The pristine glass doors of the Massachusetts General Hospital (MGH) West lobby open, and out rolls a wheelchair onto the sidewalk. But it doesn’t belong to a patient—it’s being used as a makeshift trolley, and it bears a plastic bin full of surgical gowns and latex-free gloves. A nurse stands by to make sure its contents make it safely to the Zipcar parked a few feet away. Though this may not sound like a typical 8 AM weekday scene for one of Harvard Medical School’s oldest and largest teaching hospitals, it’s typical work for undergraduate members of the Harvard College Green Medicine Initiative.

Why are college students getting up so early to collect medical supplies? They’re part of the solution to a silent, growing problem within modern medicine. Healthcare is, in fact, the second largest contributor to waste in the United States [1]. Studies performed at the Johns Hopkins University School of Medicine estimate that U.S. healthcare facilities produce more than 6,600 tons of waste per day and more than 4 billion pounds of waste annually [2]. As in laboratory science, concerns of safety and sterility in healthcare unfortunately necessitate some inefficiency in supply use and disposal. Unlike in scientific laboratories, however, wastefulness in healthcare settings is a lesser-known issue.

As in laboratory science, concerns of safety and sterility in healthcare unfortunately necessitate some inefficiency in supply use and disposal. 

In the United States, operating rooms are among the most wasteful; due to medical regulations, major U.S. hospitals dispose of at least $15 million in unused, sterile surgical supplies annually [3]. Because surgical supply kits bundle together a wide range of materials for convenience and readiness, some of those supplies may be irrelevant to a specific procedure. Considered unsuitable for future use, the irrelevant sterile supplies are then discarded with the rest of the kit, despite being uncontaminated and entirely usable. 

Overstocking may also contribute significantly to healthcare waste [4]. Because the sterility of basic items such as gloves cannot be guaranteed indefinitely, shelves full of excess sterile supplies may be rendered unusable overnight due to their relatively short shelf life [5]. 

One man’s trash, however, is another man’s treasure. While U.S. regulations ban the domestic use of unused prepacked surgical supplies, many under-resourced hospitals abroad readily accept these supplies. Similarly, as long as surpluses are identified well in advance, excess medical supplies can be safely redistributed to areas in need. Basic hospital supplies recovered through these means, like sterile gloves and face masks, can prove to be life-saving in regions hard-hit by epidemics, such as West Africa during the 2014 Ebola outbreak.

...excess medical supplies can be safely redistributed to areas in need. Basic hospital supplies recovered through these means, like sterile gloves and face masks, can prove to be life-saving in regions hard-hit by epidemics, such as West Africa during the 2014 Ebola outbreak.

This growing awareness for green medical solutions with global health impact hails from University of California, San Francisco, where medical student Lily Muldoon ‘14 founded Remedy, an organization that promotes the recovery of unused medical supplies from the UCSF medical system and donates them to health clinics abroad. While completing her MPH at the Harvard T.H. Chan School of Public Health, Muldoon sought out students at Harvard to carry on the mission of promoting environmental sustainability and consciousness on a global scale. Over the course of the 2014-2015 academic year, this new group, headed by a cohort of Harvard undergraduates, laid the groundwork for what would become the Green Medicine Initiative.

Leah Schwartz ‘16 and Samantha Guhan ‘16, then juniors at Harvard College, emerged as leaders of the young organization. They formed partnerships with the Fireman Vascular Center at Massachusetts General Hospital West and the Emergency Department at Brigham and Women’s Hospital. Using collection bins at each partner location and their college dorm rooms for temporary storage, Schwartz and Guhan coordinated several rounds of supplies collection and donated the materials to the Afya Foundation.

In 2015, the Green Medicine Initiative became an officially recognized student organization at Harvard College and began efforts to expand student membership and organizational partnerships. Today, the Green Medicine Initiative is a fifteen-strong, tight-knit team of undergraduates passionate about sustainability, global health, and public service.

Back on the sidewalk outside MGH West, the bin atop the wheelchair-trolley is filled with supplies collected from surgical supply kits and excess inventory. In a few days, the Green Medicine Initiative will send those supplies to the Afya Foundation, which will redistribute them to hospitals in Greece, Haiti, and other crisis-stricken regions. 

However, inefficient allocation of medical supplies is just one source of waste in healthcare settings. Improper waste segregation is another huge contributor to medical waste, according to a 2003 study of Massachusetts healthcare settings [6]. Most medical waste can be safely landfilled or recycled, which is generally the most cost-effective and environmentally-friendly means of waste management [6]. On the contrary, medical waste that is pathological, chemical, infectious, or radioactive in nature is subject to hazardous waste regulation and must be specially processed [6].

Incineration is the most widely-used hazardous waste treatment method and offers several advantages, as it sterilizes waste, reduces physical volume of solid waste, and generates heat energy, which can be recovered to provide power [6]. However, incineration of certain contaminated wastes, such as plastics, may release toxic air pollutants, including heavy metals and dioxins, that bioaccumulate in organisms and threaten ecosystems and humans alike [6].

Environmentally friendly alternatives to incineration—including washing, microwaving, and autoclaving (high-temperature treatment through steam, dry heat, or radiation)—exist, but they are not viable for all types of contaminated medical waste [6]. Additionally, healthcare practitioners often improperly separate recyclable or landfillable waste as hazardous waste [2], raising environmental and public health concerns. In this case, being safe rather than sorry by over-treating waste may not be so safe after all.

This is another area where the Green Medicine Initiative intervenes. With a two-pronged approach—education and empowerment—Harvard College students are helping hospitals to reduce medical waste at its sources. Simply making healthcare professionals more aware of what they use and throw away, through educational presentations and flyers in healthcare settings, can make a tangible difference.

With a two-pronged approach—education and empowerment—Harvard College students are helping hospitals to reduce medical waste at its sources. 

In addition to working with healthcare professionals and collecting excess medical supplies for areas in need, the Green Medicine Initiative engages the Harvard community by fundraising for the Afya Foundation and other medical non-profits. The Green Medicine Initiative’s upcoming fundraising event on April 22 coincides with Earth Day and takes place at the Boston Burger Company’s Cambridge location. Thirty percent of all sales at the event will be donated to the Afya Foundation. 

By aligning sustainability goals with global health and public service missions, the Green Medicine Initiative seeks to engage more of the Harvard community in environmental awareness. Read more about the Green Medicine Initiative’s work.

By aligning sustainability goals with global health and public service missions, the Green Medicine Initiative seeks to engage more of the Harvard community in environmental awareness.


References:

[1] http://www.hopkinsmedicine.org/news/media/releases/going_green_in_the_operating_room

[2] http://archsurg.jamanetwork.com/article.aspx?articleid=406778

[3] http://www.hopkinsmedicine.org/news/media/releases/study_documents_millions_in_unused_medical_supplies_in_us_operating_rooms_each_year

[4] http://www.bidmc.org/QualityandSafety/QualityandSafetyImprovementsatWork/~/media/Files/QualityandSafety/1st%20Silverman%20Symposium/Eliminating_Expired_Supplies.ashx

[5] http://www.bu.edu/orccommittees/iacuc/policies-and-guidelines/conditional-use-of-expired-medical-materials/

[6] http://www.sciencedirect.com/science/article/pii/S0956053X03002101