This piece was written by Amy Jahr and Peggy Ebner, both medical students at USC Keck School of Medicine, as part of a collaborative project between the Global Health and Family Medicine student interest groups. Hospital waste is a growing and frequently ignored problem that has far reaching impacts on underserved communities both in the US and abroad. Photo credit: Peggy Ebner
The question of sustainability in healthcare is a growing concern that has yet to receive much attention. While hospital waste is extraordinarily voluminous and the necessity of so much non-recyclable waste is questionable, hospitals for the most part resist efforts to quantify this waste. This may be due to the fact that measures of wastefulness could be used in unfavorable comparisons between facilities, or because hospital administrators suspect that sustainable practices may be more expensive. Practice Greenhealth, a nonprofit membership organization that promotes environmentally-conscious healthcare, estimates that U.S. hospitals generate 5.9 million tons of waste per year. Recent peer-reviewed articles that address the subject are difficult to find. Without data on how much waste hospitals produce, it’s difficult to find solutions for a problem we don’t yet understand. (1)
There are two types of hospital waste, hazardous and non-hazardous. Hazardous materials may be infectious, toxic, or radioactive while non-hazardous items are things like plastic wrappers, packaging, papers, disposable gowns, empty fluid bags, etc.(2) Generally, developed nations have systems in place for ensuring that hazardous waste is disposed of in a way that won’t cause a public health concern. Our problem in the U.S. has more to do with the non-hazardous waste that contributes not only to our rising healthcare costs, but also to the challenge we now face as a society to try to live sustainably with limited resources. However, the problem in a developing nation may be quite different as developing countries struggle to dispose of sharps or infectious materials safely.
While the estimated 5.9 million tons of hospital waste is only a tiny fraction of the estimated 250 million tons of municipal solid waste Americans produce annually, it represents a nontrivial added cost to healthcare. A study of operating room waste for neurosurgeries at University of California, San Francisco found that an average of $968 of medical supplies are wasted per case. This represents 13.1% of the total surgical supply cost for these operations, and totals to an estimated $2.9 million per year for wasted medical supplies, just from the department of neurosurgery. These estimates only grow when scaled to encompass the many other services offered by major medical centers.
A nontrivial portion of these wasted medical supplies are actually still potentially usable. Partners for World Health, a nonprofit dedicated to redistributing surplus medical supplies, reports that hospitals may unnecessarily dispose of many medical supplies for a variety of reasons, including: disposing of “obsolete” equipment after upgrading to a newer model, disposing of competitor’s stock after changing medical supply vendors, disposing of supplies that are past their expiration date, and disposing of supplies due to aggressive infection control procedures. While hospitals typically describe these waste habits as “unavoidable,” the significant volume of these wasted supplies should call these practices into question as we evaluate our role in the stewardship of our environment and rising healthcare costs.
Nonprofit groups like Partners for World Health help to reduce the burden of this waste by collecting unused medical supplies and distributing them to developing communities in need, or even financially-struggling rural U.S. facilities. These efforts are applaudable for redirecting unused medical supplies from landfills, but are a temporary solution to the growing problem of hospital waste. Often in global health we seek to supply a low resource healthcare system with disposable supplies like the ones we use in the U.S., without considering that these items depend on a constant supply arriving indefinitely and often aren’t designed to be sterilized. Therefore, items that can be autoclaved, boiled, or cleaned with disinfectants could be expected to both save money and improve safety in a hospital with limited resources. Reusable items may be even more cost effective in a low resource environment than a U.S. hospital because the number of uses per item may be much higher.
Evidence now exists that shifting to a model of reusable items may also be better for hospitals in developed countries.(3) However, there is currently little pressure on medical supply companies to replace disposable products with items that can be reused. There is even less pressure to design low-cost supplies for developing markets.(4) Until a demand is created for sustainable supplies, disposable items will likely remain the norm in both domestic and international hospitals.
- Mukesh Yadav (2001) Hospital Waste – A Major Problem. JKPractitioner 8(4): 276-282.
- World Health Organization (WHO) (2011) Some Basic Information on Healthcare Wastes. http://www.who.int/news-room/fact-sheets/detail/health-care-waste
- Muscarella LF. Biopsy forceps: disposable or reusable? Gastroenterol Nurs. 24(2):64-68. https://www.ncbi.nlm.nih.gov/pubmed/11847729
- O’Hara NN. Is safe surgery possible when resources are scarce? BMJ Qual Saf. 2015;24(7):432-434. doi:10.1136/bmjqs-2015-004377