Wednesday, April 6, 2011

How Nursing Changed My Life (about Talking Trash)

So, you may be wondering why a nurse would bother learning about waste as this is where I focused my public health classes of my third and fourth years in the BScN program. Well, I guess it's not that far of a stretch for nurses to focus on waste of the hospital as we do a lot of focusing and colourful charting on the wastes of our patients! Let me enlighten you on what I have learned... (about garbage, not excrements!)

***NOTE: I am aware that this is just the surface of a HUGE discussion. I'm not really giving many answers here, just exploring options about what happens with the options we have now and how else we can do things, mainly in hospitals. There are many things I won't go in to detail about, but please comment as I'll write more about those topics later. But please, don't comment on the terrible choppiness in tone of this post. I made the terrible mistake of trying to convert an essay while keeping a lot of what I originally wrote. Anyway, you may proceed, but be warned!


The facts are pretty clear now and I think that most of us agree that it is necessary to do something to counteract the process of climate change. We propelled this unnatural process during the industrial revolution and have created many new technologies that have made our lives easier and allows us more time to do other interesting things (like you know, reading blogs!). This has meant that there have been steady gains in the human population but because industries and people’s new way of living, immense amounts of garbage and pollution have been produced. The contribution of waste, specifically in medical facilities, proliferated when HIV/AIDS became epidemic in North America in the 1980’s (De Boer & Spink, 2008). There was little known about the disease and how it was contracted. People’s response was fear because there was limited knowledge of how HIV was transmitted (as is what happens anytime there is something we don't know how to control - we find a way to feel like we're in control; Think the plague and killing dogs). This fear strengthened the trend for the use of disposable medical supplies right alongside our wasteful habits at home. While this problem cannot be seen in the same light as the pandemic of HIV/AIDS or any other disease/illness, it is a problem that has been quietly affecting people’s health (which had happened before this time regarding other illness/disease and to see an interesting time-line of garbage, go here). 

Interesting facts to note:

  • The World Health Organization (WHO) estimates more than 150,000 deaths and approximately 5 million ‘disability-adjusted life years’ (DALYs) annually as a result of increasing incidences of disease and malnutrition caused by global warming (Physicians for Social Responsibility, 2007).

  • Infectious medical waste, “such as sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials need to be treated before being incorporated into the landfill” (WHO/ Pruess, A., Giroult, E., & Rushbrook, P., 1999, p.78). Incineration is widely used around the world and is usually selected to treat wastes that cannot be recycled, reused, or disposed of in a landfill site (WHO et al., 1999, p.78). Properly incinerated waste drastically reduces the spread of disease and infection, which is a great thing because as we all know cleanliness is something hospitals pride themselves on.

So, where do these statistics come from resulting in deaths and DALYs?

Part of the issue is when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride ( PVC same plastic generally found in shower curtains ) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions and/or in bottom or fly ash (ash that is carried by air and exhaust gases up the incinerator stack) (WHO, 2008).

There are many adverse health effects that happen because of exposure to these toxins, and dioxin is a known carcinogen (aka cancer causing agent) which “poses a host of health problems as it is bioaccumulated in the environment and eventually consumed by people” (Sattler, 2007, p.3). This information is not known or understood by the general public which adds to the ignorance of not implementing proper and safe recycling practices at hospitals.

Also, an interesting fact: "Excessive costs of waste management in countries that over-regulate medical waste management –based more on political issues than on scientific data– [are] draining health budgets, which are particularly meager in developing countries” (Volkow, 2003, p.121).

Should we be putting this stuff in landfills instead? 

No, the practice of filling up landfills with disposable product and incinerating hazardous waste both create more work for health care professionals by unintentionally harming people through the practices that aim to heal. According to the WHO, 75-90% of healthcare waste is similar to domestic waste (2008). This is referred to as health care general waste which is made of “paper, plastic, packaging, food preparation, etc. that has not been in contact with patients” (WHO, 2008). Did you hear that? Never been in contact with a patient! But what do many of us envision when we think of medical waste? The biohazardous material that has a high possibility of being infectious or laden with disease, this is what I thought too before getting into health care. This misconception is also part of the reason why purchasers of recyclable material are hesitant to accept the 75-90% of medical waste from hospitals that is fully recyclable. Education plays a big role to implement change regarding this false belief, so I hope some of this is sinking in!

I'm sure many of you have heard from someone that garbage in landfills doesn't break down and that you can find 25 year old hot dogs and 50 year old newspapers in decent condition. That is true and you can read about the University of Arizona's Garbology project that started shortly after the first earth day here. But landfills (which are different and slightly better than just an open dump) do breakdown on the outside and what we throw away does leach out when it is broken down, to combat the toxins from being produced, this is a general idea of how most landfills work:

“A thick plastic liner is placed on the bottom of the landfill and perforated pipes are laid down to collect the leachate for treatment at the wastewater treatment plant. This reduces the impacts to groundwater and surface water. Gas generated in the landfill from anaerobic bacteria is collected for burning or generating energy. The main component of landfill gas is methane which is 21 times more potent a greenhouse gas than carbon dioxide. A clay cover is placed on top of closed portions of the landfill to reduce the escape of the methane. Soil material, including ground wood waste and biosolids, are placed on top of the clay to provide a surface for grass to grow and enable methanotrophic bacteria to capture the methane that seeps through” (Regional District of Nanaimo, 2008).

This system only reduces the effect on our environment; it cannot completely keep the waste out of our air, water, and soil. As a nurse, I know that I throw out a LOT of garbage for every patient I have (generally 4 patients per nurse). We use countless styrofoam cups, straws, and lids, food, medical supplies, paper for the never ending charting, and the list goes on. With this knowledge gaining public attention, more people should be concerned with our environment and know that landfills can only get so big before we are living in our own waste. More programs are starting up and people are supporting these to help reduce the strain on the landfills and in turn, promote health in our environments.

Many of the employees working at hospitals are very focused on cost, this is a business despite many people's vision of Canada's public government funded system who think they deserve everything for free there. Because hospitals care of the sick is and should always be a hospitals first priority, management of waste is not seen as a high priority. 

So, what can we do?

Wait for my next post on garbage (Hopefully won't be as long of a wait as this one was!)

Until next time, 

No comments:

Post a Comment