Thousands of tons of biomedical waste are generated annually by healthcare establishments in Quebec, including syringes, glass vials, compresses, surgical tools, etc. However, some hospitals are more innovative than others in managing these colossal quantities of waste.
Although it is not the most polluting sector – in Quebec, health generates 3.6% of the province’s GHG emissions – a significant quantity of biomedical waste ends up in landfill sites.
According to the organization Synergie Santé Environnement, more than 17,000 tonnes of biomedical and pharmaceutical waste are produced annually by health and social services establishments in Quebec.
There are two main categories of waste: anatomical waste, which includes human tissues, and non-anatomical biomedical waste. The first category only represents about 20% of biomedical waste. Moreover, it must be treated by incineration.
No hospital processes anatomical waste on site. It is entrusted to companies to be processed by incineration outside Quebec, the Ministry of the Environment said.
For non-anatomical waste, the ministry said that about thirty hospitals use an autoclave to disinfect it. Once treated, this waste is managed as residual materials.
Other hospitals that do not manage their waste on site use specialized companies that use autoclave or microwave technologies.
Autoclave technology, which disinfects its contents with very hot steam, has its share of drawbacks, according to Jérôme Ribesse, general director of Synergie Santé Environnement.
He argues that water, which has potentially been in contact with viruses or products harmful to health, is returned to the sewers. “We have a potential impact on water in terms of water consumption and water that we return to the environment. We don’t know exactly if it is polluted or not, if it meets standards or not,” he says.
Mr. Ribesse believes that Quebec was avant-garde when it adopted its Regulation on biomedical waste which was intended to reduce the risks associated with their management, but since then he says the province has been dragging its feet.
“It’s always this problem in Quebec: we don’t pay for water, or we pay for it, but we don’t really know how much. We don’t pay much attention to it. Our idea in working with health establishments was to start working on different aspects of sustainable development, to have the most holistic vision possible of environmental impacts,” he explains.
Mr. Ribesse worked with the CISSS des Laurentides to install an Ecosteryl machine on the Saint-Jérôme Hospital site in 2018. In Quebec, there are only two machines of this type from the Belgian company AMB, the other being owned by the company DBM environnement.
In summary, the Ecosteryl machine disinfects biomedical waste by microwaves, therefore without using water, and it shreds its contents into small confetti, which reduces transport to landfill sites in addition to taking up less space on the site. It also reduces the risk of cuts and injuries for people operating the machine.
Eliminate waste at source
Non-anatomical biomedical waste from all CISSS des Laurentides health facilities is repatriated to the Saint-Jérôme Hospital, except for a few more distant sites. With the Ecosteryl machine, the volume of waste is reduced by 80% in addition to generating savings. The CISSS is talking about a few hundred thousand dollars annually since the machine was put into service in 2018.
Ultimately, the goal would be to recycle biomedical waste, but for now there are too many types of waste that should not end up there.
Other hospitals that don’t have this machine are working hard to reduce waste at the source. This is the case at St-Mary’s Hospital in Montreal, which has changed small practices that are making a big difference.
The hospital first changed the anesthetic gases to other, less polluting gases because it was an easy step to take.
Lyndia Dernis, an anesthesiologist at St. Mary’s Hospital, has led several projects to reduce and better sort waste. For example, her department made rolling laundry bins to sort paper and plastic while staff prepare the operating room. This small gesture makes a big difference and maximizes recycling, says DD Last.
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St. Mary’s Hospital in Montreal has changed its anesthetic gases to other, less polluting gases.
“The side that generates the most waste is the surgical side. Quickly, the nurses on the surgical side said that it was on their side that it would make a big difference. We started small, and gradually it really grew,” mentions DD Last.
“There are some studies that say that 75% of the waste in an operating room is ready before the patient even enters the room,” she points out.
The operating theatre at St. Mary’s Hospital has also switched from disposable armrest pads to pillowcases. It also introduced breathing circuits last year with reusable tubes instead of single-use ones. The theatre previously used 14 tubes a week, but now only needs one.
DD Dernis says she is discouraged by companies that sometimes triple-package the same item. “For a lot of products, we have user guides in every language you can think of, especially for prosthetics and things like that. But if you have that in your hands, you’re supposed to know how to use it instead of being given a bible that explains how to do it. I’m sure we can do better, but the industry isn’t necessarily working to help us,” she says.
Significant savings
Another aspect of exemplarity at St. Mary’s Hospital concerns the polypropylene packaging of surgical instruments. Often, the packaging would tear, which would render the instruments non-sterile, and could even delay surgeries. Now, gradually, these packagings are being replaced by reusable (and sterile) metal boxes.
“In the operating room, we know that we pollute, we know that single use is a disaster, and we started to work on what we can switch to multiple use, what we can try to avoid as waste and it has become a huge project, not only in reducing the carbon footprint, but also in reducing the overall ecological footprint,” rejoices DD Last.
One of the hospital’s most recent changes involves sending surgical forceps, where possible, to an American company that sterilizes them again and sells them for less. Without risk to the patient, this has saved the hospital $4,000 in six months.
“We save on costs and we save on waste,” emphasizes D.D Denis. She has not finished having ideas that she is implementing voluntarily with the environmental committee of the CIUSSS l’Ouest-de-l’Île-de-Montréal.
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