Item 17: Waste not, want not
Matter for discussion submitted by the RCN Southampton and District Branch
That this meeting of RCN Congress discusses the real impact of waste management and waste segregation policies on patient care
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Lynsey Newton (Southampton and District Branch) opened the discussion by admitting that when she had be given a waste management project to complete, her initial reaction was that she'd been saddled with the boring topic. However, the more she learned about the bigger picture the more her interest grew.
The hospital at the focus of her project had no waste segregation plan, but drivers for change had come into force via a steering group which identified that the hospital was paying fines and premium disposal rates due to the lack of segregation.
Lynsey discovered that 32% of waste was being disposed of incorrectly, that nurses were confused about what they should be doing and that with a bit of clarity and training there was the potential for savings to be made and funds redirected into patient care. She continued that it's not difficult to segregate waste when you know how.
Susan Bell, manger of a satellite dialysis unit described how she and her team are working towards tough environmental standards and have reduced their clinical waste by nearly 50% without increasing household waste. She also pointed out that by reducing the carbon footprint of the organisation she was indirectly looking after her patients with respiratory conditions.
Paul Hobson referred members to the 2007 RCN publication Safe management of health care waste and stated that safety representatives have the responsibility to push forward the waste management agenda to ensure everyone's safety and protection.
Greg Usrey said that waste management operatives, otherwise known as bin men, removed waste from his home. He continued that as far as he is aware nurses are not bin men, so why are community nurses using their own cars to transport clinical waste. There are examples of nurses resigning their posts in protest of this practice, he said.
Susan Sanderson, agreed with Greg's points, going on to say that some PCTs have waste contractors. She said infection control and health and safety are very important and we need to protect community nurses.
Roger Hill described how he had tired to instigate a green bag system at his clinic at one time. It ended up full of lunch wrappers as it was located in the staff room. He also said that changing the colour of the bags from green to orange was a mistake as it was too similar to the yellow bags also used.
Catriona Forsythe continued the discussion by highlighting that most needlestick injuries are to support staff who are stabbed through yellow bags by sharps that have been incorrectly disposed of. She went on to say that it is very clear that you have to be a licensed waste carrier to transport clinical waste and we need to support community nurses.
Daren Higginson presented statistics that the NHS produces nearly quarter of a million of tonnes of waste each year at a cost of nearly £14million pounds. It is that we reduce this cost and redirect the money into patient care, he said.
Marva Duncan spoke about having around ten different bins in her area of work. She said that nurses will learn to use them, but everyone is short of time, so let's use the minimum number of bins we can and make things simple.
Lynsey thanked everyone for their contribution and said that it would be an uphill but worthwhile struggle.
Background
It is widely recognised that carbon emissions contribute to climate change, and around the world governments have implemented targets to reduce carbon emissions. Health care waste production and disposal represent a significant source of carbon emissions; one in every 100 tonnes of domestic waste generated in the UK comes from the NHS, with the vast majority going to landfill sites. An effective health care waste strategy can significantly contribute to carbon reduction, helping in turn to mitigate the longer term negative health consequences of climate change. Indeed, the Sustainable Development Commission estimates that if the NHS achieved a recycling target of between 40% and 60%, the emissions savings delivered would be an estimated 16,500 to 23,000 tonnes of carbon dioxide a year.
The health sector is governed by a plethora of health and safety, transport, and environmental regulations in relation to waste management. In 2006 the Department of Health published its Health technical memorandum 07-01: safe management of health care waste, which set out a unified approach to health care waste management in the UK. This introduced some fundamental changes, including a new colour-coded system - linked to safe disposal - for waste segregation, and regulatory requirements relating to waste audits to support waste segregation, minimisation, recycling and reuse. In November 2007, the RCN published its Safe management of health care waste guidance, providing a summary of the key requirements contained in the Department of Health memorandum.
Effective waste management strategies make sound economic sense. For example, in just three months one major UK teaching hospital successfully reduced its annual volume of clinical waste from 60 tonnes to 45 tonnes, saving £40,000 in disposal costs. The Department of Health's Healthcare waste minimisation - a compendium of good practice contains a number of case studies illustrating the cost savings health care organisations have achieved through the introduction of waste minimisation programmes. Each of the four UK countries now has a national waste strategy in place.
Public health bodies and the government fully acknowledge that any failure to address and mitigate climate change will ultimately lead to a widening of health inequalities. The negative health effects of climate change have recently been documented in a 2008 report by the Department of Health, entitled, Health Effects of Climate Change in the UK.
In 2008, the International Council of Nurses called on nursing associations to support actions to reduce climate change, including the introduction of environmentally friendly waste disposal systems. The RCN is a signatory of the Climate and Health Council's declaration to take action on climate change and global health, and is also a member of Health Care Without Harm, a global coalition of 473 organisations in more than 50 countries working to protect health by reducing pollution in the health care sector.
References and further reading
Royal College of Nursing (2007) Safe Management of health care waste, RCN guidance: London : RCN. Available from the publications section of the RCN website.
Staines R (2008) Can the NHS ever be green? Nursing Times, 104 (29).
Sustainable Development Commission (2008) Healthy futures: the NHS and climate change, SDC. Available from the SD Commission website.