Extreme weather events have become a more common occurrence in Australia and worldwide. It has long been established these events are exacerbated by climate change, mainly due to greenhouse gas emissions arising from fossil fuel combustion. It has also been confirmed by the Intergovernmental Panel on Climate Change that human activity is responsible.
What has all of this to do with recycling?
All products require energy, water and materials to produce, including those used in health care. Large amounts of greenhouse gases are released to supply natural resources for the manufacture of such products with a quarter of the Victorian Government’s energy-related carbon emissions caused by public hospitals and health services. This is due to the nature of services that hospitals provide, which use significant amounts of energy and water and generate large volumes of waste. So, if we can reduce waste in health services, we will have a positive impact on our carbon emissions.
Monash Health has a sustainability committee with broad departmental representation. The health service has rolled out a number of initiatives to reduce waste, including within the Pharmacy Department.
Single use stainless steel forceps and scissors are used within our aseptic suites. These are sent, with those from other areas of the health service, for recycling to a specialty stainless steel recycling company. For the 2017-18 financial year, Monash Health recycled 1822 kg of stainless steel, preventing this from going to landfill. Empty PVC infusion bags and infusion lines are collected and sent for recycling; in the first six months of the 2018-19 financial year, 1200 kg of PVC was recycled and prevented from going to landfill. In addition to these environmental savings, the organisation also saves money on its general waste pick-up, charged by the kilogram.
Another waste item recycled at Monash Health is the Kymguard wrap – a synthetic fabric used as a protective wrap for surgical instruments and gowns when sterilising these items. These are recycled into park benches and road bollards!
A major initiative recently undertaken at one campus was to eliminate plastic bags from the pharmacy journey. Over 45,000 prescriptions are dispensed annually and over 20,000 non-imprest items are supplied to the wards which until July 2019 were contained in plastic bags. With the change to paper bags for prescriptions and reusable PVC satchel for ward supply, this change will eliminate almost 59,000 plastic bags going to landfill annually.
There is, however, a lot that still needs to be done. We need to work with the pharmaceutical industry to improve the labelling of strip packing, to include batch and expiry date on every tablet. This will reduce wastage of medicines being returned from wards not being able to be reused due to the lack of this information. Although the cost of a particular medication may be low and it might be considered not worth the effort to reuse, the bigger picture of the cost of resources – like the electricity required, the land which needed to be cleared to build manufacturing plants and final carbon footprint of the product itself – should also be considered.
Another challenge is transport logistics – we need to lobby wholesalers and manufacturers to make this part of the process greener. Some send deliveries in totes which are collected on the subsequent delivery, but others still deliver in cardboard boxes; even though these can be recycled, it is better to use products which can be reused.
The cold chain delivery of medicines is another transport challenge for pharmacy. Passive shippers, like products made from polystyrene, are frequently used and require the use of gel packs to maintain the temperature. These polystyrene containers can’t be recycled, are damaging to the environment and should be removed from use altogether. We need to lobby for alternate ways of transporting these temperature sensitive items. Reusable containers, while they may increase short-term costs, reduce carbon emissions. One such product is the ‘Cool Green Cell’ utilised by DHL. It is also important to choose transport logistics which offset carbon emissions. Overall, do we just choose the cheapest transportation or do we also consider how green they are? This is a challenge when there is a limited budget but maybe the bigger picture needs to be considered, as the impact of climate change on health will increase the need of the health dollar!
There is a lot to be done to make healthcare more environmentally sustainable and a lot of it requires behavioural change and modified lifestyle choices. It’s best to begin with the ‘low-hanging fruit’ or target those projects which are easy to implement – for example, removing plastics in the pharmacy journey. The decision to take action is crucial, but it’s just a start. In the words of Debra Roberts, Co-Chair of IPCC Working Group II, “The decisions we make today are critical in ensuring a safe and sustainable world for everyone”.
This is an abridged version of an article that originally appeared in the Autumn issue of SHPA’s member journal Pharmacy GRIT (Autumn 2019 issue). SHPA Members can access the article here.