Guy’s & St Thomas’ is one of the largest NHS foundation trusts in the country. The two hospitals that form the trust, located on the banks of the Thames in central London, treat more than one million patients each year combined and produce around 2,000 tonnes of domestic and clinical waste per annum.

Waste is an important focus for the trust’s sustainability. The nature of work conducted on site requires extremely stringent regulations to maintain public health and prevent the spread of infection. However, this has led to much of the waste being classed as clinical and being heat treated or incinerated to eradicate all infection risk.

In reality, much of this material is easily recyclable – paper, card, plastics, food and flowers – if kept separate from clinical waste streams. It’s a realisation that the trust’s waste manager, Alan Armstrong, is only too aware of.

“Looking back, just four years ago, near enough all our waste, which didn’t require specialist treatment, went to landfill. We’ve made significant progress in the interim, but what has been our main challenge is educating our 12,000 staff members to instil recycling into their everyday work lives,” he recalls.

“It’s a difficult challenge, especially in this environment, but by undertaking waste audits within different wards and departments and providing guidance on how to improve sustainability we’ve seen significant achievements in a short time.”

Armstrong heads up a 34-strong team that includes representatives from its two waste management partners, SRCL and Bywaters. In a relatively unique arrangement within the NHS, Guy’s & St Thomas’ has appointed SRCL to undertake overall management of its waste contracts with objectives to reduce waste going to landfill and improve source-segregation.

“Working in partnership with our waste management providers has helped us deliver results more quickly,” Armstrong explains. “We operate as one team – we have representatives from both companies based within the NHS team. Consequently, we are all striving for a common goal. They also bring innovation to challenges and solve potential issues before there is a problem.”

Bywaters has strategically placed blue recycling bins, known as the ‘bycycler’ throughout the hospital, to collect mixed dry recyclables such as paper, cardboard, cans and plastic bottles. Office supplies, such as toner cartridges, electronics and batteries are also recycled via separate collection processes.

Steady adoption of the blue recycling bins is helping the hospital on its way to its 2012 target of 40% recycling. Meanwhile, a good relationship between the waste team and housekeeping is helping to identify areas where more recycling bins can be placed and also areas of non-compliance.

By educating staff through waste awareness sessions, leaflets and training, participation and engagement have increased across all departments. In particular, women’s services have been a key success according to Armstrong.

“Across 15 departments, we’ve removed around 200 black bag bins and replaced them with the bycycler. Key to achieving this level of engagement has been a passionate recycling champion who has helped change behaviour on the ground and encouraged people to put recycling first”.

He points out that if there is any resistance, most of it can be solved by education. “At a recent waste awareness day staff said to us that the segregated recycling actually ended up in landfill, which is categorically not the case. In a hospital with over 12,000 staff ensuring a good level of understanding is a difficult task to achieve and there are inevitable misunderstandings and urban myths about our recycling processes.”

When it comes to furniture, the waste team has achieved hospital-wide behavioural change. Indeed, no department is able to order new furniture without first consulting with the waste team and its furniture reuse scheme is in high demand.

“We’ve been pleasantly surprised by how the furniture reuse scheme has been embraced across the trust,” says Armstrong. “We take all unwanted furniture and find it a new home. Often demand outstrips supply, especially when it comes to chairs, but even with items that are broken beyond repair we salvage the usable parts – like wheels – and reuse them to fix other items.”

So far, it is believed that this scheme has saved the trust in excess of £60,000. Meanwhile, changes in staff behaviour when it comes to waste have improved recycling rates and had an important impact on the amount of clinical waste the trust produces.

Through more stringent waste segregation, clinical waste levels have dropped significantly giving further evidence to the Royal College of Nursing’s estimates that between 40-50% of waste ending up in clinical waste bags is domestic waste that doesn’t need such stringent treatment.

In the first half of 2011, clinical waste sent for incineration – the most costly – and carbon intensive – of disposal options – fell by 48%, despite an increase in the amount of overall clinical waste produced by the hospitals, while recycling increased by 34% compared to same period in 2010.

Armstrong adds: “We’re delighted with the achievements we’ve made to date. However, we’re not sitting back on our laurels. Looking towards 2012 we are focusing on segregating out offensive waste from clinical streams.”

Offensive waste has recently been re-categorised to enable its disposal to deep landfill or through waste to energy processes as it is has minimal infection risk compared to clinical waste. However, infection control will err on the side of caution to eliminate all risk. Therefore, Armstrong and the team will be identifying departments where the offensive waste can be easily separated – for example special care baby units.

This has already been rolled out to the trust’s mobile endoscopy unit where all waste is suitable for the offensive stream. However, the team recognises that there will be limitations and for some departments – such as ward areas – it may be safer from an infection control perspective to treat all waste as clinical.

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