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. 

Related stories:

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.”

Related stories:

PVC Recycling in Hospitals scheme to reach 150 hospitals by end of 2018

The Vinyl Council of Australia aims to expand its PVC Recycling in Hospitals program to cover 150 hospitals by the end of 2018.

After launching in 2009, the recycling program has grown to operate in 138 hospitals throughout Australia and New Zealand. It is managed by the the Vinyl Council of Australia and its member partners: Baxter Healthcare, Aces Medical Waste and Welvic Australia.

Related stories:

More than 200 tonnes of PVC waste from hospitals has been diverted from landfill to recycling over the past year. The material is redirected to reprocessors, which use the recycled polymer in new products such as garden hoses and outdoor playground matting.

The program partners also explore designs for new product applications for the material generated through the program.

Vinyl Council Chief Executive Sophi MacMillan says thanks to the great support and enthusiasm from healthcare professionals, the PVC Recycling in Hospitals program is now operating in every state in Australia, except the Northern Territory.

“It’s a great example of how the healthcare sector can demonstrate leadership in PVC sustainability and recover high quality material that can be genuinely recycled locally for use in new products,” Ms MacMillan said.

“We are currently looking at further end product applications for the recyclate.

“New South Wales is one of our priorities given it only has 11 hospitals participating in the program at the moment. As the state with the biggest population in Australia, the opportunity to grow the program there is really good.”

X