation. The purpose of this study was to estimate the cost and carbon footprint of waste disposal of RCR kits that use disposable instrumentation compared with reusable instrumentation. METHODS: The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution ($0.14 per kilogram) and reported values from the literature for carbon emissions produced from the low-temperature incineration of noninfectious waste (249 kgCO 2 e/t) and infectious waste (569 kgCO 2 e/t), we estimated the waste management cost and carbon footprint of waste disposal produced per RCR kit. RESULTS: The disposable systems of four commercial medical device companies had 783%, 570%, 1,051%, and 478%, respectively, greater mass and waste costs when compared with the reusable system. The cost of waste disposal for the reusable instrumentation system costs on average $0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems. CONCLUSION: According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint. LEVEL OF EVIDENCE: Level II.

Resource utilization of medical waste incineration fly ash to activate peroxydisulfate for tetracycline degradation: Synergy between adsorption and PDS activation.

Medical waste incineration fly ash (MWI FA) is classified as a hazardous solid waste. Therefore, the development of recycling technologies to convert MWI FA into useful products is necessary and challenging. In this study, we developed a sustainable approach for preparing a catalyst through the pyrolysis of water-washed MWI FA (WW FA-x, where x corresponds to the pyrolysis temperature). Subsequently, it was applied as a potent peroxydisulfate (PDS) activator to remove tetracycline (TC) from water. The results showed that the WW FA-800 exhibited remarkable adsorption performance as well as highly efficient catalytic activation of PDS, with a 115 mg/g maximum TC adsorption capacity and 93.5% (reaction kinetic rate = 315 µmol/g/h) TC removal within 60 min. A synergistic effect was achieved by adsorption and PDS activation. TC degradation was primarily driven by non-radical (1O2 and electron transfer) processes. WW FA-800 possesses multiple active sites, including defects, π-π*, O-CO groups, Fe0, and Cu(I). Three possible pathways for TC decomposition have been proposed, with the majority of intermediates exhibiting less toxicity than TC. Furthermore, the WW FA/PDS system exhibited an excellent anti-interference ability, and universality in the degradation of various organic contaminants. Notably, energy consumption was minimal, approximately 2.80 kWh/(g·TC), and the leachability of heavy metals in the WW FA-800 was within acceptable limits. This study provides a MWI FA recycling route for the development of highly active catalysts.

The environmental impacts of anesthesia.

PURPOSE OF REVIEW: The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. RECENT FINDINGS: The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. SUMMARY: Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.

Review of sustainable practices for the gynecology operating room.

PURPOSE OF REVIEW: Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement. RECENT FINDINGS: From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals. SUMMARY: This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.

Predicting medical waste generation and associated factors using machine learning in the Kingdom of Bahrain.

Effective planning and managing medical waste necessitate a crucial focus on both the public and private healthcare sectors. This study uses machine learning techniques to estimate medical waste generation and identify associated factors in a representative private and a governmental hospital in Bahrain. Monthly data spanning from 2018 to 2022 for the private hospital and from 2019 to February 2023 for the governmental hospital was utilized. The ensemble voting regressor was determined as the best model for both datasets. The model of the governmental hospital is robust and successful in explaining 90.4% of the total variance.Similarly, for the private hospital, the model variables are able to explain 91.7% of the total variance. For the governmental hospital, the significant features in predicting medical waste generation were found to be the number of inpatients, population, surgeries, and outpatients, in descending order of importance. In the case of the private hospital, the order of feature importance was the number of inpatients, deliveries, personal income, surgeries, and outpatients. These findings provide insights into the factors influencing medical waste generation in the studied hospitals and highlight the effectiveness of the ensemble voting regressor model in predicting medical waste quantities.

Operating Room Waste Generated From Corneal and Conjunctival Surgeries.

PURPOSE: The purposes of this study were to bring awareness to the surgical waste generated from corneal and conjunctival surgeries and to compare those findings with the waste generated from cataract surgeries. METHODS: This was an observational prospective pilot cohort study at a tertiary corneal/anterior segment private practice. All waste related to cataract, cornea, and conjunctival surgical procedures (including anesthesia waste and corneal tissue storage) was weighed. The primary outcome was total waste generated while other outcomes included surgical setting (ambulatory surgical center, hospital, and minor operating room) and comparison of corneal/conjunctival surgeries with cataract surgery. RESULTS: Surgical waste data were collected from 119 surgeries (82 corneal/conjunctival surgeries and 37 cataract surgeries). Hospital surgeries produced more waste than ambulatory surgical center and minor operating room surgeries. Penetrating keratoplasty (2.22 kg, P = 0.483) and Descemet stripping only (2.11 kg, P = 0.326) procedures generated comparable mean waste with cataract surgery (2.07 kg) while endothelial keratoplasties produced more ( P < 0.001, 0.002). (Deep) anterior lamellar keratoplasty results depended on the surgical setting. All conjunctival surgeries produced less waste than cataract surgery. CONCLUSIONS: In comparison with cataract surgery, keratoplasties overall produced comparable or more waste while conjunctival surgeries produced less waste. The surgical setting and type of anesthesia played a substantial role in the amount of waste generated. Assessing waste production from different ophthalmic surgeries may increase awareness of the negative environmental impact of surgical waste and promote practice or legal changes to improve environmental sustainability.

Reducing blood product wastage through the inter-hospital redistribution of near-outdate inventory.

BACKGROUND: Hospital transfusion services order blood products to satisfy orders and maintain inventory levels during unexpected periods of increased blood demand. Surplus inventory may outdate before being allocated to a recipient. Blood product outdating is the largest contributor to blood wastage. STUDY DESIGN: A province-wide redistribution program was designed and implemented to redistribute near-outdate plasma protein and related blood products from low-usage to high-usage hospitals. Program operations and details are described in this paper. Two transport container configurations were designed and validated for transport of all blood products. A cost-analysis was performed to determine the effectiveness of this redistribution program. RESULTS: A total of 130 hospital transfusion services contributed at least one near-outdate blood product for redistribution between January 2012 and March 2020. These services redistributed 15,499 products through 3412 shipments, preventing the outdating of $17,570,700 CAD worth of product. Program costs were $14,900 for shipping and $30,000 for staffing. Failed time limits or non-compliance with packing configurations resulted in $388,200 worth of blood products (97 shipments containing 816 products) being discarded. Courier transport delays was the most common reason (42/97; 43%) for transport failure. CONCLUSION: Redistributing near-outdate blood products between hospitals is a feasible solution to minimize outdating. Despite heterogeneity of Canadian blood product inventory, all products (each with unique storage and transport requirements) were successfully redistributed in one of two validated and simple containers. Total operation costs of this program were small in comparison to the $17.6 million in savings associated with preventing the discard of outdated products.

Public attitudes toward medical waste: Experiences from 141 countries.

BACKGROUND: Medical Waste (MW), conceptualized as waste generated in the diagnosis, treatment, or immunization of human beings or animals, posing massive threat to public health. Environment-friendly public attitudes promotes the shaping of pro-environmental behavior. However, the public attitudes of MW and the potential determinants remained scarce. The present study aims to reveal globally public attitudes towards MW and captured the determinants. METHODS: We integrated the crawler technology with sentiment analysis to captured the public attitudes toward MW across 141 specific countries from 3,789,764 related tweets. Multiple cross-national databases were integrated to assess characteristics including risk, resistance, environment, and development. The spatial regression model was taken to counterbalence the potential statistical bias. RESULTS: Overall, the global public attitudes towards MW were positive, and varied significantly across countries. Resilience (ß = 0.78, SD = 0.14, P < 0.01) and development (ß = 1.66, SD = 0.13, P < 0.01) posed positive influence on public attitudes towards MW, meanwhile, risk (ß = -0.1, SD = 0.12, P > 0.05) and environment (ß = 0.09, SD = 0.09, P > 0.05) were irrelated to the shaping of positive MW public attitudes. Several positive moderating influences was also captured. Additionally, the cross-national disparities of the determiants were also captured, more specific, public attitudes towards MW in extremely poor areas were more likely to be negatively affected by risks, resilience and development. CONCLUSIONS: This study focused mainly on the public attitudes as well as captured the potential determinants. Public attitudes towards MW were generally positive, but there were large cross-national disparities. Stakeholders would need to designate targeted strategies to enhance public satisfaction with MW management.

Research on the impact mechanism of changes in the production of medical solid waste in China before and after COVID-19.

The changes of medical solid waste (MSW) output in recent years have had a significant impact on the spread of the virus. There is a high-risk transmission of MSW in various stages such as storage, transportation, and treatment during the COVID-19. To cope with the risks brought by the epidemic, normalized prevention consumes a large amount of protective clothing, medical masks, goggles, packaging bags, and other related medical supplies. There is a significant uncertainty in the amount of MSW output that poses a risk of COVID-19 infection in the event of an emergency, which increases the difficulty of collecting and handling epidemic prevention MSW. The analysis of MSW data from 2000 to 2022 found a stable growth trend before 2019. However, the MSW data was a sudden increase trend from 2020 to 2022, and the COVID-19 in China was characterized by an initial stage, an outbreak stage, and a stable growth stage. The range of MSW output during the epidemic was (1.19-1.75) × 106 t a-1. The amount of MSW was approximately 1.19 × 106 t a-1 during the normalized epidemic period, and its treatment cost was as high as 3.57 × 109 yuan (RMB)·a-1. The distribution of MSW output was uneven due to factors such as climate conditions, population data, and local economy. This study has important reference value for epidemic medical material reserves and MSW treatment.

The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs.

BACKGROUND AND PURPOSE: The rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. METHODS: The study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. RESULTS: In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 â€‹kgCO2e per case, revision hips 23.50 â€‹kgCO2e, primary knees 15.82 â€‹kgCO2e, and primary hips 14.64 â€‹kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 â€‹at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. CONCLUSION: The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Bone cement in total hip arthroplasty - Is it really green?

BACKGROUND: Total hip replacement (THR)is typically cemented, cementless or hybrid depending on patient factors and surgeon preference. To date no studies have evaluated waste generated with each of these procedures in relation to implant choice, and particularly waste related to consumables. We aimed to quantify the volume; type and ability to recycle this waste and suggest potential strategies for reducing the overall waste related to consumables in THR. METHOD: This was a prospective review of all waste related to consumables in THR. The waste was weighed using a Salter 1066 BKDR15 scale, accurate to the nearest 1 â€‹g. The primary outcome was the amount of waste generated per case depending on implant choice (cemented vs. uncemented). Secondary outcomes included: proportion of clinical waste and proportion of recyclable waste. RESULTS: Cemented THR generated a total of 1.89 â€‹kg of waste compared to 775 â€‹g for an uncemented THR. Cemented THR generated significantly more sterile (hazardous) waste than uncemented THR both as overall volume and as a proportion 763 â€‹g (40%) vs 76 â€‹g (10%). Significantly more of the waste related to uncemented THR was amenable to being recycled through conventional waste streams with simple changes in theatre 672 â€‹g (86%) compared to 989 â€‹g (52%) with cemented THR. Between 20 and 30% of waste packaging for both types of surgery compromised information booklets. CONCLUSION: Cemented hip replacement generates significantly more waste from consumables than uncemented and a greater amount of this waste is hazardous requiring intensive processing. For both implants a significant proportion of waste can be recycled with simple process changes in theatre. Industry partners have a responsibility to minimise unnecessary packaging and work with surgeons to improve sustainability.

Sustainable practices in hospital and operating theaters.

PURPOSE OF REVIEW: This review aims to provide an update on the results of studies published in the last two years involving the development of sustainable practices in hospital and operating theaters (OT). RECENT FINDINGS: Recently, many studies evaluated various initiatives to better understand the environmental impact of the OT but also to minimize its environmental impact. Many trials evidenced the positive impact of the instrument's reuse using an appropriate reprocessing procedure. Better waste segregation is associated with a reduction of produced waste and contributes to a significant reduction in CO 2 equivalent emissions. Regarding anaesthetic gas, Desflurane is known to have the worst environmental impact and the majority of the study evidenced that its reduction permits to drastically reduce greenhouse gas emission of the OT. SUMMARY: Greening the OT necessitates climate-smart actions such as waste reduction, the improvement of reusable instruments, recycling of our waste and better anaesthetic gas management. Within the last two years, many efforts have been made to reduce and better segregate waste produced in the OT and also to better understand the environmental impact of disposable and reusable devices.

Process Mining Uncovers Actionable Patterns of Red Blood Cell Unit Wastage in a Health Care Network.

Packed red blood cell transfusions are integral to the care of the critically and chronically ill patient, but require careful storage and a large, coordinated network to ensure their integrity during distribution and administration. Auditing a Transfusion Medicine service can be challenging due to the complexity of this network. Process mining is an analytical technique that allows for the identification of high-efficiency pathways through a network, as well as areas of challenge for targeted innovation. Here, we detail a case study of an efficiency audit of the Transfusion Medicine service of the Nova Scotia Health Administration Central Zone using process mining, across a period encompassing years prior to, during, and after the acute COVID-19 pandemic. Service efficiency from a product wastage perspective was consistently demonstrated at benchmarks near globally published optima. Furthermore, we detail key areas of continued challenge in product wastage, and suggest potential strategies for further targeted optimization.