Pharmaceutical substances that make their way into our soils and waterways are known to negatively impact human health as well as ecological and aquatic life.1 Northern Sydney Local Health District (NSLHD) is working to address the management of pharaceutical waste, to support their target of net zero emissions by 2035.
Environmental exposure of organisms to antimicrobials can lead to the development of multi-resistant organisms (MROs) which can impact medication effectiveness in humans.2 In recognition of these impacts, the Environmental Protection Agency and NSW Ministry of Health have legal standards that require pharmaceuticals to undergo high-temperature incineration to render them in-active.
Prior to project implementation, clinical areas in NSLHD did not have waste streams that adequately managed pharmaceutical waste. NSLHD disposed of waste via ‘Sharpsmart’ bins, general landfill waste bins or the sink. This was evident following an audit of general waste and sharps bins which were found to contain medication, administration equipment, vials and syringes.
Prioritising health through waste management
The ‘Pill-easing the planet’ project aimed to optimise management of pharmaceutical waste in all Hornsby Ku-ring-gai Hospital clinical areas. We introduced a waste stream dedicated to pharmaceuticals to all clinical sites within Hornsby Ku-ring-gai Hospital. Through an existing contracted state-wide waste provider, we requested ‘Pharmasmart’ bins and piloted them on six wards.
Staff in these wards were engaged to develop a procedure for their use, a staff education package, and tools to support decision-making. Following the collection of feedback from pilot wards, we refined the education materials and rolled out the ‘Pharmasmart’ bins to all clinical areas in Hornsby Ku-ring-gai Hospital.
Significant reduction in waste
A majority of staff (84%) involved in the pilot were confident in using the bins following education, with 100% agreeing that the bins would address the environmental impact associated with healthcare. Appropriate management of pharmaceutical waste is also likely to positively impact individuals through reduced development of and exposure to MROs.
The use of 660 ‘Pharmasmart’ bins per year at Hornsby Ku-ring-gai Hospital is projected to save up to 9.9 tonnes of pharmaceuticals from entering landfill or waterways each year. There has been a modest increase in price per unit for ‘Pharmasmart’ bins compared to sharps bins, however we predict this will be small after accounting for decreased use of sharps bins. Costs associated with not meeting Environmental Protection Agency and NSW Ministry of Health regulations will also be avoided, as well as a potential reduction in costs associated with treatment of hospital-acquired MRO infections.
After its successful implementation at Hornsby Ku-ring-gai Hospital, the pharmaceutical waste stream has been extended to other NSLHD sites, with the aim of achieving full district-wide implementation. The next phase of the project will focus on securely placing ‘Pharmasmart’ bins within patient care areas, making it easier and safer to discard pharmaceuticals at the point of care. A viable solution would involve affixing lockable bins to walls, and a customised design will be developed to ensure the next steps are effectively carried out.
Influencing change in nursing everyday practice, and therefore implementation of staff education was pivotal for success of the project. Finding appropriate bin locations that are convenient for use, but secure from public access is a difficult and ongoing issue. Classification of pharmaceutical waste is currently not well-defined in NSW, so we used definitions from Victoria for this project.
This project was part of the NSLHD Net Zero Leads Program.
References
- Samal, K., Mahapatra, S., & Ali, M. H. (2022). Pharmaceutical wastewater as Emerging Contaminants (EC): Treatment technologies, impact on environment and human health. Energy Nexus, 6, 100076. https://doi.org/10.1016/j.nexus.2022.100076
- Ahmad, I., Malak, H. A., & Abulreesh, H. H. (2021). Environmental antimicrobial resistance and its drivers: a potential threat to public health. Journal of Global Antimicrobial Resistance, 27, 101-111. https://doi.org/10.1016/j.jgar.2021.08.001
- Aus der Beek, T., Weber, F. A., Bergmann, A., Hickmann, S., Ebert, I., Hein, A., & Küster, A. (2016). Pharmaceuticals in the environment—Global occurrences and perspectives. Environmental toxicology and chemistry, 35(4), 823-835. https:// doi.org/10.1002/etc.3339
