Over the past five years or so, some 95 healthcare facilities across Australia and New Zealand have started to recycle PVC medical products and other recyclables used in the delivery of healthcare services. The PVC Recycling in Hospitals program has been something of a world first – now being adopted in the UK, North America and South Africa - driven by passionate medical staff concerned by the growing consumption and waste of resources in the healthcare sector.

Our program has shown the enormous will of staff to do at work what they do at home – recycle. It has paved the way to recover and recycle other plastics and materials from healthcare. However, working with these hospitals to put systems and infrastructure in place to allow recycling has highlighted some challenges in the design of these buildings.

When it comes to hospital development, waste management is not a top design priority (nor should it be compared to patient comfort and outcomes), but as a building type, hospitals generate significant - and growing - volumes of waste: food, plastics, metals, glass, paper and cardboard. And this waste generation represents a sizeable operational cost over the building lifetime.

The World Health Organisation has found that high income countries like Australia produce over 3.3 kg of waste per bed per day, 85 percent of which is generally non-hazardous / non-infectious waste. A metropolitan general hospital in the US is estimated to produce a whopping 10.7kg per occupied bed per day of which almost 8kg is general waste.

In part, this waste generation has been driven by improved infection control which has led to increasing adoption of single-use, disposal medical products. Much of this is plastic material and 30-40 percent of that is PVC. These items, such as oxygen masks and tubing, fluid solution bags, bottles and containers, are treated as general waste in Australia, and have traditionally gone to landfill at a cost to the hospital.

Our older hospitals were not designed to cater for this growth in waste. As we found in developing the PVC recycling program, buildings had insufficient floor space for placement of bins in medical areas; lacked interim storage space for bins of collected waste and had loading docks that were clearly struggling to cater for the growing volumes of various waste streams. In one case, the depot ceiling height was even too low to allow entry of today’s larger waste collection trucks!

If healthcare facilities are going to meet commitments to waste management principles, they need to implement comprehensive systems to facilitate segregation of wastes at source in medical areas and the safe movement of waste through the hospital to the loading dock for transportation away from the site.

Under current Australasian Health Facilities Guidelines, a typical 14m2 dirty utility room – the largest specification - in a general hospital might have space allowed for just two 240 litre bins, one of which would probably need to be for clinical waste. If hospitals are to collect and segregate waste streams effectively at source i.e. in the medical area, then appropriate space is required for suitable bins: clinical waste, PVC, general waste, and other recyclable streams. This has been a challenge for virtually every hospital we have worked with.

It requires forward thinking design of safe and efficient systems for collecting, handling, storing, transporting, treating, recycling and disposing of healthcare wastes. This encompasses:

• Location and size of waste storage rooms
• Holding areas (eg dirty utility rooms) sufficient for segregated waste streams close to where waste is generated
• Internal waste movement routes (separated from high people movement and sensitive areas)
• Layout and design of loading docks with space for balers and compactors, recycling bins, waste treatment, hazardous waste storage, bin and trolley cleaning, transport access etc

As recycling of consumables in healthcare grows, this means planning up front as hospitals upgrade or are built new, estimating waste generation volumes, types of waste and the types and numbers of bins to accommodate it, as well as identifying the departments that will recover and segregate waste streams for recycling.

Design of sustainable healthcare facilities today has come a long way in terms of infection control and improving comfort and outcomes for patients. But let’s make healthcare waste management a carefully integrated part of that system to avoid the potential public health and environmental consequences of waste generation.