In November of 2016, Aarhus University Hospital carried out a sample survey. Nine departments were asked to sort out clean plastic from their waste disposal for 48 hours. The clean plastic was now weighed and analysed. All in all, 90 kg of plastic, equivalent to 500 kg of daily waste, was analysed. The results of the sampling corresponded more or less with previous, and larger, surveys conducted at Stanford Hospitals and Clinics from 2013, as well as a smaller Dutch survey.
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Plastic types found during mapping
Sampling showed that large amounts of clean plastic packaging could be collected relatively easily, from operation theatres, and other areas with a controlled environment – examples being the hospital pharmacy or intensive care unit preparation. However, the survey also illuminated the difficulties of maintaining focus on plastic sorting in hospital areas with many mobile patients and visitors like the emergency reception.
A Minimum of 40 % of plastics were not identifiable
The survey sample showed that, at least, 40 % (the blue part of the pie chart on below) of plastic packaging could not be identified (unknown plastic) Partly because plastic packaging is often unmarked, making it impossible to see what it consists of, but also because a lot of plastic is made from laminates, which are often different plastic types melted together to attain certain properties. These can be properties that contribute to maintaining the sterility of the packaged product. Laminates cannot be recycled mechanically, but current experimentation with other forms of recycling are underway. However, the technology is currently unavailable for commercial use.
About 25 % of plastic packaging consists of LDPE
About 25 % of clean plastic packaging is LDPE (the orange part of the pie chart below). This is positive, since LDPE is reusable. LDPE is, among other things, found as transport packaging around pallets and as the plastic layer in many sterile packages. Transport packaging, on pallets, is also easily collectible, which is something that already often occurs.
Plastic packaging from hospitals comprises of many plastic sorts
During the survey from AUH, 16 different polymers and combinations of polymers were discovered. The large number of plastic types, as well as the large of combinations, mean that large scale loads of plastic packaging for recycling are made impossible.
Different plastics contain different chemical compositions and melting points. This makes it difficult to recycle plastic types together due to quality losses in the plastics properties. One plastic package can both comprise of one or more plastic types, as well as different additives, an example being UV protection, softeners and colouring.
Unknown plastics
About 40 % of the found plastic packaging was unidentifiable for the experts carrying out the analysis. Samples taken from this category, and sent for further laboratory identification, showed that a large amount of this category consisted of laminates, meaning packaging that consists of layers of different plastics moulded together, thus making them unidentifiable, even for experts.
Laminate plastic is often used to achieve special functional properties in packaging. Many products used in the healthcare sector come in sterile packaging. Sterile packaging means that a product has to have 3 different packaging layers, and that the innermost packaging has to maintain the sterility of the packaged item. This is often achieved, by various methods, where the sterilisation is undertaken by sterilising straight through the packaging. This process inflicts certain demands on the packaging involved, which is where laminate packaging comes into the picture.
There are also a large number of sharp instruments in hospitals that are required to maintain sterility during unpackaging. To prevent these products from perforating packaging under transport, nylon, for example, is often used to strengthen the packaging. It is conditions such as these that often limit, if not prevent, the recycling of plastic packaging, and constitute a special challenge for plastic packaging in the healthcare sector.
The following category comprises of the so-called “covers”. Covers look like textiles but are made of plastic and are often made of more than one plastic type.
LDPE
The next largest fraction in the test comprised of LDPE (Light Density Poly Ethylene). About 25 %.
LDPE is a “soft” plastic type, often used as wrapping film around pallets and products. AUH has, for many years, collected LDPE for recycling. There is also a substantial amount of LDPE in peel-packs, that among other things, can constitute sterile packaging. While it is relatively easy to collect large pieces of transport film, it is often less easy to collect the LDPE part of sterile packaging, since sterile packaging, more often than not, is made of different types of plastic that cannot be recycled together.
In the pie chart above, beside the fractions, a number is indicated in parentheses. The number in parentheses refers to the international codes for sorting, for the purpose of recycling. As shown, not much of collected, or sorted plastic packaging – apart from LDPE – is considered suitable for recycling. On a whole, our experts estimated that about 37% of sorted plastic packaging was recyclable.
In the table below, one can see how much plastic is sortable in a 48-hour period in nine different departments. In the regular wards, it was not possible to get the normal daily waste and the source sorted plastic to leave the ward at the same time so they could be weighed together. There is, and was a very busy atmosphere in wards with this level of activity, with patients and visitors present. These wards did not manage to sort much plastic either. Subsequently, attempts to further examine sorted plastic form the wards were halted, as the extra activity could constitute a hindrance for staff compared to possible rewards. A common discovery however, in operation theatres, was that 15% of daily waste was clean plastic that was easily sortable. In the pharmacy, as well as intensive care preparation, more than double this amount was sortable. Radiology departments could not sort much plastic however. Even though the radiology department had a lot of plastic containers containing residual liquid, these containers were excluded from the sorting process, due to reluctance from the recyclers.
Supplier or manufacturer information was both available, or visible, on about half of the sorted plastic packaging. On the 90 kg of plastic packaging, about 150 different supplier or manufacturer names were available. There was a minority of suppliers that provided a predominantly larger amount of plastic packaging than the average supplier. There was also a large group of suppliers that all delivered lesser amounts of plastic. The result of the mapping was used to identify the most important suppliers, and hereafter invite them to a value chain workshop.
Packaging types in medical plastic
The majority type of plastic packaging in a hospital is often “soft” plastic. Soft plastic is found in so called peel-packs. Peel-packs are often the primary packaging (innermost) for sterile products. A large amount of peel-packs consist of LDPE. However, peel-packs also consist of an array of other plastic sorts, as such, making it virtually impossible for a non-expert to determine which peel-packs contain recyclable plastic, like LDPE, and which do not.
Covers, which are also used routinely in large amounts, resemble textiles, but are plastic. The covers found during test sorting consisted of many different plastic types, and combination of plastic types, of which not all were recyclable.
With the mapping as a starting point, an array of packaging types has been identified as being especially challenging in regards to recycling:
Product
Function
Challenge
Blue mattress covers
A big plastic cover with elastic edges used to protect clean, made, hospital beds from dust and other contaminants during and under transport
The blue cover reduces material value during recycling. The sown-in elastic edge makes recycling impossible
Peel-Packs
Protects instruments under transport and maintains sterility. Is often the primary packaging for sterile products
There are many functional demands on packaging, which means that certain peel-packs consist of up to 7 different plastic types
Overwraps for dialysis fluids and intravenous fluids
Protects clean products in fluid form that are delivered in bags
Relatively big plastic bags, consisting of a combination of polymers, which cannot be recycled together
Plastic containers
For transport and storage of contrast etc., used in connection with different radiology procedures
The design of these plastic containers prevents them from being emptied entirely, thereby ensuring residual fluid. Despite the fact that these fluids are not characterised as hazardous (They are injected into patients during routine examinations), They are still defined as hazardous and the empty plastic containers are disposed of as hazardous waste
Bottles for rinsing fluids
Containers, ranging in size from 10 ml. – 5000 ml. containing sterile water, or saline solutions, are used in large amounts in connection with a varied number of procedures in hospitals
These containers, which are often in bag or bottle form, often consist of several different types of plastics (bottles, corks, isolation materials for corks and labels). There is often residual fluid left in the bottles
The survey sample showed that, at least, 40 % (the blue part of the pie chart on below) of plastic packaging could not be identified (unknown plastic) Partly because plastic packaging is often unmarked, making it impossible to see what it consists of, but also because a lot of plastic is made from laminates, which are often different plastic types melted together to attain certain properties. These can be properties that contribute to maintaining the sterility of the packaged product. Laminates cannot be recycled mechanically, but current experimentation with other forms of recycling are underway. However, the technology is currently unavailable for commercial use.
