“Lessening healthcare waste has proven to be more difficult,” says Dr. Gerardo Legaspi of PGH.
Culture Spotlight

How our hospitals are disposing the tons of trash caused by COVID treatments

One group says there is no need to burn PPEs. PGH, for example, is using microwave technology to shrink the volume of hazardous waste. BY BAM V. ABELLON
ANCX | May 14 2020

The massive and distressing effects of the coronavirus pandemic has affected almost all aspects of our waking life, from economics to mental health to education. However, one topic is rarely heard in conversations about COVID-19—the environment, particularly figuring out how to manage the burgeoning trash that comes from the treatment of the virus.  

Before the enhanced community quarantine (ECQ), reusable and recyclable products were taking the limelight. Here and there, people had been keen on using non-plastic materials for their everyday essentials like toothbrushes, utensils, straws, etc. But as experts started to disseminate information on how contagious the virus is, people started going back to one-time use items. This is especially true, and necessary, in the medical field.

An HCWC staff member (in green) provides the hospital personnel guidelines on proper waste audit.

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As the pandemic worsened, it became mandatory to throw—at once—anything that was exposed to an infected, or possibly infected, area or person. Even in regular households, people were advised to throw away, immediately, used face masks in a separate container. In a matter of days, as garbage disposal exponentially grew, a waste problem emerged.

 

The need for reusable PPEs

Ramon San Pascual, MPH, executive director of the global non-profit organization Health Care Without Harm-Southeast Asia, tells ANCX that while all measures that have been taken to lessen the spread of the virus and aid in patient recovery have been astounding, they will significantly increase the volume of waste in the capital region and other cities. “By how much additional volume of garbage is added, we don’t have the actual figures as the attention is on the treatment of those who are sick,” he clarifies.

Health Care Without Harm-SEA attends to issues of healthcare sustainability, promoting resilient and climate-smart healthcare. Through their initiatives, they aim to reduce environmental and climate footprint of hospitals and health facilities. For this pandemic, San Pasucal sees three big challenges, in terms of environmental impact: single-use plastic, improper and unsafe treatment and disposal of healthcare waste, and non-adherence to waste management system.

Waste segregation is one of the most effective ways to contain waste disposal problems. It also helps maintain a safe environment for healthcare facilities.

Single-use plastics can be found in hospitals, in quarantine centers, new testing centers, and the like. Most personal protective equipment (PPEs) are used only once, and a lot of them are made of plastic. When the PPEs are disposed, the waste, if not treated right, are a health threat in themselves.

“For the single use plastic, the solution is to find reusable PPEs, masks and even gloves,” San Pascual suggests. “This is being done by some members of the Global Green and Healthy Hospitals (GGHH) international network.  Another way is by adopting means of mass testing that will avoid frequent use and disposal of PPEs.”

According to San Pascual, sustainable healthcare practices—waste minimization, recycling, and segregation—are already implemented in other hospitals, called “green hospitals.” It’s possible, then, to bring those practices to the Philippines.

“COVID-19 waste must be treated as normal, infectious waste,” San Pascual adds. “Collection of waste bags must be done regularly. Storage areas must be maintained and cleaned, and they must always be functional. There is no need to burn COVID-19-related waste.”

 

The cost of garbage disposal

Dr. Gerardo D. Legaspi, MD, director of the University of the Philippines (UP)-Philippine General Hospital (PGH) in Manila, explains that as a tertiary hospital, their facility accumulates around 1.2 to 1.5 tons of garbage daily. Disposing waste can cost 1.2 to 1.3 million pesos a month, and this amount continues to rise with the increasing number of patients.

There are a few tips that the healthcare facilities can use to avoid waste disposal problems, according to this infographic created by HCWH.

PGH had contracted a company that collects and treats hazardous waste, and it was the only bidder that passed the UP Manila bids and awards committee criteria.

Before the pandemic, the UP-PGH has had problems with the overflowing garbage depository, which can happen when contract of the hauler expires. And the bidding process can take a long time to finish. This happens, too, when the hauler encounters problems and couldn’t do their tasks—and the hospital has no choice but to wait for them to settle their issues.

At the start of ECQ, the hauler’s trucks were prohibited by authorities in their city to run their routes. The waste started to pile up again. Fortunately, PGH had come up a few solutions to dispose their garbage at a faster and safer pace. These solutions have helped ease the waste disposal problem. First, they use the segregation scheme, which classifies waste into categories: healthcare waste, municipal waste, organic waste (nabubulok), and recyclable waste.

They also searched for waste management systems that could treat healthcare waste and turn them into municipal waste. This way, they wouldn’t have to depend solely on the hazardous waste collector for all of their garbage, and the city garbage service can pick up their waste for free.

 

Using microwave technology

Early this year, after a long, open bidding process, PGH purchased and installed a Sterilwave machine, distributed by the French Company, Bertin Inc. The machine uses microwave technology, which, after much deliberation and research, they found out was the most efficient and the most environment friendly system that could help them address their medical and/or hazardous waste problem.

The equipment, Dr. Legaspi said, is non-burn. It heats garbage like a microwave oven heats food. The differences is that the Sterilwave uses a temperature of 110 degrees Celsius, and it grinds waste in the process. It is also able to shred needles tubing and small bottles, making trash collection safer for the personnel. The grinding mechanism shrinks the volume of garbage to more than half of its original size.

Medical waste disposal is one of the challenges faced by healthcare facilities during the pandemic.

Sterilwave does not use chemicals or liquids, so it does not harm the environment.

As of 2019, PGH has also banned Styrofoam food containers and plastic utensils in their premises. Even their food providers have been encouraged to use paper and wooden products. Their pharmacy no longer uses plastic bags, and instead make use paper and eco bags.

These measures have been substantially helpful in dealing with the heaps of hazardous waste brought about by the pandemic. “Lessening healthcare waste has proven to be more difficult,” Dr. Legaspi admitted. “But we manage to steer clear of problems, and our microwave equipment will help much in this regard.”

Ramon San Pascual said that regular citizens can help solve this waste disposal issue, too. At home, proper waste segregation may be done by relying on reusable packaging, rather than disposable plastic bags. Thorough sanitation must, of course, be done as often as needed. And experts can’t emphasize this enough: proper hand washing should be strictly observed.