Background: Plastic waste contaminates all planetary ecosystems, impacting human and animal health. The United States is the largest generator of plastic waste in the world, and the healthcare industry produces a disproportionate amount due to a reliance on single-use products. The COVID-19 pandemic has seemingly led to a global increase in plastic waste, partially correlated with use of disposable personal protective equipment (PPE), but its effect on waste production in U.S. hospitals, and specifically on inpatient medicine units, remains unknown. Hospital medicine is the foundation of inpatient care, so refinement of clinical practice has the potential to transform and widely impact waste reduction strategies. Waste audits have been utilized to quantify waste produced in healthcare delivery although none have specifically focused on inpatient medicine units.

Purpose: The purpose of this waste audit was to quantify and characterize all municipal solid waste (MSW) and regulated medical waste (RMW) produced on an inpatient general medicine unit to inform opportunities for diversion and elimination.

Description: The audit was performed over a 24-hour period in August 2021 on a 20-bed inpatient unit at Massachusetts General Hospital, an urban tertiary-care medical center in Boston, Massachusetts. Historically, roughly three-quarters of this unit’s patients are on contact precautions, per hospital policy, for various infectious diseases including MRSA, VRE, COVID-19, and MDRO. All solid waste generated on the unit during this 24-hour period was collected and stored in a prepared space. The audit excluded waste from cafeteria-delivered patient meals, disposed of separately by nutrition services, but unit galley food waste was included. Waste was divided into MSW and RMW, the latter defined as biohazardous or contaminated medical waste collected in red bags and sharps containers, as per Massachusetts state regulations. MSW was weighed after further sorting into categories based on raw materials; additional items of interest were also cataloged and weighed (Table 1). RMW was weighed in established containers without sorting given safety concerns. A total of 168 kg of waste was collected during the 24-hour audit. Approximately 90% of waste was MSW, of which more than half (79.17 kg) was plastic. PPE accounted for nearly 70% of plastic MSW and more than one third of all MSW generated, totaling 55.97 kg. More specifically, 559 polypropylene plastic gowns, 2541 plastic gloves, 86 masks, and 20 face shields/goggles were disposed of in one day (Image 1). Numerous unused items, identified as IV syringes, masks, glove boxes, etc., accounted for 5% (7.69 kg) of MSW.

Conclusions: Much of the waste generated during this waste audit was single-use plastics, of which PPE was the largest component. Extrapolated further, for each patient, more than eight kg of waste (nearly three kg of PPE) and 28 plastic gowns were used to provide care in a single day. The substantial use of PPE reflects pandemic-associated changes in healthcare delivery superimposed on a chronic overreliance on single-use disposable products, thus suggesting opportunities for inpatient medical units and hospitalists to reexamine and reduce waste generation. Areas for improvement may include transitioning to reusable items such as washable PPE gowns, reevaluating certain contact precaution policies, clustering patient care, and investing in staff education to reduce wasteful practices.

IMAGE 1: TABLE 1: Municipal Solid Waste (MSW) Cataloged by Raw Materials and Items of Interest

IMAGE 2: IMAGE 1: Photograph of municipal solid waste (MSW), including most of the PPE gowns generated in one day