RNs are needed to guide efforts.
- The healthcare industry contributes to solid waste production, greenhouse gasses, and climate change.
- Healthcare workers are obligated to ensure patient safety while practicing environmental stewardship.
Waste reduction in the U.S. healthcare industry is challenging; 931,203 staffed hospital beds produce over 5.9 million tons of waste every year. The effects of mismanaged waste are far reaching and include misspent money, depleted natural resources, toxic chemicals placed in trash and landfills, prolonged plastic degradation, and harmed wildlife.
In support of environmental sustainability, the federally managed Healthy People 2020 initiative focuses on promoting health with objectives that include advancing environmental health. Internationally, the nongovernmental organization Health Care Without Harm (HCWH) aims to reduce healthcare organizations’ environmental footprint through goals that include “responsible consumption and production.” A 2019 position statement from the International Council of Nurses concluded that RNs are well positioned to take a pivotal role in reducing waste, and that the profession has a duty to reduce greenhouse gases and become an advocate for environmental sustainability. In addition, Standard 17 of the Standards of Professional Nursing Practice found in the American Nurses Association’s Nursing: Scope and Standards of Practice, 3rd Ed., charges RNs to practice in an environmentally safe and healthy manner.
RNs’ role as environmental advocates who help monitor and reduce waste continues to grow in response to current disposal processes, advancing technology, and increasing use of disposable patient care items.
Solid waste disposal in healthcare
Healthcare solid waste disposal in the United States has changed over the past 40 years, driven in part by bloodborne infections such as HIV and hepatitis C. In the 1980s, solid waste separation in healthcare organizations became strictly regulated with the Medical Waste Tracking Act (MWTA), which resulted when medical waste (including needles) washed up on the east coast at a time when bloodborne pathogens (specifically HIV) were of particular concern. The MWTA led to state and federal regulations for separating solid waste into two categories: medical (infectious) waste (also called red bag waste) and regular waste (broadly referred to as municipal solid waste [MSW]).
Medical waste is regulated through state governmental agencies such as the departments of health and environmental protection. However, commonalities exist among states. For example, most medical waste is discarded in two containers: red bags and sharps containers. (See Safe disposal.)
Terminal medical waste disposal is state regulated, and every healthcare facility must have a plan for red bag and sharps container disposal that renders microbes innocuous. One process is incineration, which is linked to increased cost, atmospheric emission release that may contribute to health problems, and residue ash that’s disposed of in landfills. To limit red bag use and disposal, the bags should be reserved for infectious waste as defined by each state.
MSW from healthcare settings is deposited in white, clear, or black bags and disposed of in landfills or incinerated and then placed in landfills. According to the U.S. Environmental Protection Agency (EPA), paper and plastics account for 40% of all MSW generated in the United States. In hospitals, this waste includes disposable patient care items and packages, cleaning wipes, paper and plastic waste (cups, forks, paper towels), and personal protective equipment (PPE; gowns, gloves, masks, caps) used in most isolation precaution rooms to reduce the spread of infection. Some PPE, however, may be considered red bag waste if used when caring for patients who are highly infectious (for example, those with Ebola virus disease or filovirus hemorrhagic fever).
The amount of waste from isolation rooms in individual hospitals depends on infection rates and isolation screening and precaution policies. PPE waste disposed of as MSW can be voluminous. Saber and colleagues (2017) conducted a descriptive study that examined solid waste generated from two stable medical patients with methicillin-resistant Staphylococcus aureus infections who were in contact isolation for 1 week. The researchers found that 93% of waste produced was MSW (white, black, or clear bags), 43% (nearly 61 pounds) of which was PPE (gloves, gowns, packaging). Only 8% (11 pounds) of the waste resulted from sharps containers and red bags. This indicates that a tremendous amount of waste can be generated from PPE worn while caring for isolated patients. In fact, caring for one stable patient using contact isolation precautions can produce over 3,700 pounds of solid waste in 1 year.
RNs and environmental sustainability efforts
Both the EPA and World Health Organization promote waste reduction, product reuse, and recycling to limit the amount of waste that goes to landfills and negatively impacts the environment. Support programs are promoted in homes, work places, communities, and schools; they also should be promoted in healthcare organizations. As environmental stewards, RNs can add valuable information and recommendations to reduce, reuse, and recycle MSW and decrease red bag and sharps container waste in healthcare environments. (See Environmental stewardship action plan.)
Responsibility for environmental sustainability belongs to communities, individuals, families, industries, and policymakers. Healthcare, including nursing, is obligated to ensure patient safety and optimal well-being while also practicing environmental stewardship because an unhealthy environment affects overall health and well-being. RNs are knowledgeable about these issues and well positioned to recommend and guide change.
Deborah A. Saber is an assistant professor of nursing at University of Maine School of Nursing in Orono.
American Hospital Association. Fast facts on U.S. hospitals, 2019. January 2019. aha.org/statistics/2020-01-07-archived-fast-facts-us-hospitals-2019
American Nurses Association. Nursing: Scope and Standards of Practice. 3rd ed. Silver Spring, MD: ANA; 2015.
Centers for Disease Control and Prevention. Environmental infection control guidelines. Regulated medical waste. July 23, 2019. cdc.gov/infectioncontrol/guidelines/environmental/index.html#i
Centers for Disease Control and Prevention. Interim guidance for environmental infection control in hospitals for Ebola virus. May 31, 2018. cdc.gov/vhf/ebola/clinicians/cleaning/hospitals.html
Climate Central. Climate matters: World Meteorological Organization annual greenhouse gas bulletin 2015. climatecentral.org/outreach/alert-archive/2016_10.24_GHG-Bulletin.php
Florida Health. Biomedical waste program. floridahealth.gov/%5C/environmental-health/biomedical-waste/index.html
Health Care without Harm. Hospitals find cool ways to reduce greenhouse gas emissions. March 18, 2019. noharm-global.org/articles/news/global/hospitals-find-cool-ways-reduce-greenhouse-gas-emissions
Healthy People.gov. Environmental health. healthypeople.gov/2020/topics-objectives/topic/environmental-health
International Council of Nurses. Position Statement: Nurses, climate change and health. 2018. www.icn.ch/sites/default/files/inline-files/ICN%20PS%20Nurses%252c%20climate%20change%20and%20health%20FINAL%20.pdf
Maine Department of Environmental Protection. Chapter 900: Biomedical waste management rules. maine.gov/dep/waste/biomedical/index.html
NIWA: Taihoro Nukurango. Climate change information for climate solvers. niwa.co.nz/education-and-training/schools/students/climate-change-global-warming-and-greenhouse-gases#change2
Saber D. Disposal of medical wastes from infectious hospitalized patients: A mandate for re-examining current practices. Spire: The Maine Journal of Conservation and Sustainability. May 4, 2017. umaine.edu/spire/2017/05/04/saber
Saber DA, Howlett B, Waterman T, de Tantillo L. Solid waste and disposal processes for isolated patients with infectious disease. OJIN: The Online Journal of Issues in Nursing. 2018;23(2). ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Articles-Previous-Topics/Solid-Waste-and-Disposal-Processes.html
Septimus E, Weinstein RA, Perl TM, Goldmann DA, Yokoe DS. Approaches for preventing healthcare-associated infections: Go long or go wide? Infect Control Hosp Epidemiol. 2014;35(7):797-801.
U.S. Environmental Protection Agency. Greenhouse gas emissions: Overview of greenhouse gases. epa.gov/ghgemissions/overview-greenhouse-gases
U.S. Environmental Protection Agency. Advancing Sustainable Materials Management: 2015 fact sheet: Assessing Trends in Material Generation, Recycling, Composting, Combustion with Energy Recovery and Landfilling in the United States. July 2019. epa.gov/sites/production/files/2018-07/documents/2015_smm_msw_factsheet_07242018_fnl_508_002.pdf
U.S. Environmental Protection Agency. Climate change indicators: Weather and climate. epa.gov/climate-indicators/weather-climate
U.S. Environmental Protection Agency. Climate change indicators: Ecosystems. epa.gov/climate-indicators/ecosystems
U.S. Environmental Protection Agency. Reduce, reuse, recycle. epa.gov/recycle
Voudrias EA. Healthcare waste management from the point of view of circular economy. Waste Manag. 2018;75:1-2.
Windfeld ES, Su-Ling Brooks M. Medical waste management—A review. J Environ Manage. 2015;163:98-108.
World Health Organization. Annex to the Leaders’ Declaration G7 Summit. June 2015. who.int/pmnch/media/events/2015/elmau_annexes.pdf