Frontline support: Ace Waste

Waste Management Review speaks with Queensland Health operators and suppliers about managing medical waste in the wake of COVID-19.

As governments, working in conjunction with medical and scientific experts, continue to evaluate the transmissibility and severity of COVID-19, Australia’s National Biohazard Waste Industry Committee is suggesting a degree of precaution.

While there is no evidence as of yet that direct, unprotected human contact during the handling of healthcare waste has resulted in COVID-19 infections, medical knowledge is evolving with each passing week based on epidemiological advice.

The committee therefore suggests medical staff responsible for the management of increased, and potentially more hazardous, clinical waste volumes introduce additional safety measures.

To respond to the COVID-19 situation, Logan Hospital, a major hospital in one of the fastest growing regions in Queensland, has set up a specialised Fever Clinic to test patients suspected to have COVID-19.

The clinic is located in a separate concreted alcove adjacent to he hospital’s Emergency Department to protect staff, visitors and other patients, and can only be accessed with consent from triage nurses after an outdoor consultation.

In addition to setting up the new clinic, Wayne Hebblewhite, Logan Hospital Environmental Services Manager, says the hospital is adapting its waste management processes.

“The main change is that we’ve had to double bag all our clinical waste, as well as labelling and locking or zip tying all our clinical waste bins. It’s a change in processes,” he says.

These changes are in line with the National Biohazard Waste Industry committee’s COVID-19 clinical waste guidance, which urges healthcare workers to implement double bagging of waste from COVID-19 confirmed patients.

“By placing contaminated waste into a primary clinical waste bag and tying this bag up prior to disposal in the lined mobile garbage bins – the bag lining the mobile garbage bin must also be tied up – a significant increase in protection can be achieved,” the committee states.

To manage these changes, in addition to heightened levels of waste generation, Wayne has been working closely with Logan Hospital’s clinical and related waste management provider Ace Waste.

“From day one, they sent out all the literature we needed to follow their instructions and gave us clear guidelines on how to manage potentially COVID-19 contaminated waste,” Wayne says.

He adds that Logan Hospital’s Ace Waste Key Account Manager, Ben Huxley, came to the hospital to discuss process changes and walk the Logan team through the process. Wayne says he’s been very supportive.

“We needed additional bins and they were provided the following day,” Wayne says.

“We also required foot pedals for bins in our clinical waste areas to minimise human contact, and Ace Waste were able to provide those to us as well.”

According to Wayne, Ace Waste’s level of service has been consistent throughout the long-standing relationship.

“We’ve always found Ace Waste to be 100 percent professional. Ben is in contact at least once a month to discuss any sorts of issues we have. Nothing is too much trouble, if they can help us, they will,” he says.

David Brown, Wide Bay Hospital & Health Services Region Operational & Support Services Manager, expresses similar sentiments.

“We’ve been working with Ace Waste for 12 months, and in those 12 months we’ve had a seamless transfer from our previous contractor to Ace Waste,” he says.

“We’ve had no issues whatsoever, and to this date, I’ve had zero complaints from any of our facilities about the clinical waste service Ace Waste provides.”

Servicing more than 214,000 people across an area of 37,000 square kilometres, David’s operations cover the Bundaberg, Fraser Coast and North Burnett regions, as well as parts of Gladstone.

“We’ve seen an increase in our clinical waste product, with more kilograms being created, and as a by-product of that, we’ve had to increase the storage capacity of our bins, which Ace Waste helped facilitate,” he says.

Queensland Health’s recently released COVID-19 waste management recommendations stipulate that all staff should be trained in the correct procedures for waste handling.

To support this effort, Ace Waste have provided Wide Bay with extensive educational material that breaks down waste segregation in a simple and consistent manner.

“The material covers: what is clinical waste and what goes in which bin. It’s been very handy having that at this point in time with COVID-19 happening,” David says.

As part of its response to COVID-19, Queensland Health is supporting the internal expansion of Intensive Care and Emergency Department capacity.

According to Ben Huxley, Ace Waste Key Account Manager, Ace Waste is working to support their clients through this expansion by developing bespoke procedures and providing information on safe handling, transportation and waste receiving requirements.

“Since early March, there have been a considerable number of Fever Clinics established throughout our service area, both within hospital campuses and as stand-alone operations,” Ben says.

“An ongoing challenge faced by Ace Waste in supporting these services has been identifying and adapting to the rapidly evolving demands and service delivery platforms.”

Using their intimate knowledge of healthcare industry needs, systems and compliance, Ben says Ace Waste have been able to assist in process development and provide appropriate equipment requirements for each facility it services.

“Ace Waste is also providing expanded waste collection frequencies and facilitating additional servicing demands to ensure the focus of our healthcare professionals remains on providing the highest level of care to our community,” he says.

Ben adds that Ace Waste understands that future changes are likely to occur and is planning for a ‘worst case scenario’.

“Ace Waste is working on further expansion to accommodate future increased demand, and we are well positioned to service the Queensland community should the need arise,” he says.

“We’re in the midst of an unprecedented global pandemic, and it’s now more important than ever to support our valued clients in the medical and healthcare sector.”

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Pharmaceuticals in the water

Waste Management Review speaks with Ace Waste about a waste definition loophole that’s seeing upwards of 525,000 kilograms of pharmaceutical waste landfilled in Victoria each year.

Following a two-year testing period of Melbourne water streams, a 2018 study, published in Nature Communications, found traces of 69 different drugs in observed insects and spiders.

According to the study, a platypus living in a stream on Melbourne’s fringes could receive more than a half human dose of anti-depressants each day.

The study did not specifically address how the drugs ended up in Melbourne’s waterways. That said, the research team suggested that they likely entered via the sewer system.

Similar studies have been conducted into the result of household flushing of pharmaceuticals, such as a 2017 Environmental Pollution report that found pharmaceuticals in surface water in Antarctica. Investigations into the phenomenon from the context of hospitals, however, yield little results.

While pharmaceuticals entering the environment via hospitals hasn’t sparked significant publicly accessible research, Ace Waste’s directors believe it’s a significant issue.    

Under Australian federal law, all pharmaceutical waste must be incinerated to ensure it is disposed of in the safest way possible. Clinical waste however, which includes any material resulting from medical, nursing, dental or otherwise health related activity, can legally be either incinerated or treated before landfill.

While on the surface the distinction seems apt, a half-full vial of codeine poses more environmental and human health harm than a disposable medical glove, the standard makeup of clinical waste complicates the situation.

Managing Director John Homewood says Ace Waste has been working in this industry for 31 years and as part of its central business practice, conducts regular waste audits.

“We’ve found that on average, 15 per cent of clinical waste is pharmaceutical, including physical drugs and chemical residue.”

For example, Executive Director Alex Homewood says when a patient is injected with morphine or other scheduled drugs, residual liquid remains inside the sharp or syringe.

“That sharp then goes into a sharps container, but the residual morphine remains present,” he says.

“Residual pharmaceutical additives also remain in infusion bags and IV lines, which can hold in excess of 100 millilitres.”

Currently, no public hospital in Victoria incinerates its waste according to Alex, meaning all clinical and related waste in the state is treated and landfilled.

“It has simply been that way for many years, and whether Melbourne health facilities have done audits to satisfy themselves I do not know, but what I do know is that our audits show 15 per cent of clinical waste contains pharmaceutical residue, if not pharmaceuticals,” he says.

“That fact implies that all Victorian hospitals are inadvertently breaking the law.”

In contrast, Alex says all public hospitals in South East Queensland use incineration to process clinical waste.

“All hospitals from Wide Bay right down to the border insist on high-temperature incineration because they recognise the problem of pharmaceutical waste residues,” Alex says.

While the Victorian EPA is responsible for regulating the storage, transport, treatment and disposal of clinical and related wastes in Victoria under the Environment Protection Regulations 2009, its Clinical and Related Waste Operational Guidance resource highlights generator responsibility.

Generator responsibility, broadly, refers to the concept that a producer of waste is responsible for its accurate definition and subsequent disposal.

According to the EPA guidance paper, generators must take all necessary precautions to minimise potential hazards, and ensure they manage clinical and related wastes safely and legally.

While the EPA guidance resource was published in 2009, at the time of writing, it is the only related resource available on the EPA Victoria website.

“I can’t speak to internal processes and whether or not individual hospitals are aware of the problem, but when hospitals are branding pharmaceutical waste clinical and related, and therefore sending it to treatment and landfill, that’s a breach of the law and a basic responsibility to protect human health and the environment,” John says.

While the knowledge of individual hospitals isn’t clear, John and Alex say they have informed the Victorian Health Department (VicHealth).

“The Health Department is aware, and they need to start taking serious steps to address the problem,” John says.

In an average year, 3.5 million kilos of clinical waste is produced in Melbourne Metro, using Ace Waste audits, that equates to 525,000 kilograms of mistreated waste. John says expanding that figure to Victoria at large highlights a real problem of scale.

“If Victorian hospitals don’t change the way they operate in this space, the health risks are huge, but it’s not that complex, there are very clear avenues available to address it,” he says.

John adds that rectifying the issue will not require huge investments in new waste infrastructure, because the capacity already exists. When you include Ace Waste, there are two companies currently capable of incinerating Victoria’s clinical waste, he says.

“If the state’s hospitals don’t implement strict procedures to separate clinical and pharmaceutical waste at the source, which given the fact medical professionals operate in stressful and often life-threatening situations, would be borderline impossible, VicHealth needs to begin enforcing incineration,” he says.

“Treating and landfilling residual pharmaceuticals is not only contributing to our current environmental problems, but actively making them worse.”

At the time of writing, VicHealth had not responded to Waste Management Review’s request for comment.

This article was published in the December edition of Waste Management Review. 

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Incinerating oceans of plastic: Ace Waste

As the medical industry examines its waste generation and recycling practices, Waste Management Review explores incineration as a solution for non-recyclable plastic.

When speaking with Australian media in September, Peter Thomson, the United Nations’ top envoy for the world’s oceans, compared the fight against plastic pollution to the fight against big tobacco.

Plastic has become so ubiquitous in the natural environment that United Nations scientists suggest it could serve as an indicator of the Anthropocene and lead to a reengineering of the planet.

While extreme, the statement is not without merit. A Project MainStream report, for example, suggests material in the ocean could outweigh fish by 2050, with an estimated eight million metric tonnes entering the world’s oceans every year.

In 2018, an Australian senate inquiry into the waste and recycling industry recommended a ban on all single-use plastics by 2030. Similarly, on the other side of the globe, members of the European Parliament earlier this year voted to ban the material by 2021.

Though initiatives like this are a step in the right direction, associated conversations regularly focus on seemingly frivolous consumer items such as coffee lids, straws and plastic bottles. However, as plastic’s chemical composition lends itself to sterility, it is also a necessary material for the medical industry.

For generations, plastic has been used to manufacture IV drips, syringes, bandages, garments, surgical covers and other indispensable medical products.

One of the most commonly used plastics in the medical industry is polypropylene, which is used to make syringes, pouches, test tubes and beakers. While it is recyclable, state and territory health regulations require it to be disposed of post-use.

Problems stemming from the inadequacy of disinfection methods lead to much of this material ending up in landfill or, as is sometimes the case, the natural environment.

A key issue is a lack of material substitutes for clinical products, meaning the use of single-use plastics in the medical industry is largely unavoidable.

Princess Alexandra Hospital (PAH) in Woolloongabba, Queensland is one of many Australian hospitals attempting to address the issue by introducing proactive reduction and recycling initiatives.

Brendon Seipolt, PAH Operational Services, says the hospital’s actions include recycling programs for PVC, soft plastics and kimguard (a form of sterilisation wrap) and the introduction of sugar-cane-derived, biodegradable kidney dishes.

Brendon says these initiatives led to a 600,000-kilogram waste reduction in 2018. Despite this, much of the waste PAH produces is non-recyclable, namely contaminated clinical soft plastic. To handle the material, PAH engaged clinical waste incineration specialists Ace Waste.

“PAH produces an average of 700,000 kilograms of clinical waste per year that requires incineration, in keeping with safety and quality practices,” Brendon says.

“This is a significant reduction of over 200,000 kilograms since 2012, through an ongoing program of appropriate waste identification and disposal.”

Alexander Homewood, Ace Waste Executive Director, says that while sustainability programs like those implemented by PAH and other medical facilities are important, recycling alone cannot sufficiently address the plastic problem.

“In the medical industry, the spectre of non-recyclable plastics is complex, with the reality of infection control and single-use necessity challenging the notion that recycling and landfill are the only waste management mechanisms available,” Alexander says.

He adds that conservative estimates suggest 30 per cent of all clinical waste is non-recyclable contaminated plastic.

“Ace Waste works with the PAH and other health clients throughout Queensland and Victoria to manage the second part of the equation, and in doing so close the loop with a service that destroys everything through incineration,” Alexander says.

“Ace Waste’s high-temperature incinerators present a viable alternative by completely destroying infectious materials, which stops it from entering the ocean, while also ensuring pathogens are unable to enter the ground or atmosphere.”

In addition to destroying the material in its entirety, the Ace Waste incineration process creates a high-calorific energy source.

Incineration plants generally require natural gas to maintain combustion. However, Alexander says the high plastic content of clinical waste streams means Ace Waste’s incinerators produce enough energy to independently maintain combustion conditions.

“Contaminated plastic in clinical waste produces 28 megajoules per kilo of heat energy, and by comparison coal produces 32,” Alexander says.

“By burning contaminated non-recyclable plastic, Ace Waste is generating significant amounts of energy from a material source that usually ends up in landfill or worse, in the ocean.”

While avoidance and recycling are the key drivers towards positive environmental outcomes, society can’t ignore the reality of waste generation in the medical industry.

“We need to understand that some waste is unavoidable, and rather than turning a blind eye, should consider disposal methods that support the overall goal of a more healthy and sustainable future,” Alexander says.

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High Temperature Incineration: Ace Waste

Waste Management Review talks to Metro North Hospital’s Waste Manager Gregg Butler about clinical waste regulations and the benefits of high temperature incineration.

Becoming one of the healthiest communities in the world by 2026 is the official vision of the Queensland Health Department.

To achieve this outcome, the department is committed to ensuring available resources are used efficiently for future generations, according to the department’s 2018-20 Waste Reduction and Recycling Plan.

To attain desired sustainability, the department has repurposed the waste hierarchy to highlight the importance of waste reduction and recycling within hospitals.

Brisbane’s Metro North Hospital and Health Services Environment and Waste Manager Gregg Butler, who has worked in the health sector for over 40 years, is at the forefront of rethinking waste in the industry.

“Over the years, Metro North have worked to install all sorts of waste management initiatives throughout our facilities,” Gregg says.

Metro North initiatives include the “Know Which Bin To Throw It In” campaign, which educates staff on correct waste segregation and the tube terminator, a machine that destroys lightbulbs to reduce the impact of mercury in landfill.

“The money we save through recycling and waste reduction initiatives allows us to buy new equipment such as hospital beds, which is beneficial for the community,” Gregg says.

While the waste hierarchy privileges avoidance and reduction, hospitals by their very nature generate a significant amount of waste that cannot be recycled.

“Recycling what we can is important, but a lot of hospital waste is hazardous and needs to be disposed of responsibly, namely clinical waste,” Gregg says.

Clinical waste is an unavoidable waste stream with limited diversion and processing methods. It is generally defined as any waste with the potential to cause disease, including discarded sharps, human tissue and laboratory waste.

Standard Australian destruction practices fall largely into two camps, autoclave and incineration.

“I don’t like treating clinical waste though autoclave because as far as I’m concerned, it doesn’t get rid of the pathogens and some of the needle and blood products,” Gregg says.

“Ace Waste are the only ones with incinerators in Queensland, and in my personal opinion, incineration is the way to go.”

To process its clinical waste, Metro North work closely with family owned medical waste disposal company Ace Waste.

Ace Waste was founded in 1987 in response to the need for a professional clinical waste collection and disposal service. The company provides hospitals, healthcare facilities and other businesses with safe waste collection, storage and disposal services.

Additionally, Ace Waste offers secure transportation and high temperature incineration at their Brisbane treatment facility, located at Willawong.

“Metro North have had a relationship with Ace Waste since they were established in the late 80s,” Gregg says.

“We choose to work with Ace Waste specifically because they incinerate, which I consider the most appropriate disposal method for clinical and related toxic waste.”

According to Gregg, when medical waste regulations came into effect in 1994, Ace Waste were already compliant.

As per the Queensland Government’s clinical and related waste policy, hospital waste must be handled, stored, and transported appropriately to minimise the potential for contact. Additionally, prior to disposal at landfill, all clinical waste must be treated.

While incineration renders the waste unrecognisable, the bi- product in the form of residual ash still requires disposal at a regulated waste disposal facility, which Ace Waste facilitates.

“They can handle anything clinically related as far as regulations go, blood products, cytotoxic waste, chemical waste,” Gregg says.

“They take roughly 80 to 90,000 kilograms from Metro North every month, which is substantial, and they have the know how and capacity to dispose of it safely and efficiently.”

The Ace Waste incineration process involves loading waste into a primary chamber and incinerating it at temperatures between 1000 °C and 1150 °C. The exhaust gas from the secondary chamber is then cooled, before being passed through the air pollution control plant.

The process guarantees the complete destruction of infectious waste materials and ensures pathogens and toxic disease are unable to be released into the ground or atmosphere.

“At those temperatures there is no residue what so ever, which means contaminants won’t turn up in landfill,” Gregg says.

“Additionally, high temperature Incineration converts plastic into energy and is a great substitute for fossil fuels.”

According to Gregg, thermal degradation is a gasification process in essence.

“Not only are volatile plastics used as alternate fuel, the resultant heat destroys pathogens and pharmaceuticals and converts it into carbon dioxide and water,” he says.

Queensland regulations also require clinical waste to be effectively segregated into categories such as chemical waste, human tissue waste and pharmaceutical waste.

“Ace Waste provide appropriate storage bins, which lets staff easily sort waste at the point of disposal,” Gregg says.

“The service has always been A plus with Ace Waste, hence the contracts being renewed over and over again.”

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