Sustainable Textile Waste Management Initiative

Case study title:

Sustainable management of textile waste in theatres

Hospital or health system name:

Bongani Regional Hospital

Demographic information

• Africa

• South Africa

• Regional Hospital (Level 2)

• 827 (personnel)

• 455 beds

GGHH agenda goals

● Leadership

● Waste

● Purchasing.

Case Study Summary

This case study explores the social change initiative undertaken by a hospital to divert textile waste from landfill to clothing banks, with a focus on minimizing costs and pollution. The sustainability strategy implemented addresses textile waste management in hospital settings, outlining the implementation process, progress tracking, challenges faced, lessons learned, and future steps.

The issue

The utilization of single-use theatre gowns and an increase in the generation of miscellaneous waste such as old patients clothing, used or torn linen and soiled fabric, can have significant environmental and financial implications. Below, we have summarized four main issues with textile waste emanating from the hospital settings (perspective of Bongani Regional Hospital) and the main environmental issues associated with the item:

1. Waste Generation:

Single-use theatre gowns, soiled linen and old patient kits at Bongani Regional Hospital contribute to the generation of large amounts of Healthcare Risk Waste (HCRW), classified as miscellaneous waste according to SANS 10248-1: Management of healthcare waste – Part 1: Management of healthcare risk waste from a healthcare facility. This waste stream is typically made from solid fibrous materials such as polypropylene, cotton, nylon, polyester, and few more which are not easily biodegradable. Improper disposal of these items can lead to increased landfill waste and contribute to the depletion of natural resources, Bongani Hospital does however have a contracted service provider (For Management of Healthcare risk Waste) until 2026.

2. Energy and Resource Consumption:

The latter consumes non-renewal fossil oil as the basic material and generates large amounts of waste in the life cycle. Moreover, disposable materials release more toxic compounds such as dioxins and mercury into the environment during disposal process.

3. Pollution:

Improper disposal of single-use theatre gowns, soiled linen and old patients’ kits can lead to pollution of land, water, and air. When these items end up in landfills, they can release harmful chemicals into the soil and groundwater. Furthermore, incinerating these items will release pollutants and greenhouse gases into the atmosphere, contributing to air pollution and climate change.

4. Implications on Costs

The utilization of single-use items, including theatre gowns, soiled linen and old patients’ kits, can have cost implications for healthcare facilities. While the initial cost of these items may appear lower compared to reusable alternatives, the cumulative costs can be higher in the long run. This includes expenses related to purchasing and disposal of single-use items, as well as potential fines or penalties for non-compliance with waste management regulations.

Hospital Goal -

Implementing sustainable alternatives can help mitigate these environmental issues and potentially reduce costs by:

• Piloting the use of reusable theatre gowns.

• Cost analysis to assist the hospital financial control committee to make informed decisions (to procure industrial washing, drying and ironing machines), in order to drive transition.

• Repurposing and donating treated textile material (emanating from hospital and classified as miscellenous healthcare risk waste) to clothing banks in Welkom.

Sustainability Implementation Strategy

To initiate the process and implement the strategy to transition from single use linen items and management of textile waste at Bongani Regional Hospital the following initiatives were instigated:

1. Reusable Theatre Gowns:

Using reusable theatre gowns made of durable and washable materials can significantly reduce waste generation. These gowns can be laundered and sterilized for reuse, reducing the need for single-use items.

2. Recycling and Waste Management:

An SOP on sustainable management of old patients’ kits, torn and old linen (classified as textile waste), was drafted and signed by the hospital CEO. The SOP emphasized on the alternative management of disposing the textile waste stream emanating from Bongani Regional Hospital.

3. Cost Analysis:

Conducting a comprehensive cost analysis can help healthcare facilities evaluate the long-term financial implications of using single-use items versus sustainable alternatives. This analysis should consider factors such as procurement costs, disposal costs, and potential savings from implementing reusable options.

Item Cost Weight

Textile Waste Management (Theatre gowns, plastic aprons, disposable theatre caps, and old patients’ kits.), classified as Miscellaneous healthcare risk waste R 19.38 per kilogram 6000 kilograms monthly average

Outsourcing of linen services R 109 per kilogram 1000 kilograms monthly average

Implementation process -

Textile Waste (Old patients’ kits and linen):

The hospital team consisting of EHP (Environmental Health Practitioner), IPC (Infection Prevention and Control), Linen Supervisor and Procurement Officer, initiated the sustainable management of textile waste by first conducting a thorough assessment of their waste streams. This assessment helped identify the types and volumes of textile waste generated, allowing for targeted interventions.

To ensure the success of this initiative, the team engaged various stakeholders, including staff, patients, and suppliers. Training programs were conducted to educate staff on proper waste segregation techniques and the importance of textile waste management. The hospital also worked closely with suppliers to explore sustainable alternatives and reduce the overall generation of textile waste.

Repurposing and donation:

Next, partnerships were established with local clothing banks and charitable organizations to divert the textile waste from Bongani Regional Hospital to be repurposed or recycled. Several steps were followed to ensure smooth implementation of the initiative:

1. Collection:

Establishment of a collection system specifically for textile waste. This may involve designated bins or containers placed in strategic locations to encourage staff to separate and deposit textile waste properly.

2. Sorting:

Once collected, the textile waste needs to be sorted based on its condition and type. This includes segregating linen, patient gowns, and other clothing items. Sorting is important to determine the appropriate recycling or disposal method for each category.

3. Laundering and sterilization:

Before recycling, the linen and clothing items should go through a laundering and sterilization process to remove any biological contaminants. This ensures that the recycled textile materials are safe for reuse.

4. Recycling options:

Depending on the condition and type of textile waste, there are different recycling options available. These may include:

a. Reuse: If the linen and clothing items are in good condition, they can be reused within the hospital or donated to other organizations in need.

b. Repurposing: Textile waste can be creatively repurposed into new products like rags, insulation material, or even upcycled clothing.

c. Fiber recycling: Textile waste can be mechanically or chemically processed to extract fibers, which can then be used as raw material for manufacturing new textile products.

d. Energy recovery : In some cases, textile waste that cannot be recycled can be used as a source of energy through processes like incineration or gasification.

5. Proper disposal:

If recycling is not feasible or viable, the remaining textile waste should be disposed of properly. This may involve disposal by the appointed service provider for healthcare risk waste. Also adhering to the precautionary principles for disposing of miscellenoius waste as healthcare risk waste.

By following these steps, Bongani Regional Hospital successfully implemented the transition from single-use theatre gowns and linen items to reusable alternatives, promoting sustainability, cost-effectiveness, and improved patient care.

Tracking progress

To track progress, the hospital established key performance indicators (KPIs) related to textile waste reduction and diversion rates. Regular waste audits were conducted to measure the effectiveness of waste management practices and identify areas for improvement. Additionally, data on waste volumes, recycling rates, and cost savings were collected and analyzed to inform decision-making and demonstrate the initiative's success, using the GGHH tools and Waste Guidelines including the data captured on Hippocrates (Annual Data Captured on the system)

Progress achieved

The implementation of transitioning from single-use theatre gowns to reusable gowns, as well as repurposing and recycling of textile materials emanating from hospital environment, has achieved significant progress. Let's highlight the financial, environmental, and human health benefits of this transition:

Financial Benefits:

1. Cost Savings:

By eliminating the need for single-use items, Bongani Regional Hospital experienced a substantial cost savings over time. Reusable gowns and bottles, although initially more expensive, can be used multiple times, reducing the need for frequent repurchasing.

2. Efficiency:

Reusable gowns and bottles can streamline inventory management and procurement processes. With a well-planned system in place, the hospital team was able to optimize their resources and reduce wasteful spending.

Table 2, below illustrates and tabulate the financial figures before and after the implementation of the transition strategy.

Item Before the Pilot (2020) After the Pilot (2023)

Healthcare Waste generation 6000 Kilograms monthly average, equates to R 120 000 (approximately) 5500 Kilograms monthly average, equates to R 110 000 (approximately)

Outsourcing of laundry services 1500 Kilograms monthly average, equates to R 150 000 (approximately) 1000 Kilograms monthly average, equates to R100 000(approximately)

Environmental Benefits:

1. Waste Reduction:

Transitioning to reusable gowns and clothing items significantly reduces the amount of waste generated. Single-use items, like theatre gowns and caps, contribute to the growing problem of textile waste pollution. By using reusable alternatives, healthcare facilities can minimize their environmental impact and contribute to a more sustainable future.

2. Carbon Footprint:

Reusable gowns and clothing items require fewer resources and energy for production compared to single-use alternatives. This transition helps reduce greenhouse gas (GHG) emissions associated with manufacturing and disposal processes.

Human Health Benefits:

1. Infection Control:

Reusable gowns and clothing items can be designed with high-quality materials and effective cleaning protocols, ensuring proper infection control. This promotes a safer environment for patients and healthcare professionals, reducing the risk of healthcare-associated infections.

2. Comfort and Fit:

Reusable gowns can be tailored to provide better comfort and fit for healthcare workers, allowing them to perform their duties with ease. This can enhance their overall well-being and job satisfaction.

In summary, the transition from single-use theatre gowns to reusable gowns, as well as from single-use plastic theater suction bottles to reusable bottles, has brought about significant financial savings, environmental benefits, and improved human health outcomes. This progress contributes to a more sustainable and efficient healthcare system.

Challenges and Lessons learned

Throughout the implementation process, several challenges were encountered. One major hurdle was changing ingrained behaviours and practices among staff. Overcoming resistance and ensuring consistent adherence to waste management protocols required ongoing communication, training, and incentives. Additionally, finding suitable partners and logistics for textile waste diversion proved challenging but was ultimately resolved through collaboration and resource-sharing

Lessons learned from this initiative included the importance of strong leadership support, effective communication, and continuous engagement with stakeholders. It was vital to create a culture of sustainability and make waste management a shared responsibility across the hospital community.

Next steps

Building on the success of the textile waste management initiative, the hospital plans to expand its sustainability efforts further. This includes exploring innovative recycling technologies, engaging with suppliers to reduce packaging waste, and implementing sustainable procurement practices. The hospital is also committed to sharing its experiences and best practices with other healthcare facilities to promote wider adoption of sustainable waste management strategies