A Prognosis for Medical Waste

With the dramatic increase in medical supply production to combat the spread of COVID-19, improperly discarded PPE poses a threat to our environment. Luckily, a new Israeli invention is revolutionizing how we manage this waste safely and sustainably.

As infection rates from the COVID-19 pandemic begin to decline in some countries, the long-term effects of its impact are now becoming clearer. In the wake of rising mortality rates, massive blows to the economy, and disruptions to our daily routines, the virus has also shed light on the limited capacities of our hospitals and has also highlighted the many shortcomings of our healthcare systems. Due to the virus’s transmissibility, the pandemic has revealed the importance of protective gear and medical tools to prevent the spread of infection. But like most things we use and throw away today, its waste management has been questionable, and the COVID-19 crisis has simply made the issue more visible.

Not only has COVID-19 overwhelmed hospitals, treatment facilities, and individual households with patients, but it has also prompted a significant increase in both the production of personal-protective equipment (PPE) and the amount being discarded as waste. Estimates show that globally, we use about 129 billion face masks and 65 billion gloves on a monthly basis. As face masks became obligatory, PPE items have been found sprawled across urban settings, beaches, and coastal shorelines everywhere, further cementing the fact that Coronavirus-related litter is exemplary of our single-use society.

Photo by Kadir Celep on Unsplash.

As vaccination rates continue to persist in both Israel and abroad, questions surrounding what to do with empty vials, needles, latex gloves, and single-use masks have still largely been left unanswered. With the pandemic not quite over yet, the widespread use of PPE is still in effect, carrying with it an impending threat to nearby wildlife. Much of the medical equipment used by hospitals is single-use, which burdens and inundates disposal sites and storage facilities. Although COVID-19 may eventually dissipate, the plastic waste from protective gear and vaccine equipment will remain much longer, perhaps even forever.

The COVID-19 litter that was once protecting humans from transmitting the diseases now entraps, entangles, and endangers surrounding wildlife. A marine animal might become entangled, resulting in death from suffocation or drowning. Thus with the emergence of new COVID-19 variants, medical waste management is likely to continue to play a crucial role in its impact on the environment.

Luckily, an Israeli invention is tackling the surge in increased medical waste. The Envomed 80 is an on-site medical waste machine that produces a safe product that is not only disposable alongside municipal waste but is environmentally conscious as well.

Making Sense of Medical Waste

The World Health Organization (WHO) defines medical waste as all forms of waste generated by health care facilities; about 80% of medical waste is defined as “general” in that it does not pose a direct health risk to people. The remaining 20% is often considered to be infectious and hazardous.

Hazardous waste can take many forms; in fact, there are several different ways to classify this type of medical waste. Infectious waste is contaminated with bodily fluids whereas pathological waste might contain organs, tissues, or body parts. There are also sharp wastes, which refer most notably to needles, blades, and other similar equipment. Pharmaceutical waste includes expired or contaminated drugs as well as unused vaccines. If overlooked or mismanaged, these various forms of medical waste can directly lead to various infections including HIV, and HEP A, B, and C.

Medical waste disposal is neither cost-effective nor sustainable. It’s often forgotten that the financial undertaking of waste management systems begins with initial investments, which includes operating costs for labor and consumables as well as utility requirements, and finally ends with overhead costs. While compiling discarded medical supplies is a hurdle in and of itself, the difficulties do not end there. The need to properly transport, store, and dispose of medical waste is both labor-intensive and costly, adding layers of complexity that should be considered.

Unfortunately, improper management of medical waste is an all-too-familiar reality here in Israel. In fact, when compared to most developed countries, Israel is quite behind regarding the collection of household medical waste. In particular, more than 85% of publicly accumulated medications disposed of at home are done so by either flushing them down the toilet or sink or by throwing them away in the garbage bin that will eventually be transferred to landfills where the active materials in the medications might leak into the groundwater. Plus, residues of medications may contaminate purified wastewater normally used for agricultural irrigation. These environmental hazards have dire implications when it comes to public health of both humans and animals alike. With the potential to contaminate water reservoirs and aquifers that provide drinking water, pharmaceutical compounds contaminate all kinds of ecological systems.

Photo by Dex Ezekiel on Unsplash.

Insufficient training, little to no public awareness, and a lack of effective regulations and legislation are some of the reasons holding Israel back from improving its waste management. With medical waste now on the rise, the need for a comprehensive and effective solution is becoming urgent.

The Environmental Detriment of Improper Disposal

Firstly, increased medical waste has put human health at risk. Studies show an increase in the quantity of packaging waste by nearly 20% when compared to pre-pandemic levels as a result of widespread lockdowns. Although this “at-home” waste of used masks, gloves, and protective gear is not directly generated by a healthcare facility, it is still considered medical waste because it can enable the transmission of bodily fluids and even illnesses like COVID-19’s viral particles via its surfaces. In fact, people might still acquire the virus after touching contaminated and improperly discarded plastic-based biomedical waste (although this is not a main transmission pathway of SARS-CoV-2).

Given the disproportionate amount of marine pollution from land-based sources, researchers have grown concerned that the additional discarded surgical masks, medical gowns, face shields, safety glasses, protective aprons, sanitizer containers, plastic shoes, and gloves arising from the current coronavirus pandemic could end up in our aquatic ecosystems, thereby compounding the existing marine pollution issue.

Photo by Aleksandr Kadykov on Unsplash.

The Envomed 80: A Safe and Sustainable Solution

In order to adequately address the growing volumes of medical waste, a sustainable solution must tackle challenges pertaining to sorting, segregating, and storing materials. Thankfully, an Israeli company, Maabarot Metal Works, developed the Envomed 80, a machine that can do just that. In just under 20 minutes, a singular Envomed 80 machine can treat up to 80 liters of waste, and by the end of a 9-hour shift, it can treat up to 250 kilograms (2,220 liters) of waste, serving nearly 350 hospital beds. This innovative technology is in response to the need for on-site waste treatment, offering a revolutionary tool that is both safe and environmentally conscious.

“We were looking for a field in which there’s a scarcity of technical solutions. We came across infectious or medical waste treatment, and after exploring this market, we identified two problems,” shares Envomed’s CEO David Segev. “The first one was that there is no on-site treatment, it’s all done off site, which makes no sense. The second thing is that off-site treatment mainly involves incinerators, which is horrible. When we re-explored the market, we found that hospitals don’t process on-site because there’s no adequate alternative.”

“The technologies available back then were mainly heat treatment technologies––autoclaves. The problem is that they aren’t valid for both solids and liquids. Infectious waste carries both liquid and solid phases, which autoclaves cannot tackle,” Segev explained.

“The challenge was finding a process that is valid for both solid and liquid waste. Even so, every stream of waste has different materials, so there’s really no way to know exactly what’s going through the machine every time. Also, hospitals are highly regulated institutes that don’t like the uncertainty or invalid treatment technologies. We needed to design a solution that would have repetitive and valid infectious waste sterilization results for both solids and liquids.”

The Envomed 80 first shreds waste, creating up to an 80% reduction in volume before sterilizing the collected materials to STAATT Level IV in a fully thorough manner.

Photo courtesy of Maabarot Metal Works.

“Our machine uses a very strong oxidizer, so the efficiency is very high. After the activation stage agitates the shredded waste with the sterilization agent, the outcome yields both solids and liquids. From there we have a liquid and solid separator where the liquid will go directly to the sewage, because at that point it will dissolve into water, oxygen, and acetic acid, so it’s totally eco-friendly. The solid product will later be dried, leaving a confetti-shaped municipal grade waste product,” says Segev.

During the sterilization step, the materials undergo rigorous agitation using novel “Biocetic” technology––a powerful oxidizer combining peracetic acid and hydrogen peroxide that can attack all cell components like proteins and enzymes to fight against bacterial spores. Segev expressed that the Envomed machine is capable of eradicating a concentration of 6 log colony-forming units/mL of bacterial spores. Leaving zero live pathogens residue behind, the Envomed 80 eliminates the need for off-site management, bringing with it the reassurance of safety and hygiene within healthcare facilities.

Envomed has begun piloting its sanitation units in Asia-Pacific and European countries with installations in progress in Israel with Clalit Health Services, one of largest HMOs in Israel. “We have machines in the Soroka medical center in Beer Sheva, and we’re installing more in Beilinson hospitals in Petah Tikva,” shares Segev.

“There’s also some installations in Scandinavia. Installing our machinery in these places is relatively easy for us because they’re all fairly sustainable countries so they can appreciate our technology,” says Segev.

Although current practices and regulations of waste management are suited for off-site solutions, Segev believes Envomed has the potential to pave the way for other initiatives in waste management as installations proliferate. “If you have good technology, it makes no sense to treat it off-site. It makes more sense to treat it immediately at the place where it was generated.”

Taking It One Step Further

Despite the machine’s capabilities, the Envomed 80 alone cannot reverse the damage caused by the COVID-19 pandemic and the medical waste problem it exacerbated.

“We’ve seen in Israel that the amount of waste grows tremendously, particularly from COVID-19,” says Segev. “When you have an on-site instrument, it’s really helpful in avoiding pileups of waste. Especially during the pandemic, there’s no everyday waste pick-up service, so waste pileups become very dangerous, not to mention they’re not so eco-friendly. When you have the instrument at the site, you are not really beholden to pick-up services, so there’s closure in knowing how the waste is managed.”

However, Segev thinks the solution to managing medical waste does not end with Envomed’s functionality. “We need to take things one step further,” he says. “In Israel now, municipal grade waste ends up in landfills. We are trying to take things one level higher by taking this municipal grade waste and recycling it. Let’s take the waste product and make something of it,” he concludes.

Adopting technology like Envomed 80 and incentivizing more eco-friendly energy consumption and waste management is a recipe for a happier, healthier, and safer future. It is crucial that medical waste management be prioritized to avoid the spread of illness, maintain human hygiene, and protect all ecological life on our planet especially during the transition from a global pandemic to a state of normalcy. Failure to adapt both quickly and adequately can put the health of the earth and its human occupants in jeopardy.

This ZAVIT Article was also published in Israel21c on 5 Jul. 2021