The increase in the production of hospital waste during the Covid-19 pandemic, which completes two years this Friday (11), and the inadequate disposal of this waste have been alert targets of the WHO (World Health Organization) and boosted initiatives to reuse waste. materials by leading health institutions in the country.
Among the projects are the transformation of food into fertilizer for the production of organic food, bed and bath linens in bags made and marketed by seamstresses in needy communities, plastic packaging in face shields and even infectious waste in energy capsules. .
A 2021 report by Abrelpe (Brazilian Association of Public Cleaning and Special Waste Companies) shows a 15% increase in the production of hospital waste in the first year of the pandemic in the country compared to 2019, totaling 290 thousand tons. Domestic waste generation grew by 4% in the same period, reaching 82.5 million tons. In previous years, the increase was 1% per year, on average.
But the association itself believes that the figure is underestimated because many health services still mix materials with common waste. It is estimated that 30% of waste from institutions is dumped in landfills without prior treatment.
This practice is contrary to current regulations and presents direct risks to cleaning workers, garbage collectors, public health and the environment. There are clear rules from Anvisa (National Health Surveillance Agency) on the treatment and packaging of hospital waste, according to each type. For example, the infective (such as blood and other secretions), the chemicals (drugs), the radioactive ones (radiographic material), sharps (needles) and common waste.
According to Carlos Silva Filho, director-president of Abrelpe, the production of more hospital waste during the pandemic was inevitable, due to the increase in hospitalizations and greater use of disposable materials, to avoid contamination – and this volume was also added to the waste generated by the kits of testing and vaccination against Covid.
Silva explains that there is no way to track this waste generated by health services. “We depend a lot on the generator’s own conscience of not doing the wrong thing.”
In Brazil, more than 3,000 municipalities maintain open-air dumps. In one of them, in the city of Eunápolis (BA), for example, collectors say that the amount of hospital waste has increased a lot in the pandemic. It is common to find serum vials, gloves, masks, bandages and cotton still covered with blood, syringes, needles and catheters there, some still trapped in transfusion bags.
“They forget that there are human beings here who depend on garbage even to eat,” says José, 62, who has worked at the dump for 15 years looking for recyclables. From there he takes R$ 600 a month. Another 20 families do the same.
According to a recent WHO report, even before the start of the pandemic, the safe management of hospital waste was insufficient. Covid-19 only made the situation worse.
According to the latest available data, from 2019, 30% of healthcare facilities in the world do not have a safe system. In less developed countries, the proportion is almost 60%. For the WHO, it is vital that countries devote more attention to sustainable management.
In Brazil, there are several initiatives underway. Hospital Moinhos de Vento, in Porto Alegre (RS), has a waste transformation center inside the hospital and, in 2021, created a project to recycle 100% of the waste that can be reused, in partnership with companies.
A ton of high-density plastic, for example, was transformed into 40,000 face shields for frontline professionals, 90% of which were donated to public hospitals.
Currently, the hospital sends about a ton of recyclable material per day for reuse. More than 3,000 TNT (non-woven fabric) cloths go to seamstress associations, which manufacture ecological bags. Polyethylene, on the other hand, is transformed into 60-liter garbage bags.
All food scraps become organic fertilizer, used in the institution’s vegetable garden. A part goes to a cooperative, which exchanges the fertilizer for organic rice that is prepared in the hospital.
Last year, 140,000 kilos of paper were also recycled. The material went to a company, which, through an exchange, supplied the hospital with the equivalent of R$ 70 thousand in toilet paper.
According to Mohamed Parrini, CEO of Moinhos de Vento, the pandemic also generated a large increase in infectious waste: the volume went from 363 thousand kilos in 2019 to 536 thousand in 2021.
“These residues, after being treated, would be discarded [em aterros específicos], but we started to work to minimize the impacts on the environment. We incinerate it and convert it into energy capsules”, explains Parrini.
The next phase, which depends on partnerships and environmental approvals, will be to transform these already clean energy cells, currently stored in the hospital’s plant, into gas for the institution itself, to supply boilers, for example.
Parrini says that the idea of recycling its own waste came when the institution began to have doubts about the quality and reliability of the treatment that third-party companies would give to the waste.
“We started looking for solutions that would give us full assurance that we wouldn’t find any of our labels in a landfill. We sterilize here, we incinerate here and convert them into energy capsules here.”
In São Paulo, one of the Albert Einstein Hospital projects managed to eliminate the disposal of hospital textile waste, such as uniforms, bed linen and towels, in sanitary landfills. That’s seven tons a day.
According to Ana Paula de Araújo Santos, Hospitality and Facilities manager at Einstein, after decontamination, the material is removed by NGOs and companies that support 80 seamstresses from the periphery of Brazil, and transformed into returnable bags and bags, cases and toiletry bags. There are about 3,000 pieces per month.
In some cases, at the end of the process, Einstein buys the products to distribute gifts and donations. “The project promotes the circular economy, because this product generates income and work.”
Hospital Alemão Oswaldo Cruz also has a system that involves reducing infectious waste. Thus, for the institution, in 2021, even in the pandemic, there was a drop of 8% in the generation of this waste. A total of 325 tons of waste was recycled, an increase of 13% compared to 2020.
At Hospital Sírio-Libanês, 37% of the total waste generated (3,445 tons) is reused. In addition to several projects involving the recycling of materials with partner companies, the institution has also been involved in the purchase process so as not to generate unnecessary waste.
For example, it negotiates so that certain products no longer come in numerous cardboard boxes, but in large plastic bags that, once sanitized, are reused in subsequent shipments.
“None of this will have a negative impact on assistance, but rather optimizing these deliveries and processes, and using as little as possible. We cannot provide health care at any price. It has to be sustainable”, says Gizelma Simões Rodrigues, Sírio’s environmental sustainability manager.
As in other hospitals, at the beginning of the Covid pandemic, the lack of knowledge about Sars-CoV-2 caused the volume of infectious waste produced in Sírio to represent 40% of the total waste, almost double the pre-war period. pandemic (22%). Today, the amount has returned to pre-pandemic levels.
Currently, all infectious waste produced by hospitals is treated in autoclaves, which guarantees the elimination of biological risk, and then sent to the sanitary landfill, according to managers.
For the architect Vital de Oliveira Ribeiro Filho, volunteer chairman of the board of the Healthy Hospitals, a project that brings together 160 institutions engaged in the sustainability theme, this approach is still the best alternative.
In his opinion, waste incineration projects for energy transformation, in addition to being a very high investment, are not sustainable because they involve the burning of plastic.
“This plastic will take many pollutants into the air. If you burn only polyethylene, the result is reasonable, but a large part of the plastic used in health services is PVC”, says Ribeiro Filho, who works at the São Paulo government’s Health Surveillance Center. .
