Healthcare is becoming more green, slowly, sometimes very slowly, but there are improvements.

Some measures are clearly valuable and worthwhile. Others perhaps less so though if it sends a positive message and supports a package of changes then perhaps they too are worthwhile.

But some interventions aimed at greening of our healthcare activities are far too unlikely to reap any tangible dividend, may be inconvenient or disruptive, and ultimately damaging. That damage may be psychological, causing a nuisance to others who feel that a particular intervention is in some way unworkable or otherwise unacceptable, or practical in which event the input and energy or other resources required required cannot be justified to an extent that the overall effect is negative rather than positive.

One such example comes from recent US correspondence, where a lab seeks to recycle their used pathology specimen containers. They have 330 pounds, about 120kg, of these containers a month to recycle and in terms of vials, it is 5,000 a month.

In some circumstances the content of these pathology containers  might be considered a biohazard but the small specimens are suspended in a fluid composed of 60-65% alcohol which essentially sterilizes anything in it.  Specimens can be anything ranging from a loose cluster of cells to tissue fragments.  There is patient data on the vials.

Recycling plasticware is an important contribution to greener healthcare. However, this proposal implies immediate recovery, emptying vials of chemical waste and human tissue fragments each of which have their own particularly complex controls and constraints. Plastic waste would need to be washed, consuming energy and using water. Confidentiality concerns exist assuming that the labels cannot easily be destroyed or obliterated.

Where is the evidence that 60-65% alcohol sterilises each and every sample? There is a heavy burden placed on the operators of all ATT waste processing systems to demonstrate STAATT compliance. That duty must apply also to operations such as this, however modest in scope, and also to the very many pathology autoclaves that are used to process high risk laboratory wastes without detailed control or independent regulatory oversight and control. That is not right.

The amount of plastic in clinical waste is considerable though varies widely. Processed effectively by a licenced ATT procedure, rendered anonymous by in-process and/or post-process shredding biological safety and confidentiality issues are satisfied. Chemical and environmental safety is a concern but discharge consent comes with waste audit and composition analysis, dilution and heat destruction – in some but not all ATT systems – and if necessary separate collection and processing of wastewater that can be minimised by plant design and water conservation/recycling.

Post-processing material recovery is likely to be efficient and effective, though the option of using waste floc as a fuel for heat recovery may be the easier option – the typical calorific value makes that economically viable.

Though careful design and with the support of regulators, post-process materials/resource recovery becomes economically viable and universally acceptable. Recovery processes are already available and with further investment will become yet more cost-effective.

The environmental and other benefits are considerable. All that is lacking is support form the regulators who should be demanding post-process recovery instead of the current default landfill option.