Innovative Quebec hospitals managing biomedical waste

Syringes are examples of medical waste that hospitals are responsible for disposing of. (Ryan Remiorz, The Canadian Press)

Thousands of tonnes of biomedical waste are generated annually by health-care establishments in Quebec, including syringes, glass vials, compresses, surgical tools and more.

Yet, some hospitals are more innovative than others when it comes to managing these colossal quantities of waste.

Although not the most polluting sector - in Quebec, health care generates 3.6 per cent of the province's GHG emissions - a significant amount of biomedical waste ends up in landfill sites.

According to Synergie Santé Environnement, over 17,000 tonnes of biomedical and pharmaceutical waste are produced annually by Quebec's health and social services establishments.

There are two main categories of waste: anatomical waste, which includes human tissue, and non-anatomical biomedical waste.

The first category represents only around 20 per cent of biomedical waste.

It must be treated by incineration.

No hospital treats anatomical waste in-house.

Instead, it is contracted out for incineration outside Quebec, according to the Ministry of the Environment.

For non-anatomical waste, the ministry said that some 30 hospitals use an autoclave to disinfect it.

Once treated, this waste is managed as residual waste.

Other hospitals that do not manage their waste on-site use specialized companies that employ autoclave or microwave technologies.

According to Synergie Santé Environnement managing director Jérôme Ribesse, autoclave technology, which disinfects its contents with very hot steam, has its share of disadvantages.

"We have a potential impact on water in terms of water consumption and water returned to the environment. We don't know exactly if it's polluted or not, if it meets standards or not," he said.

Ribesse believes that Quebec was ahead of its time when it adopted its Biomedical Waste Regulations in 1992, aimed at reducing the risks associated with the management of biomedical waste, but since then, he says the province has been dragging its feet.

"It's always this problem in Quebec: you don't pay for water, or you pay for it, but you don't really know how much.We don't pay too much attention to it," he said. "Our idea in working with health-care establishments was to start working on different facets of sustainable development, to have as holistic a vision of environmental impacts as possible."

Ribesse worked with the CISSS des Laurentides to install an Ecosteryl machine at the Saint-Jerome Hospital site in 2018. In Quebec, there are only two machines of this type from the Belgian company AMB, the other being owned by DBM environnement.

In short, the Ecosteryl machine disinfects biomedical waste using microwaves, i.e. without using water, and shreds its contents into small confetti, reducing transport to landfill sites and taking up less space on site. It also reduces the risk of cuts and injuries to those operating the machine.

Eliminating waste at source

Non-anatomical biomedical waste from all CISSS des Laurentides health-care facilities is repatriated to the Sainte-Jerome Hospital, except for a few more remote sites.

With the Ecosteryl machine, the volume of waste is reduced by 80 per cent, in addition to generating savings.

The CISSS is talking about a few hundred thousand dollars annually since the machine was commissioned in 2018.

Eventually, the goal would be to recycle biomedical waste, but for now, there are too many types of waste that shouldn't end up there.

Other hospitals that don't benefit from this machine are working hard to reduce waste at source.

Such is the case at St-Mary's Hospital in Montreal, where small changes are making a big difference.

The hospital began by switching from anaesthetic gases to other, less polluting gases because it was an easy step to take.

Lyndia Dernis, an anaesthetist at St-Mary's Hospital, has spearheaded several projects to reduce and better sort waste.

For example, her department has made laundry bins on wheels to sort paper and plastic when staff are preparing the operating room.

"This small gesture makes a big difference and maximizes recycling," said Dernis.

The side that generates the most waste is the surgery side.

"It didn't take long for the nurses on the surgery side to say that it's on their side that it's going to make a big difference. We started small, and over time it really grew," said Dernis. "There are some studies that say 75 per cent of the waste in an operating room is ready before the patient even enters the room."

The operating theatre at St-Mary's Hospital has also changed from disposable quilts covering armrests to pillowcases.

Last year, it also introduced breathing circuits with reusable hoses instead of disposable ones. The OR used to use 14 hoses a week, whereas now only one is needed.

Dernis said she is discouraged by companies who sometimes package the same item three times: "For many products, we have user guides in every language imaginable, especially for prostheses and things like that. But already, if you've got it in your hands, you're supposed to know how to use it, rather than having some kind of bible explaining how to do it. I'm sure we can do better, but the industry doesn't necessarily work to help us."

Significant savings

Another exemplary aspect of St-Mary's Hospital concerns the polypropylene packaging used for surgical instruments.

Often, the packaging would tear, rendering the instruments unsterile and even delaying surgeries.

Now, gradually, this packaging is being replaced by reusable (and sterile) metal cans.

"In the operating theatre, we know that we pollute, we know that single-use is a disaster, and we've started to work on what we can switch to multiple-use, what we can try to avoid wasting, and it's become a huge project, not just in reducing the carbon footprint, but also in reducing the overall ecological footprint," said Dernis.

"One of the most recent changes at the hospital concerns surgical forceps, which are sent, as far as possible, to an American company for re-sterilization and resale at a lower price.With no risk to the patient, this has saved the hospital $4,000 in six months. We save on costs and we save on waste," said Denis.

She's still coming up with ideas, which she's implementing on a volunteer basis with the CIUSSS West Island environment committee.

This report by The Canadian Press was first published in French on Sept. 14, 2024.

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