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Clinical Waste Disposal: Reducing Single Use Plastic within the NHS

The environmental, legal and financial benefits of the switch to a clearly identifiable non-hazardous pharmaceutical waste stream have been appreciated by the trust for a number of years now. We were able to switch from rigid plastic to rigid board-based containment for this waste stream which has helped our trust address the requirement to improve our environmental performance, generate savings whilst continuing to move towards fulfilling our sustainability objectives

Jason Mitchell, Waste Manager
Newcastle Upon Tyne Hospitals NHS Foundation Trust

The challenge

Prior to this implementation several years ago, Newcastle Upon Tyne Hospitals NHS Foundation Trust did not have a fully defined process in place for segregating some elements of healthcare waste. Non-hazardous pharmaceutical waste was disposed of in the same bins as hazardous waste. As the disposal for hazardous waste is more expensive, their costs were being impacted. This practice was also non-compliant with HTM Guidance.

Following an internal review, the trust introduced blue-lidded plastic bins to allow pharmaceutical waste to be disposed of separately to other waste streams. With an increased focus on sustainability, they began looking at ways to reduce single use plastics; adopting board-based rigid containers for pharmaceutical waste. It was also apparent at the time that board-based alternatives were cheaper to purchase than plastic containers.

To successfully implement this new approach to clinical waste disposal, the Trust needed buy in from key stakeholders. There was a lack of awareness about the benefits of segregating pharmaceutical waste from its current method. Questions were raised regarding the quality and durability that board-based waste bins could provide when compared to plastic.

What were our objectives?
  • Raise awareness of the effective benefits when using board based clinical waste disposal streams, across key hospital departments.
  • Reduce the utilisation of single-use plastics when disposing of medical waste.
  • Generate savings on pharmaceutical waste disposal.
  • Successfully implement a segmented approach to waste disposal in line with Trust policy within 6 months of completing a successful product trial.
What is the process?
  1. Recognising the need to implement a more structured approach to waste segregation to reduce plastic usage in the waste process and to generate savings.
  2. Procurement and Waste Management worked together to identify opportunities and then engaged with stakeholders from across the Trust to increase awareness and adoption of waste segregation.
  3. Implemented a board-based blue non-hazardous pharmaceutical waste stream.
  4. Identified that board based bins offered a cost effective alternative – The specific products were selected due to in part the inclusion of an absorbent pad within the bin, allowing for medicinal waste to be added.
  5. Implemented to ‘friendly’ wards and departments including Pharmacy Stores, Clinical Research, specialist wards.
  6. Full implementation across 200 wards was achieved in a matter of weeks. Very straightforward roll-out.
What are the overall benefits?

Upon completion of the trial, 6 months implementation was anticipated – however uptake was very quick, and this was actually achieved within a matter of weeks.Jason Mitchell, Waste Manager
Newcastle Upon Tyne Hospitals NHS Foundation Trust

  • Board-based waste bins were successfully introduced in to 200 hospital wards across the Trust.
  • Based on current waste costs for the Trust 20% savings are achieved by having a separate channel for pharmaceutical waste disposal.
  • 29% of consumables saving were delivered by moving from plastic to board-based waste bins at the time of the trial.
  • There was a reduction in inventory usage due to the flat pack option available with board-based bins.
  • At the time of the trial an estimated 46% reduction in carbon emissions was achieved due to board-based bins being 96% more renewable than plastic.

A point to note is that there have been recent developments in the healthcare waste industry, particularly around incineration outlets which, has led to a reassessment of pharmaceutical waste disposal. As it is non-hazardous, the understanding is that it can be disposed of in permitted municipal incineration plants instead of specialist healthcare waste incinerators; providing it is clearly identified and appropriately labelled. For the most part, this will bring cost savings and be completely compliant if the receiving site is permitted for 18 01 09 waste.

The blue pharmaceutical waste stream was very easy to introduce once ward and department managers understood the need for a compliant and cost-effective system for waste containment and disposal. Introducing board-based containers can be the standard for this system in any hospital.Jason Mitchell, Waste Manager
Newcastle Upon Tyne Hospitals NHS Foundation Trust

Useful insights
  • Board-based clinical waste disposal should be considered when looking at the reduction of single-use plastics.
  • Implementing the change in a small number of departments before rolling out on a larger scale will enable any issues to be addressed early on.
  • Issues will need to be considered around, security of open containers, movement by porters and on-site storage prior to disposal.
  • Pharmaceutical waste does not have to be consigned to a clinical waste incinerator if an alternative permitted municipal waste recovery facility is available which can save a significant amount of money.
  • As board-based bins can’t be wiped clean, it may be that they aren’t be suitable for all Trust departments. Ensure that key stakeholders are identified and engaged with from the outset so that requirements can be captured.
  • Most suppliers provide Floor stands to accompany board-based bins; preventing the bin from splitting if the base becomes wet. This can be caused when floors are frequently mopped.
What is the NHS long term plan?

The NHS Long Term Plan was published in January 2019. It outlines some key commitments to help the NHS be a low carbon institution and lead by example in sustainable development. These commitments include:

  • Reducing carbon emissions
  • Improving air quality
  • Reduction of single use plastics
  • Improving efficiency and adopting new innovations to reduce waste, water and carbon.

Despite a 27% increase in activity, the carbon footprint of health and social care has reduced by 19% since 2007. This still leaves a significant challenge to deliver the Climate Change Act target; the target of which is 34% by 2020 and 51% by 2025. The NHS as an organisation has a huge carbon footprint. A large percentage of which is from the procurement of goods and services. Waste is a contributor to that carbon footprint. In addition, the plan responds to the global concern over single use plastics. Any activity which reduces plastic and reduces waste will be helping the NHS to deliver on its carbon reduction commitment. This will help make the NHS an anchor institution in sustainable development.



Mindray Medical introduces new point-of-care ultrasound system

China-based medical device company Mindray Medical has launched the TE7 ACE point-of-care ultrasound system to deliver targeted solutions in various point-of-care scenarios, such as anaesthesia, critical care and emergency.

The touchscreen ultrasound system comprises complete disinfection solution, smart fluid management tools and safe needling toolkit, offering seamless data connectivity.

Mindray medical imaging system business unit general manager Xujin He said: “Having identified the clinical challenges, Mindray developed this solution to empower clinicians with more confidence to focus on patient care.”

Mindray states that early assessment will help execute the fluid therapy plan and save lives by managing patient body fluid.

The advanced fluid measurement tools of the system speeds-up patient assessments accurately and efficiently based on deep learning algorithms.

Mindray’s system features Smart VTI that can automatically calculate the velocity-time integral, cardiac output and stroke volume variation. The trending graph assists in efficient recording and guides fluid therapy.

The Smart IVC can automatically trace the IVC diameter change, as well as calculate the collapsibility index or distensibility index and IVC variation to evaluate volume status and responsiveness.

The Smart B-line can automatically calculate -lines number, percentage and distance. It offers a visual scoring map for intuitive overall lung water assessment, helping to guide fluid infusion and prevent pulmonary oedema.

The newly introduced L12-3VNs with three programmable buttons brings together eSpacial Navi and remote controls to helps clinicians carry out puncture without touching the system.

Furthermore, the eGateway connectivity solution allows TE7 ACE to fit into the existing hospital network and integrate patient’s clinical data collected from both ultrasound equipment and patient monitors. Due to the paperless process, productivity becomes enhanced and the risk of transcription errors minimise.



Healthcare Supplier relationships

Covidien takes lead in promoting compliance
Healthcare corporation Covidien has launched an online resource to promote ethical working between healthcare professionals (HCPs) and suppliers of medical devices and pharmaceuticals.

Conscientious Collaboration is designed to help educate HCPs about as the laws and codes of conduct that govern supplier-clinician relationships, as well as Covidien’s own policies for commercial engagement.

This initiative comes at a time of unprecedented public scrutiny into the ethical compliance of medical device companies.

Covidien was the first large medical device company to stop direct sponsorship of HCP travel to third-party conferences and congresses worldwide (in 2010). Other measures adopted by the company to ensure its compliance include:

• Delegating decision-making authority for educational and research grant requests to a cross-functional team led by the Company’s Medical Affairs department.

• Creating Investigator-Sponsored Research Grant Committees to evaluate research grant proposals, separate from the company’s commercial operations.

• Moving its funding for minimally-invasive surgical fellowships to neutral organisations such as the Foundation for Surgical Fellowships.

“Given the advancement of technology in healthcare today, the provider-industry relationship has never been more relevant or important, nor more scrutinized or challenged,” said Michael Tarnoff, Covidien’s Global Chief Medical Officer. “Conscientious Collaboration is Covidien’s platform through which we can discuss our proactive approach to ensuring ethical interactions with our HCP partners.”

Medical Devices, a good place to work…….

After witnessing declines in every quarter since the second quarter of 2009, the UK’s gross domestic product (GDP) increased by 0.4% in the fourth quarter of 2009, an indication that the economy is on a recovery path. While the UK continues to recover from one of the worst economic downturns, the healthcare sector, particularly the medical devices industry, is well on its way to witnessing growth.
This resilience to the economic crisis is largely because demand for healthcare is not tied to consumer discretionary spending and it continues to remain stable, even during times of recession.

Healthcare’s underlying drivers

The UK is home to 62 million people, of which 16% are aged 65 and above. By 2050, this will grow to an estimated 77 million. As a sizable chunk of this population continues to age, a surge in the incidences of chronic diseases is also expected. This, coupled with a sustained rise in benefits provided by payers and providers, is expected to boost demand for medical devices and supplies. Many manufacturers and healthcare providers are spending heavily in raising awareness through direct-to-consumer advertising, and this is further boosting the country’s demand for healthcare.

It is not just the private sector that is encouraging growth. The UK Government can be credited with improvements in the country’s healthcare delivery and services infrastructure, the result of a steady increase in spending on healthcare, which was estimated at $220bn (£141bn) in 2009, roughly 10.1% of the country’s GDP.
“As a sizable chunk of this population continues to age, a surge in the incidences of chronic diseases is also expected. This is expected to boost demand for medical devices and supplies.”

UK healthcare spending has witnessed an increasing trend for more than a decade, in absolute terms and as a proportion of GDP. The overall implications of this, and consequently an improved healthcare delivery network, can be judged from the marked improvements in the country’s leading health indicators.
The adult mortality rate (the number of deaths of adults between 15 to 60 years per 1,000 population) fell to 93 in 2010 from 129 in 1990 (males), and to 58 in 2,010 from 78 in 1990 (females).
• Under-fives mortality rate (children less than five years old per 1,000 births), for both sexes, decreased to five in 2010 from ten in 1990.
• Maternal mortality rate (maternal deaths due to childbearing per 100,000 births) fell to 61 in 2008 from 65 in 1990.
• Life expectancy at birth increased to 78 years in 2008 from 73 years in 1990 (males) and to 82 years in 2008 from 78 years in 1990 (females), an indication of the improvement in the UK’s overall health climate.

The flip side to this growth is the severe budgetary constraints that the country’s National Health Services (NHS) will face in the next few years. Publicly financed healthcare expenditure has contributed to most of the increase in health spending for almost a decade.
The UK’s public healthcare is financed through the NHS, the total expenditure of which amounted to $153bn (£98.3bn) in 2009-10.
While the NHS continues to suffer from underfunding, a bigger concern is an estimated £2.6 billion ($4bn) cost savings that the NHS is expected to contribute. Consequently, the funding to NHS for 2010-11 was reduced to £102.3bn ($160bn) from the £104.6 billion ($163bn) originally planned in last year’s budget.

Reportedly, NHS trusts are expected to deliver efficiency savings in the range of £15 billion ($23bn) and £20bn ($31bn) over three years from 2011 to 2014. While there are growth obstacles that do not seem to leave the horizon any time soon, the fact that the underlying demand drivers remain in place, should make the UK industry stakeholders happy.

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