A Hospital’s Waste Journey

I cycle the perimeter of Sunshine Hospital. A multi-storey behemoth the size of a large city block, it’s one of several around Melbourne that are part of the Western Health group. Past the Emergency Department and ambulance rank, I finally find the main entrance, lock up my bike and head in. I’m early, so I take a seat in the busy waiting area.

Catherine soon arrives, smiling and friendly, and suggests we go to the hospital cafe to chat. She offers me cake, and I decline, though seeing all the hospital food brings back strong memories.

The last time I was in a hospital I’d been an inpatient, spending ten days in a recovery ward being treated for starvation. Irrigation bags were continuously providing fluid intravenously for the first few days through catheters in my arms; they did haemoglobin checks every four hours, and full blood tests daily, along with heart measurements involving my torso being wired up with electrodes. And then there was all the food — I spent the ten days eating almost continuously.

In hindsight I find myself wondering what happened to all those single-use irrigation bags, tubes, catheters, needles, surgical gloves, and electronic sensor pads, as well as the sterile packaging that it came in. What about all the leftover food and single-serve food packaging? Perhaps it all went to landfill, along with that from the hundreds of other patients each day. I was about to learn just how much waste a hospital produces.

Catherine is the Sustainability Officer at Western Health, but she tells me she started out as a nurse. She later took up a Masters in ‘Environment & Sustainability’ on the side, which, she says, knocked her between the eyes, and made her start thinking about the huge amounts of waste being produced at the hospital. She tried to make small changes, but her efforts were met with a lot of resistance from her colleagues and she was marginalised. To them, she was just making their already difficult jobs more difficult.

She grew frustrated and ended up moving out of healthcare, taking up a job at RMIT while she finished her Masters. Later she worked as a sustainability consultant to engineers doing healthcare projects.

Meanwhile in Western Health, a senior physician Dr Forbes McGain was growing similarly concerned about the environmental impact of their hospitals. I’d been corresponding with Forbes before today via email, and he’d sent me a scientific report revealing that healthcare contributed 7% of Australia’s carbon footprint in 2014/15, and that hospitals and pharmaceuticals accounted for two thirds of that.

Forbes agitated for a sustainability focus within Western Health and managed to influence the CEO — a significant first step — and a new Sustainability Officer role was created. Catherine returned to working in hospitals, this time with some strong allies committed to tackling the hospital’s sustainability issues.

Catherine remembers one of their early projects where Forbes invited in a plastics manufacturer and asked which of their waste plastic items would be useful to him. They identified three PVC items: used face masks, oxygen tubing and irrigation bags for intravenous fluids; which could be re-processed into agricultural hose. They experimented with special bins to collect these, and found it worked well in ICU, in the recovery ward and in dialysis (in other places the bins ended up with too much contamination). This started as a pilot project in Footscray Hospital and has now spread to 150 health services across Australia and the world.

They’ve also had ideas spread to them from other healthcare systems. Catherine tells me about the Little Blue Towels project. Before an operation, doctors and surgeons sterilise their hands and then dry them on little blue towels that come in a sterilised packet. Normally discarded after a single use, an anaesthetist in Melbourne, Dr David Hays, noticed the waste of these high quality, cotton towels and decided to try and change things. These towels are now collected from hospitals across Victoria, New South Wales and the ACT, and then laundered and re-sold as part of a not-for-profit enterprise raising money for people dealing with breast cancer.

We leave the cafe and set off into the maze-like hospital. Long white corridors that intersect with other corridors, countless doors, and numerous staff going about their duties. A staircase takes us to floors where there’s more of the same.

Finally we arrive at Theatre, and Catherine swipes her keycard to let us in. Blue curtains enclose cubicles with mobile beds in them, and doctors and nurses are bustling about attending to patients. Along one section of wall are a number of boxes labelled with ‘PVC Recycling’, ‘Mixed Recycling’ and a special ‘sharps’ disposal unit, as well as two small buckets for collecting the metal nose clips and plastic inlet nozzles of used face masks.

She tells me that the hospital wasn’t recycling anything initially. One of their first steps was to identify waste recycling streams already available in the community, such as co-mingled and e-waste, and then set up a system for collecting these in the hospital. They then expanded this by setting up additional recycling streams, partnering with local companies and factories who can re-process their waste. They now have around 25 different waste collection streams, from diathermy cords for the operating theatres, to machine cords from the bioengineering department, to single use metal instruments.

My brain does a little backflip at this last one. Single use metal instruments? Catherine later shows me a basket full of metal surgical scissors and scalpels that were each used once and then discarded. According to the research, these ‘SUMIs’ are the items that clinicians feel most sorely about when it comes to hospital waste. Her team invented a special basket to collect these in — one that met OH&S requirements to prevent the spread of infection. The SUMIs are then washed, sanitised and given to a scrap metal re-processor.

When starting the SUMIs recycling program, Catherine had said to management: ‘there’s no business case for this, but it’s something your nurses want.’ But then in 2016 the program was rolled out across all Western Health sites, and approximately 500 kg of steel was recycled that year. This equated to about an 80% reduction in sharps bin waste disposal — a huge cost saving.

We cruise through more corridors, and up and down lifts and stairwells, seeing more and more examples of collection bins for different waste recycling streams. In one back room she shows me an e-waste bin full of used batteries and boxes full of used printer cartridges. Another space has boxes for collecting paper and cardboard, and co-mingled recycling.

We stop at an office, interrupting several women working on their computers, and Catherine shows me a little red box on each of their desks. It’s a personal rubbish bin, she explains, visible to each of them while they work and helping to change behaviours. The office only has a recycling bin, so they’re limited to putting landfill rubbish in these small personal bins, and have to empty it themselves.

In a short side corridor lined with different bins, we find one of the waste management workers carting in bags of blue material. I ask him about these, and he tells me they do 130 Caesarian sections per month, all using disposable plastic bed wraps. The contaminated ones go into their biohazard bins to be incinerated, but the rest get recycled. These single-use bed wraps are similarly collected from other operating theatres across the hospital. When I ask him what he thinks about the recycling efforts, he replies seriously that he thinks it’s good; it’s more work separating everything, but he enjoys not having to throw as much into the landfill bins.

At the top of a set of stairs is a plastic bench; the two young men sitting on it don’t seem to understand our interest, but they happily agree to be in the photo I take. Catherine explains that new theatre gowns and a lot of their medical equipment comes packaged in polypropylene sterile wrap, which used to all go to landfill. They teamed up with another manufacturer who now recycles these into products such as bollards, speed humps and furniture, such as this bench.

At last the giant hospital complex spits us out into a rear compound, a large loading zone for trucks and deliveries. In the middle of it sits an enormous machine, the size of a shipping container. This is their rubbish compactor; all the hospital’s landfill rubbish goes in here before being collected by rubbish trucks. I find myself thinking of it as the hospital’s equivalent to the wheelie bin that we leave on the verge in front of our house each week — it’s even the same shade of green. The size of it reflects just how much waste the hospital produces, like that of a small city.

But right next to it is another equally huge rubbish compactor, this one red. A relatively new addition to the hospital, it’s a reflection of how much progress has been made diverting waste from landfill, as this is for their co-mingled recycling. I ask if the act of compacting it makes it harder for the recycling factory to separate the different types of recyclables, but apparently it doesn’t.

Apparently Western Health now recycles about 35% of its waste, diverting 570 tonnes from landfill, whereas ten years ago they didn’t recycle anything. I try to visualise how much rubbish that is, and I find that I can’t.

In a nearby corner of the compound sits a far humbler machine: the hospital’s food dehydrator. Catherine tells me that up to 40% of hospital food doesn’t get eaten, and is thrown away. They now deposit all the waste food in here; vegetables, meat scraps, everything; and the act of dehydrating it causes it to shrink and take up less space, while also preserving it. It then gets collected by a local farmer to use as compost for his olive trees. She tells me how every time she sees him he boasts about how plump and delicious his olives are now.

In another corner of the compound is a storage space stacked high with polystyrene crates, the kind you get when you unpack a new computer from its box. I’ve always assumed polystyrene is one of those things that can’t be recycled, but apparently these are sent to a company that re-processes them into ‘waffle pods’, used in the construction of concrete slabs in the building industry.

But it’s not all about recycling their waste. Ideally they’d like to reduce how much waste they produce, and re-use items where possible. Catherine tells me that she engages with each section of the hospital to come up with separate environmental action plans.

One section that has some unique challenges is pharmaceuticals, where 95% of their environmental footprint is in the packaging. The excessively large packet that tablets and pills often come in is one example, she says, and she describes how patients are often given a foil packet the size of a credit card but with only one tablet in it. The battle with pharmaceutical packaging seems to be one she’s not sure if she can win.

Re-entering the maze, we end up in the corridor outside the pharmaceuticals lab where she shows me a large stash of empty polystyrene boxes, used for the receival of medications that needed to be kept chilled. The hospital has now started sending these back to the suppliers to be re-used. Inside are bubble-wrap ice bricks, long-since defrosted. Apparently they send these back too. ‘We said to the ice brick supplier that we want you to send us the same ones back, not always new ones’, Catherine tells me. It’s a work in progress, it seems, as the suppliers don’t always cooperate.

I’m taken to one last place in the hospital. It’s a noisy room, a humming and sloshing sound emanating from three large machines along one wall. Two women wearing hospital gowns and hair nets are moving about the room busily. This is the ‘Central Sterile Services Department’, where the sterilising machines work almost continuously day and night. Each machine uses the energy of about ten houses, Catherine says, but a study they did found that they spend about a third of the time idling. By switching to only using two of the machines, and keeping the third switched off and on standby just for peak times, they’ve been able to save a huge amount of power.

She tells me of a study they did looking at ‘surgical dressing packs’ (sterile kits that contain a set of surgical implements in a small dish) and comparing whether it would be more environmentally friendly to use single-use packs or packs they can sterilise and re-use. The results were mixed; for the small, simple surgical packs, they found it was better to sterilise and re-use them, but for the larger, more complex packs, single-use is better. This was because of the large amount of energy required to sterilise the larger packs, which predominantly comes from coal power.

I’m struck by how complicated the topic of sustainability is, but I admire how seriously Catherine takes it. They’re not just doing it for show, but are looking in to the details to make sure they’re genuinely reducing the hospital’s environmental impact.

In 2017, as part of dealing with their energy usage, they installed a 300kW solar system on the roof of Sunshine Hospital, delivering the equivalent of about 60 average four-person homes worth of electricity from the sun. They’ve also been upgrading their lights to LEDs in all their hospitals, and gradually making the move to more energy efficient equipment. Catherine’s also trying to push to escape their existing electricity contract so they can switch to a power provider that sources electricity from renewables, but she says this is very contentious, as medicine is very conservative.

We move into a quieter alcove at the back of the sterilising room so we can talk more easily. It’s lined with more bins for the different recycling streams than any place we’ve visited so far; kind of a culmination of the hospital’s enormous recycling effort. There’s the PVC face masks, irrigation bags and oxygen tubing, the single use metal instruments, single use bed wraps, commingled recycling, paper and cardboard; and there’s even a box for aluminium foil pharmaceutical packets.

Another waste management worker comes in while we’re there, a man named Agim, and he stops to chat with us. Apparently he’s very dedicated to the recycling cause, and Catherine tells me he’s one of their superstars, making sure that the different types of waste are separated properly. As we’re chatting one of the women operating the sterilising machines meekly appears and, having overheard our conversation, she confesses she put some rubbish in the wrong bin and proceeds to try to fish it out.

Catherine finally escorts me back to the main entrance — I wouldn’t be able to find it without following her — and we’re back amongst patients and their families, most of whom are oblivious to the remarkable work being done behind-the-scenes here.

It’s been a jam-packed tour, and I’m amazed at how much Catherine and her team have achieved. I imagine that changing behaviours in such a large and conservative institution must be like trying to turn the Titanic, to which Catherine says that it can be frustrating; projects take a long time and she’s learnt to become more patient, as people don’t like change.

After saying goodbye and returning to my bike, it strikes me that the turning of the ship started with the hiring of a Sustainability Officer to drive forward the change. I find it reassuring to know that her role has become a key part of the medical profession.

A huge thanks to Dr Forbes McGain for helping me arrange my visit, and to Catherine O’Shea for taking the time to show me their amazing work.

Thanks for following my journey! Can you donate to help keep me pedalling forwards?