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 today.
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,
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.