The rapid advancement in medical technology and healthcare services has undoubtedly improved patient outcomes and global health. However, the consequential surge in medical waste poses a significant threat to the environment.

Medical waste, also known as healthcare waste or biomedical waste, is generated during the diagnosis, treatment, or immunisation of humans [and animals]. The improper management of medical waste can lead to severe environmental pollution and pose health risks to both humans and ecosystems.

While medical waste constitutes a relatively small percentage of the total waste generated globally, its ecological impact is disproportionately significant, because of its biological and chemical nature. According to the World Health Organisation (WHO), healthcare activities generate approximately 6 million tons of medical waste annually, with the potential for exponential growth as healthcare services expand.

1. What is the composition of medical waste?

Medical waste is a diverse mix of materials, each requiring unique disposal methods. The major components include:

Infectious waste: waste contaminated with blood and other bodily fluids.

Sharps: needles, syringes, and other objects capable of causing injury or transmitting infections.

Pathological waste: tissues, organs and body parts removed during surgery or autopsy.

Pharmaceutical waste: expired or unused medications.

Chemical waste: laboratory reagents, disinfectants, and other chemical substances.

Nuclear waste: from degenerated nuclear isotopes used in nuclear medicine tests and treatments.

2. What are the current and the recommended disposal practices?

The disposal of medical waste varies widely across regions and healthcare facilities. Common methods include incineration, autoclaving, landfilling, and non-burn technologies. Unfortunately, inadequate waste segregation and improper disposal practices contribute to environmental contamination and the release of harmful pollutants.

A comprehensive and standardised approach to disposal is essential. This includes:

Segregation at source: proper sorting of waste at healthcare facilities to separate different types of medical waste.

Safe packaging: ensuring secure packaging of medical waste to prevent leaks and contamination during transportation.

Environmentally friendly treatment technologies: such as autoclaving, microwaving and advanced non-incineration methods.

Promotion of recycling: exploring opportunities for recycling and reusing certain types of medical waste, such as plastics and glass.

To achieve these recommended disposal practices, a multi-faceted approach involving all stakeholder, at various levels, is required. Key strategies should include:

Legislation and regulation: implementation and enforcement of stringent regulations governing the management and disposal of medical waste.

Education and training: training healthcare facilities in proper waste management practices to ensure compliance with guidelines.

Green Procurement: adoption of environmentally conscious procurement policies.

Research and innovation: encouraging research into alternative, sustainable materials in healthcare and promoting innovation in waste control technologies.

3. Plastic, and more plastic

While it is not a medical waste per se, plastic is ubiquitous in medical facilities. Single-use plastic packaging, while providing sterility and convenience, contributes to the accumulation of non-biodegradable waste.

This issue is compounded by the fact that many medical products, from gloves and syringes to medications and equipment, are individually wrapped or over-packaged, leading to redundant plastics that may exceed what is necessary for sanitation and protection. Reducing the reliance on single-use plastics, optimising packaging designs to minimise waste, and adopting reusable or biodegradable alternatives are critical steps in addressing the environmental impact of plastics in the healthcare industry.

4. What about energy consumption in medical facilities?

In addition to the environmental impact of medical waste, the high energy consumption in medical facilities is a significant contributor to the overall ecological burden:

Electricity consumption: medical facilities often house a multitude of energy-demanding equipment, including diagnostic imaging machines, laboratory instruments, and life-support systems. The 24/7 operation of these devices contributes to substantial electricity use. Implementing energy-efficient technologies, such as LED lighting, smart machines and HVAC systems, and renewable energy sources, can significantly reduce the carbon footprint of healthcare facilities.

Petrol consumption: the transportation of medical professionals, patients, and supplies relies heavily on petrol-powered vehicles, contributing to air pollution and greenhouse gas emissions. Integrating electric or hybrid vehicles into medical transportation fleets and promoting the use of public transportation can be quite helpful.

5. Radiation scatter from imaging machines: a hidden environmental impact

In addition to the conventional concerns detailed above, the radiation scatter from imaging machines poses a unique environmental challenge that often goes unnoticed. Medical imaging technologies, such as X-ray machines and computed tomography (CT) scans, emit ionising radiation. The scatter of this radiation beyond its intended target can contribute to an increase in background radiation levels in the environment and communities. It goes without saying that the more X-ray based machines are in a given community, the higher is the level of background radiation.

Ionising radiation has the potential to interact with and ionise atoms in living tissues, leading to potential health risks, including an increased likelihood of cancer.

To address this environmental risk, several mitigation strategies can be implemented:

Optimised imaging protocols: that minimise unnecessary radiation exposure without compromising diagnostic quality.

Advanced shielding techniques: to contain and minimise the scatter of radiation beyond the target area.

Regular monitoring: especially in the vicinity of medical facilities to ensure compliance with established safety standards.

Regulating the proliferation of imaging facilities: by balancing diagnostic necessity, financial profit and environmental safety. As an example, according to the American College of Radiology, an acceptable benchmark might be an average of one CT scanner per 100,000 to 150,000 people!

In synchrony with the 2023 COP28 meeting in the UAE.

Joe Yammine, MD, is a consultant cardiologist at the Bermuda Hospitals Board. The information here is not intended as medical advice or as a substitute for professional medical opinion. Always seek the advice of your physician