Nurses For Nature- Becoming Stewards of Environmental Change in Healthcare

Objectives

• To define medical waste and its impact on the United States.

• To understand the repercussions of COVID-19 on healthcare and the environment.

• To evaluate current environmental issues related to healthcare.

• To propose a simple, low-cost, accessible recycling technique specific to healthcare facilities.

Defining Medical Waste

Medical waste is any substance generated in a healthcare-related industry that may be infectious or hazardous (Shareefdeen, 2012). These wastes are required to be disposed of in separate bins from normal garbage bins. In a typical hospital setting, there is a regular garbage bin, a red bin for “soiled” or “biohazardous”  medical waste (ie. bodily fluids, blood, etc), and a sharps container for needles. However, there is no recycling bin present in many patient rooms- where so many clean plastic products like syringe covers, packaging, and for our purpose- masks, cannot be properly disposed of to reduce the amount of plastic waste being produced by the healthcare industry. 

The poor segregation of recyclable, non-contaminated medical waste makes the healthcare industry a large contributor to the environmental crisis we currently face. As of 2019, the healthcare practices that we participate in have contributed to 2.5 million tons of complex waste, and 10% of the United States’ greenhouse gas emissions (Clark, 2019). Although a global issue, our contributions to medical waste as individual nurses are causing the issue to escalate. And through the direct effects of pollution, patients require our diligent, yet environmentally destructive care, and the cycle continues once again.

COVID-19, Healthcare, and the Environment

The COVID-19 crisis only catalyzed the negative snowball effect that medical waste imposes on our environment. With the emergence of such a contagious disease, the resurgence of single-use plastics, like gloves and masks, skyrocketed. In 2020, 69 billion units of plastic gloves and plastic face masks were being used monthly (Filho, 2021). This statistic is not even specific to healthcare facilities like hospitals, urgent care centers, and long-term assisted care facilities, and would most definitely pale in comparison due to the acuity of COVID-19 cases alone. 

Used face masks trigger the release of many micro- and nano-plastics into the environment, which cumulatively cause an increase in plastic pollution. Although during the COVID-19 pandemic, there were shortages of proper personal protective equipment for nurses, in 2023 we face a distinct environmental issue- the overuse of face masks and other disposable plastics without proper recycling and segregation. Since the knowledge of COVID-19 and its transmission and effects are understood more, the urgency for these products has dropped. However, with the greater availability of these resources has come an overutilization of them. It could be argued that the overuse could be combatted by limiting the quantity of these plastic disposable products purchased per hospital, but this would not solve the fact that despite the number of products dropping, there are few recycling bins on the floors for nurses and other providers to utilize. Plastic materials constitute roughly 35% of all medical waste, and only 39% of medical waste is properly segregated and managed (Singh, 2022). This is a large margin, and opportunity, for the institution of recycling practices in the healthcare domain.

Recycling Proposal- Nurses for Nature

With this information, I decided to commence my initiative Nurses for Nature. Nurses for Nature is a mission I set forth to spearhead as an incoming new nurse with a passion for sustainability and environmentalism. My goal for this project is to unite environmentally passionate nurses to help catalyze these policy changes in their hospital units, systems, and on a far broader scale. Nurses for Nature calls for the implementation of low-cost recycling bins specific for masks, gloves, and other non-contaminated plastic items within all patient rooms of a hospital to maximize recycling accessibility. Penn Environmental Health and Radiation Safety on campus has a partnership with Fisher Scientific and Terracycle to utilize their gloves and masks. These supplies come in a collection box with a prepaid shipping label that can be mailed out for proper disposal. This, however, is limited to Penn’s campus and is not an initiative specifically carried out by HUP or HUP Pavillion. Because there is no specific recycling precedent set in place by the healthcare systems, there is an opportunity for growth in sustainability. Nurses for Nature proposes the implementation of recycling bins in each patient room in all units. Below we will review the costs, efficacy, and relevance of such a project.

Project Costs

A 7-gallon recycling bin costs $6.69. 

• HUP has 988 patient rooms.

• Total cost: $6,609.72

• HUP-Pavillion has 504 beds, 47 ORs.

• Total cost:  $3,686.19

To institute hospital-wide non-contaminated mask and plastics recycling, HUP would only pay $10,295.91. When contrasted to the cost saved by recycling because of the correlation between environmentally-related disease and pollution, this small implementation pales in comparison. 

Another solution to this large contribution of carbon emissions is the implementation of biodegradable face masks. These masks can reduce CO2 emissions by a margin of 30-70% in comparison to the standard plastic face masks used in daily practice. While they are more costly in production (30 cents compared to 5 cents for plastic face masks), the positive environmental impact is undeniable (Ha, 2021).

Efficacy of Project

Upon recycling these products, the Penn Medicine Healthcare System can partner with the Philadelphia Recycling Company for either pickup or mail-in services. The quote for these services was approximately insert value, and the recyclable items collected will be brought to a recycling center for guaranteed landfill-free disposal. 

Recycling drastically reduces the amount of oil and energy that we use. Its estimated that between 36 major countries, 1.5 trillion tons of plastic waste from face masks were produced. For reference, recycling 1 ton of plastic can save roughly 17 oil barrels. In terms of energy, 37% of energy use can be reduced by recycling plastics.

Relevance and Impact

Face masks are considered an “ecotoxic” material since they are largely composed of non-biodegradable and petroleum-based polymers. Many surgical and N95 masks contain small aluminum strips called polypropylene as well (Amuah, 2022). Masks single-handedly, yet substantially, contribute to carbon dioxide emissions, which then further intensify the effects of global warming. They are also a significant source of microplastics in the environment, post-2020.

By carrying out this initiative, Nurses for Nature can spark such a large impact with a small flame. When surveyed, 94% of Americans supported recycling. However, the paramount reason why Americans were not recycling was due to a lack of “convenient access” to recycling bins. As healthcare workers, we have the power to rectify this issue, and encourage others to do the same.

If I can be just one voice promulgating the urgency of this issue, I hope that other nurses and healthcare workers will hear me and join the cause for medical sustainability. I challenge you all to incorporate this practice in your daily lives and communicate the urgency of environmentalism to all those around you.