Flinders Medical Centre (FMC) initiated the Healthy Environment Project in December 1991 with the aim of minimising waste and exploring other environmental initiatives. FMC is a public teaching hospital in the southern suburbs of Adelaide, with 500 beds and 3,000 staff.
Over the past two decades, hospitals have increasingly sought to minimise the risk of infection by changing over to disposable, single-use items, rather than sterilising and re-using, for instance, syringes, bottles and gloves. This practice has led to an explosion in the garbage problem. For each occupied bed, the average amount of waste generated per day is 4.8 kilograms, according to the South Australian Health Commission.
Based on these figures, Nursing the Environment (Victoria), a group within the Australian Nursing Federation, estimates that 607,000 kilograms of solid waste are produced by Australian hospitals each day.
The principal goal of the the Healthy Environment Project is to identify, recommend and implement initiatives that will reduce FMC's negative impact on the environment. Most initiatives should also save considerable sums of money. Broadly, issues on top of the agenda are waste minimisation, energy conservation, water conservation and purchasing policy.
Most of the Healthy Environment Project's work has concentrated on waste minimisation with a resulting 50% reduction in general waste volumes and a 35% reduction in medical waste volumes. Already savings of over $300,000 per year have been realised.
A recycling centre catering for glass, paper and plastics has been established. Recycling stations have been installed in each of the wards and most other departments.
The project has been a catalyst for the development of environmental management practices within South Australian hospitals. This movement is now growing nationally and is supported officially by the South Australian Health Commission and other organisations such as Hospital Environmental Awareness Link (HEAL) in Western Australia; Nursing the Environment in Victoria; and an inter-hospital network in South Australia.
Ilkari, the Flinders Conservation Group, was the catalyst behind the program. Its 80 strong membership was instrumental in the development of a paper recycling program at FMC, as well as organising staff meetings and coordinating the establishment of the initial system. Another vital component was the commitment of the Board of Management to the establishment of the Healthy Environment Project and the subsequent formation of the Environmental Management Committee (EMC). The brief of the EMC is to identify and implement environmental initiatives, formulate a document recommending ecologically sustainable work practices and help educate and inform staff concerning environmental issues.
Keys to the success of the project are high levels of consultation, education and the provision of accessible information. Consultation must occur with the directors, staff, and union representatives of the departments affected by any proposed change.
The National Health and Medical Research Council has recognised the relationship between health and the environment in recommending that 'all industry sectors, including the health sector, will need to minimise waste, conserve energy, and reduce future risk and irreversibility of ill health and environmental degradation'.
A waste audit was undertaken identifying all types of waste emanating from the hospital including solid, chemical, medical and liquid. A survey conducted by the South Australian Waste Management Commission at the Royal Adelaide Hospital identified that 60% of waste was paper or cardboard.
An energy audit identified potential savings of up to $230,000 (15% of the total energy budget).
Changes made and savings
A paper recycling program with 150 collection sites was established. Approximately three tonnes of paper are recycled per month.
Cardboard and paper represent about 50% of FMC's general waste. FMC recycles approximately 1.5 tonnes of cardboard per week, enough to fill a 16 cubic metre bin weekly. Savings of between $8,000 and $10,000 per annum are generated through reduced landfill costs.
A focus on medical waste and its correct segregation has also achieved significant savings and a reduction in the volume of waste incinerated by 35%.
Total savings from waste disposal initiatives exceed $70,000 per year.
In staff amenities, FMC has replaced polystyrene cups with staff-brought mugs. This eliminates the use of 600,000 polystyrene cups costing $14,000 per year. FMC has also stopped the use of disposable plates and bowls in the staff cafeteria, eliminating the use of over 400,000 disposable items costing $16,000 per year.
In plastics, FMC is recycling HDPE film plastic, HDPE film and containers and polypropylene containers.
Waste levels have been further reduced by the recycling of refundable bottles and cans, waste oils and silver recovery from old radiology films and chemicals. Returns from bottles and cans are used to purchase presents for children in the paediatric wards. Returns from silver recovery are unknown (done before the project).
Pilot 'green' wards were established to trial initiatives such as replacing disposable bedpans; reducing the use of dry cleaning for staff uniforms; and encouraging staff to reduce paper usage and recycle.
FMC has successfully trialled a bed pan sanitiser system, replacing the previous disposable system. Installation of 21 machines will save $130,000 per year. The once-off cost of installing the systems was $115,500.
A policy of purchasing recycled stationary items has been introduced throughout the hospital. It is cost neutral.
FMC is introducing a protocol for screening existing and new products, with preference being given to products which minimise impact on the environment. The protocol has become part of the terms of reference for the
Medical Products Committee.
An energy audit has identified significant savings. Co-generation is under investigation.
Costs and payback
Sponsorship pays for the lease of the cardboard recycling compactor.
Payback for the other major capital cost - the installation of the bed pan sanitiser system - is estimated at 10 months.
Two-thirds of the energy audit came from grant funding.
Savings generated in a hospital of FMC's size readily justify the extra cost of employing an Environmental Officer. Total savings on operating costs for the project are approximately $300,000 per year with total costs in the order of $65,000 per year (for the employment of the Environment Officer and a Recycling Porter - see next section). The big money savers are on the bedpans ($130,000 p.a.) and the disposal of medical waste ($50,000 p.a.)
Net savings are not reinvested in the creation of further waste and energy savings, but are used to help the FMC meet continuing budget cuts. For 1995 alone, budget cuts are estimated at $7 million.
An Environmental Management Committee (EMC) was formed, representing most hospital work groups and the medical students, with an Environmental Officer appointed for an initial term of 18 months. The success of the project has resulted in a three year extension of this position. A Recycling Porter is employed full-time to coordinate the collection of recyclables.
FMC believes it is important that staff are educated about the reasons for a particular change, clearly stating the environmental benefits and providing an accurate picture of the savings implications of the change. FMC provides time for staff to identify any problems which may arise from the change, so that by the time of the implementation, staff will be fully aware and accepting of the change.
Future plans of the EMC over the next year are to:
Complete the installation of recycling stations in wards and expand to other areas of the hospital.
Conduct a water conservation trial in patient and staff showers.
Enhance reductions in medical waste through continuing education programs.
Identify markets for recyclable materials.
Identify disposable items that can be replaced by reusable alternatives.
In the area of energy conservation, the energy audit made a number of recommendations which are to be implemented including: installing reflective panelling above fluoro tubing, enabling the removal of one fluoro tube whilst maintaining same lighting level. The library at Flinders University has undertaken this conversion and saves over $30,000 per annum, one-third of its energy bill.
Investigate alternative means of transportation such as cycling and car pooling.
A full feasibility study on a co-generation plant has been commissioned. Preliminary estimates indicate that for a capital outlay of $2.8 million, the FMC could trim its annual $1.6 million energy bill by $525,000 per annum, with an estimated payback time of seven to eight years. The co-generation plant proposal has been successfully introduced in other hospitals in South Australia and is expected to go to the Board of FMC for a decision this year.
The Cut Waste and Energy Case Studies have been produced by the ACF/ACTU Green Jobs Unit, with support and funding from the Commonwealth EPA, Department of Environment, Sport and Territories.