Telegreen Recycling Equipment

RECYCLING CASE STUDY The Use of Baling Machines to Compact Waste from Dialysis Units In 2005, an assessment by the waste management team responsible for the Birmingham Heartlands Hospital satellite dialysis unit at Runcorn Road identified two separate, but not uncommon, issues. The first issue was the disposal of the plastic acid and bicarbonate cartridges which were needlessly entering the clinical waste stream and therefore being incinerated, an expensive and environmentally damaging route of disposal. The second issue was the disposal of the very large amounts of cardboard packaging associated with the clinical supplies purchased by the unit. Despite its recyclable nature, this was entering the domestic waste stream. Moreover, collections were infrequent and the cardboard was frequently accumulating in piles. As well as taking up valuable space within the unit, the identification of the fire risk that this posed had prompted the facility’s leaseholder to cover the resulting increases in insurance costs by requesting a higher rental fee. The solution to all of these problems was the purchase of a baling machine to compact the waste. The machine (picture 1) is housed in the storage room adjacent to the main dialysis unit and measures approximately 6ft by 3ft by 3ft. An electronic machine was chosen ahead of piston-driven alternatives as it makes very little noise, an important consideration given the close proximity to a clinical area. At the end of a patient’s dialysis session the acid cartridge is emptied and rinsed with tap water by the nurse. The cartridges are collected in plastic bags holding eight cartridges each (picture 2). These bags are then baled together, along with bags containing other plastic waste collected within the unit (see below and picture 3). Ten bags are baled at a time, with cardboard layers at the top and bottom, to produce packages that weigh approximately 19 kg and are held together with binding tape (picture 4). Packages of this size can be easily moved with the aid of a roller fork. Excess cardboard is baled together in separate packages weighing around 10kg. These plastic and cardboard packages are collected from the unit on a weekly basis, free of charge, by a local company which recycles them. A similar set up is also in place at a second satellite dialysis unit in Castle Vale. Other plastic items that are collected and baled include shrink wrap, containers for alcohol-based hand gels, bicarbonate cartridges (although this is increasingly sourced in bags), and the containers for bleach and Citrosteril. Particular care must be taken with the containers of substances subject to COSHH regulations (the control of substances that are hazardous to health, such as disinfectants like bleach and Citrosteril), and dialysis units should ensure that they have the necessary sewer discharge consent if these substances are to enter the water course undiluted. Benefits The clear environmental benefits resulting from the diversion of waste to the recycling stream offer an opportunity for Trusts to highlight their good corporate citizenship.

The initiative also frees up the physical space taken up by accumulating waste and, in the case described here, reduced a potential fire risk. Importantly, there are also considerable financial gains to be made. Investment Appraisal The return on investment will depend on the investment and running costs (resulting from the purchase, installation and maintenance) and the savings resulting from the diversion of waste into cheaper disposal pathways. A typical dialysis unit will use one acid cartridge per patient. Although the Runcorn Road Satellite Dialysis Unit is a 26 station unit, it is currently run at such a capacity that it generates 270 empty acid cartridges per week, each weighing 300 grams. This equates to 14040 cartridges per year, or 4.2 tonnes of plastic. The cost of disposing of clinical waste is determined by an economy of scale; larger units will produce greater amounts of clinical waste, and will be in a position to negotiate lower disposal costs per tonne. For the purposes of this case study, we have used a cost of £750 per tonne, which is considered representative of the current cost for most satellite units. The cost of sending 4.2 tonnes of plastic to clinical waste is therefore around £3150 per year. The Runcorn Road unit also produces approximately 1 tonne of cardboard per year. These cardboard boxes were previously being put into domestic waste bins, usually uncrushed, along with other waste. The cost to the unit of their disposal was determined by the number of bins collected per year, which in turn would be influenced by how well crushed the boxes were.

It is therefore difficult to provide a method to calculate the savings made, but the waste management team at the Runcorn Road Unit estimate that the introduction of the baler, which removed the cardboard from this waste stream, has reduced the number of bin collections by 50% and has saved the unit approximately £1000 per year. Using these figures, the annual saving (equivalent to the overall cost of the original waste disposal methods) is approximately £4000 at the Runcorn Road Satellite Dialysis Unit. The purchase of a baler requires an initial one-off investment. This is likely to be in the region of £3500 and will include installation. The ongoing costs might be anticipated to include an annual service (for which the Runcorn Road Satellite Dialysis Unit pays £195), the cost of the binding tape (£342 for the 12 reels required by the Runcorn Road Satellite Unit per year), and the cost of the plastic bags (which is likely to be very small and has been assigned a nominal figure of £50 for this case study). Therefore the total cost incurred during the year of implementation is £4087, with an annual cost of £587 thereafter. The Runcorn Road unit therefore recouped the outlay cost at one year, and has been saving around £4000 thereafter. A comparable saving is also being made at the Castle Vale satellite unit. The savings might be even greater in units using plastic bicarbonate containers. The Return on Investment Point in time Total investment to date Total savings to date Return on investment End of Year 1 £4,087 (1) £4,150 (3) 102% (4) End of Year 2 £4,674 (2) £8,250 177% End of Year 3 £5,261 £12,400 236% End of Year 4 £5,848 £16,550 283% End of Year 5 £6,435 £20,700 322% (1) Derived from the cost of the baling machine (£3500) and the annual investment (£587) in consumables and maintenance (2) Derived from the initial investment (£4087) and the annual investment (£587) (3) Derived from the disposal cost of plastic to clinical waste (£3150) and cardboard to domestic waste (£1000) (4) Calculated as (Savings to date / Investment to date) * 100 Maintenance Regular maintenance is essential if the anticipated life-span of a baling machine (around 10-15 years) is to be achieved. The machine in this case study is serviced on an annual basis. A maintenance contact with the vending organisation is preferable. A provisional plan for waste disposal in the event of a breakdown is also advisable. Staff Training and Health & Safety Considerations Cartridges are emptied and rinsed by the nurses at the end of a patient’s dialysis session. Operation of the baling machine itself is very simple and only minimal training is required. Initial staff training was provided by the company from whom the baling machine was purchased, but staff joining the unit now receive their training from the unit’s Store Manager. When baling the cartridges, staff are encouraged to wear gloves and aprons in case of any spillage. Staff are advised against baling packages greater than 20 kg, and packages are always moved using a wheeled fork. Summary The introduction of a baler into these dialysis units has led to the redirection of considerable volumes of plastic and cardboard waste into more environmentally friendly waste disposal streams. Significant financial savings have resulted from the reduction of plastic entering the clinical waste stream, and the compaction of the cardboard has reduced the waste storage space required and the fire risk. This report was produced by The Centre for Sustainable Healthcare