World-Leading Medical Waste Initiative Pioneered for Kiwi Eye Surgeons

A world-leading sustainability initiative pioneered for Kiwi eye surgeons could create a new global pathway for the recycling of medical waste, according to industry experts.

According to a Ministry of Health report, healthcare waste is a significant contributor to the waste stream and makes up almost 6 million tonnes (16,164 tonnes per day) of the 1.47 billion tonnes of solid waste produced each year globally.

World Health Organisation (WHO) research shows around 85% of healthcare sector waste is considered non-hazardous and comparable to household waste.

Data from the UN’s international health agency also shows a third of healthcare facilities do not safely manage healthcare waste, and open burning and incineration of waste from this sector can result in the emission of dioxins, furans, and particulate matter. The disposal of untreated healthcare wastes in landfills can also lead to the contamination of drinking, surface, and ground waters.

Under a new initiative developed following conversations between Dr Ainsley Morris of Christchurch ophthalmology practice EyeAM, Dr Elizabeth Conner of Southern Eye Specialists, and global leader in eye health Johnson & Johnson Vision, more than 10,000 disposal lens delivery systems used in cataract procedures could be recycled annually.

The new sustainability initiative is the first of its kind to recycle waste plastics from surgical delivery systems used in cataract procedures.

It is estimated that over the coming year, more than 150 eye surgeons could have their single-use medical plastic recycled into items such as garden benches, decking and watering cans.

Dr Morris says that as surgeons they increasingly have a role as guardians of the earth, as well as meeting the immediate health care needs of their patients.

“Around 41,000 cataract surgeries are performed annually in New Zealand, with each producing a variety of forms of waste as well as 152kg of CO2e emissions. We are currently trialling a way to sanitise and recycle the medical waste which is left over from these procedures, with the hope that the programme can be expanded into other forms of surgery which use single-use plastic consumables. The idea for this initiative came from the realisation that the health care sector is a significant contributor to carbon emissions and the waste stream,” says Dr Morris.

“The Hippocratic Oath which guides the ethical decision-making process of medical professionals says ‘first do no harm’. The origins of this are rooted in the mandate to act in the best interests of your patient, however, this definition has been broadened as modern medicine and modern society evolve. Not only does it refer to the specific patient in front of you but it also has to be about all of the other patients, their whanau and also the environment. Modern healthcare professionals are increasingly paying attention to the natural world around them with a renewed focus on kaitiakitanga and conservation,” says Dr Morris.

Cataracts have been identified as one of the leading causes of blindness and low vision in the country – with one of the treatment options for the disease involving replacing the lens in the eye with an intraocular lens.

Single-use plastics are used to insert the replacement lens as part of each cataract surgery, with thousands of the units supplied to ophthalmologists in New Zealand annually.

Millions more are used in patient procedures globally, however medical plastic recycling options have been limited mainly due to difficulties involved in sorting or cleaning.

Under the new TECNIS RecEYEcle initiative, the plastic consumables used in the procedure will be collected from over 30 surgical practices and sanitised at one of four sites around the country prior to being shredded, separated, aggregated and finally recycled into other products.

Dr Conner says she welcomes the opportunity to work with others in the industry to reduce the barriers which can impede the implementation of environmentally conscious change programmes within the sector.

“This new programme is the first of its kind and is one part of my mission to improve sustainability in my practice. I am excited to be able to use this service. Doctors need to work together with industry partners, to reduce waste, reuse what we can and recycle what we can't," she says.

Mark Shephard of Johnson & Johnson Vision, who spearheaded the recycling programme, says once proven successful here, there may be opportunities to expand the model beyond New Zealand. He says that this world-leading process could potentially be used to recycle plastic consumables from a much wider range of surgical procedures.

“While the number of cataract procedures performed in New Zealand is a relatively small part of the global market, the sustainability initiative developed here has shown that navigating the complexity of industry regulations is achievable and there is a viable alternative to incineration or disposal of this waste form in landfill,” he says.

Aligned to their global sustainability efforts around waste reduction, Shephard says Johnson & Johnson Vision is committed to working with surgeons to improve health care sustainability in New Zealand as well as reducing the environmental impact of its own activities at a global level.