In intensive care units, 17 kilograms of waste are produced per patient daily. ICU nurse Lobke Hazelaar saw this with increasing dismay and joined one of Erasmus MC’s Green Teams.

12 meters of plastic tubing, 108 gloves, 57 compresses, 24 syringes, 16 isolation gowns, 8 pads. It’s just a fraction of all the materials that go into the trash daily per intensive care patient, including packaging materials. Every day this leads to 7 full garbage bags per patient.

The entire healthcare sector is responsible for 7 per cent of the Netherlands’ CO2 emissions. Part of those emissions are in that gigantic mountain of waste that hospitals secrete daily. ‘A bizarre amount is thrown away because almost everything is disposable these days. Especially during the corona crisis, this became clear. The corridors were full of containers where we threw away our masks, aprons, gloves and splash goggles,’ says Lobke.

The intensive care unit’s Green Team, set up by hospital pharmacist Nicole Hunfeld, is looking at how to make the ICU more sustainable and even completely circular by 2030. For starters, the ICU is now mapping all waste streams. To see what could be more sustainable and whether waste can be better separated.

Monstrosity

The dialysis bag is one of those monstrosities contributing to the mountain of plastic waste every week. The bag used to be simply thrown away, but it is now collected separately. And that is more challenging than it seems.

Here’s the thing: such a bag contains 5 litres of dialysis water. This is needed to filter the blood of IC patients. ‘Many IC patients have poor kidney function and are on dialysis 24 hours a day. They use around sixteen to twenty of these bags per 24 hours. Sometimes we only have two such patients, but sometimes as many as eight,’ explains Lobke, who together with ICU nurses Hilde Struijk and Emma Baars is trying to get ICU colleagues enthusiastic about waste separation.

Challenge

That’s a challenge. Because those bags don’t just consist of the stiff plastic that holds the water, there are hard plastic taps into which all sorts of tubes are inserted. And those plastic bags of water are also wrapped in, yes, plastic. ‘Those hard little taps have to be collected separately. Fortunately, the bag and the packaging are made of the same material, so we can collect them in the same waste stream.’

Separating waste is quite a hassle for the nurses, who don’t have much time to do their work anyway. That is why Lobke, Hilde, Emma and Nicole make it as easy as possible for their colleagues. ‘A student from TU Delft is now working on designing a handy cutting device to cut those hard tubes from the plastic bags. She is also designing a system to hang waste bags on our carts to bring those dialysis bags to the ward.’

The waste stations in the ICU now have two giant clear garbage bags: one for dialysis plastic and one for soft plastic. A hospital waste processor collects that separated waste. Lobke acknowledges that only the dialysis bags are collected separately in this project.

‘It is shocking how much waste is produced per ICU patient. The blade for the laryngoscope, which is used to insert a breathing tube, is no longer made of metal these days, but disposable. There are metal scissors that are made for single use only. Why? No idea. But we have a use for those scissors. We clean them and give them to a hospital in Suriname.’

We need to evolve to circularity in small steps, Lobke believes. ‘The world has to last longer than just today and tomorrow. I have young children myself. My daughter often watches the ‘Jeugdjournaal’ [red: news show for kids], which often discusses the climate. She worries about it quite a lot at age ten. That inspires me.’

Public Annual Report

This story comes from Erasmus MC’s Public Annual Report 2022: a magazine full of personal stories from our patients, colleagues and students. Pick up a free copy from the light blue bins at the hospital entrances, or read it online (in Dutch).