PRE2022 3 Group3

Group members

Name	Student id	Major
Luta Iulia Andreea	1671685	BCS
Sonia Roberta Maxim	1675656	BCS
Marie Spreen	1909983
Fenna Schipper	1625624	BPT
Hakim Agni	1430149	BCS
Lazgin Mamo	1502506
Dhruv Manohar	1568868

Introduction

Problem statement

Plastics have had a big impact on the medical industry. Their main advantage is the ease of sterilization compared to traditional materials used in healthcare such as ceramics, glass and metal. The latter materials needed time-consuming sterilization processes, steaming or autoclaving, whereas for plastics, there is a new technology used: gamma sterilization. With the use of plastics, procedures are easier and safer and the costs have been reduced a lot. But this revolutionary change of plastics in health care also results in a lot of plastic waste. In 2020, globally over 32 billion pounds of healthcare plastics were produced, and this is expected to grow to 48 billion pounds by 2025. Most of this plastic is being disposed of in landfills or by incineration even though much of this material is uncontaminated and recyclable. During the Corona crisis, the waste became even more because the large amount of single-use plastics that were needed as personal protective equipment. "There has been a dramatic demand for personal protective equipment (PPE). PPE which includes masks, safety goggles, face shields, hair covers etc. are all made of plastics like polyethylene terephthalate (PET)" . All these plastics have a great impact on the environment, especially because most of these plastics are not recycled. Recycling these plastics is a solution to solve the crisis of plastic pollution, but recycling medical plastic has difficulties involved in sorting and cleaning.

To use plastics for biomedical application, it is important that plastics are selected with appropriate material, chemical or thermal properties, sterilization potential and durability because not all plastics can be recycled. If the plastics are not recycled in the correct way they can cause serious health issues and long-term pollution. Even though recycling medical plastic can make a serious difference, still very little is known and done. There is an association, HPRC (Healthcare Plastics Recycling Council), that tries to solve this problem. However, still not a lot has improved.

Objectives

To help the recycling process of medical plastic, we will try to come up with a robot which makes helps with dividing the different plastics based on their properties so it will be easier to recycle them. In order to do this literary research will be done and a concept will be made.

Why?

Medical staff already have a heavy workload and many responsibilities to deal with during their time at hospitals and clinics. Except from the shortage of medical staff due to the growing population in European countries, the available medical staff already spend much time on other tasks than taking care of patients. For instance, a study published in SAGE journals reports that doctors for instance spend 8.7 hours per week (16.6 % of working hours) on administration less than physicians who spend 20.3 % of working hours on administrative tasks. Training medical staff to separate medical waste based on their chemical properties could be a cheaper and easier solution , however it would also put more workload on them and affect the service quality they provide for their patients.

In addition , Stericycle’s Healthcare Workplace Safety Trend Report found that more than 90% of healthcare professionals surveyed believe effective medical waste management is key to providing the best patient care possible. On the other hand, those surveyed also reported that improper medical waste management contributes to fatigue and burnout (68%) and can negatively impact patient health and safety (72%). Nurses can save time and energy when they can dispose of medical waste through a streamlined process."

State of the art

In this section we will investigate potential attempts that have already been implemented in order to tackle different aspects of this problem and existent technologies that can help towards creating a final design.

Machines developed that can separate 12 different types of plastic

Researchers from the Department of Biological and Chemical Engineering at Aarhus University have created a new camera technology that can differentiate among 12 types of plastic From these types, PVC, PP, PS, PE, PC, PET, PA12, ABS are frequently used in the healthcare system. For example, Polycarbonate (PC) is usually found in syringes, tubes and stents. The camera technology separates the different types of plastic based on their pure chemical composition. It uses a hyperspectral camera and machine learning algorithms to analyze the type of plastic directly on the conveyor belt.

In comparison, the current technology that usually uses near-infrared technology or density tests, can separate a much smaller variety of plastics and it is not as efficient.

Plastic classification via in-line hyperspectral camera analysis and unsupervised machine learning

Hyperspectral imaging with wavelengths from 955 to 1700 nm on thirteen different plastics analyzed by PCA has shown that the spectral range is sufficient to differentiate plastics. Unsupervised machine learning has proven to cluster the plastic types and the resulting loading matrix correctly classified unknown plastic samples.

Healthcare Plastics Recycling Council (HPRC)

The council showcases multiple case studies run in hospitals regarding plastic recycling. Even though multiple hospitals are planning and developing a recycling program, none of them had promising enough results to make a breakthrough.

• Chicago Regional Recycling Project: HPRC and Plastics Industry Association (PLASTISCS) are currently running a recycling program in the Chicago area. Participating hospitals are Advocate Illinois Masonic Medical Center, and NorthShore University Health System’s Evanston, Skokie, Glenbrook, and Highland Park Hospitals. The project includes various companies providing logistics and recycling support, sustainability management software service, financial support and specialized bags for collection and transportation of the plastic materials.
• Kaiser Permanente and Cleveland Clinic: the approach focuses on external waste recycling companies that will deal with sorting the mixed plastic waste. The programs are not yet running.
• Mayo Clinic: Mayo Clinic’s Healthcare Plastics Recycling Program began in 2013 and from 2016-2017 it saw a 78% increase in recycling the PP, PS and other types of plastic and a 9% increase in recycling PET AND HDPE plastics. The project involves the addition of a baler, a grinder and willing external plastic buyers.

TRASHBOT

Physical implementation of a autonomous sorting waste technology. Developed by cleanrobotics, the technology uses AI and computer vision to detect the recyclables and then applies machine learning algorithms to sort them and divert them into specific bins.

ECOSTERYL

Ecosteryl is a machine produced by the company AMB based in Belgium that offers a solution for medical waste treatment and recycling. The waste is shredded and decontaminated in a secured machine. The machine does not need any water or steam.

ECODAS

ECODAS is a company based in France that also deals with medical waste. This includes medical waste from hospitals, clinics, other healthcare institutions, seaports and airports. The ECODAS machine is an automated system that sterilizes regulated medical waste and thereby reducing around 80% of the waste volume. The recycling and sterilization include shredding and steaming of waste.

Users

Primary Users: Medical Staff

In the USA, the current workflow of medical staff regarding plastic waste management varies depending on the facility and region. However, there are generally accepted guidelines and best practices that medical staff follow to manage plastic waste.

Firstly, medical staff are trained to segregate waste at the point of generation, which means that they sort the waste into different categories such as infectious, hazardous, pharmaceutical, or general waste. This helps to ensure that each type of waste is managed appropriately and safely. Once segregated, the plastic waste is typically collected in specialized containers that are labeled and color-coded to indicate the type of waste they contain. For example, infectious waste may be collected in red containers, while hazardous waste may be collected in yellow containers. Medical staff are also encouraged to minimize the amount of plastic waste they generate by using reusable or sustainable alternatives whenever possible. This includes using cloth gowns and towels instead of disposable ones, using reusable containers for sharps disposal, and minimizing the use of single-use plastics in the medical setting. Overall, the workflow of medical staff regarding plastic waste management in the USA involves careful segregation, labeling, and disposal of plastic waste, as well as a focus on minimizing the amount of waste generated.

For this group of users , it is essential that the segregation of medical plastic waste is done appropriately and automatically. Segregation robots can help medical staff quickly and efficiently sort medical waste, saving time and increasing productivity. Furthermore , Medical waste must be properly segregated and disposed of according to local and national regulations. Segregation robots can help ensure that medical staff comply with these regulations, reducing the risk of fines and other penalties.

Secondary Users: Hospital Management

Now in hospitals, waste is generally separated into color-coded bins or bags. This system however is far from flawless. Because the color selected for each waste type varies between different regions. This lack of standardizations results in errors in the waste separation and makes the system inefficient.

In hospitals the separation of infectious and non-infectious waste is an important process because faults during this process can result in higher costs and danger for the people working with the waste. Studies conclude that 70 to 80 percent of the infectious waste stream leaving hospitals include non-infectious wastes that have been mixed into the infectious waste stream due to poor separation practices. When non-infectious waste ends up being mixed with the infectious waste the costs will be significantly higher because it all has to be processed as infectious waste which is a more expensive process. The poor separation system can also become dangerous when a person comes in contact with infectious waste.

To prevent a mix up of the non-infectious and infectious waste it will be best to separate the two directly when it is deposited into the bins. This however comes with another problem, a lack of clear sorting protocols which makes it hard for the staff to correctly separate the waste.

When sorting plastics there are some additional points to take into consideration in the separation process. There should be a separation between the plastics that can be recycled and the ones that cannot to recycle as much of the plastic as possible. This should be done very carefully because when the waste is not handled correctly it can lead to serious environmental problem. The plastics which can be recycled should again be sorted into their ease of recyclability. When the plastics are infectious, they first have to be sterilized before they can be send with the other waste.

So overall for the good waste separation system in hospitals it is best if the waste is separated at the source and for the plastics it is important that is correctly separated based on the recyclability of the plastic to recycle as much of the plastic as possible.

Tertiary Users: Waste Handlers

In the process of plastic-recycling, waste handlers are working on reprocessing plastic scraps and waste into useful products. This often requires greater processing than the recycling of other materials, due to the unique properties of plastics and the various steps that need to be considered. Due to the high molecular weight of large polymer chains, dissolving plastics cannot easily be achieved through heating. Therefore the mixing of different plastics tends to produce phase-separated material, which is structurally weak and only useful in a very limited range of applications. In addition the widespread use of dyes, fillers and other additives leads to many more impurities that have to be accounted for. Oftentimes the polymers are damaged in the process of removing these impurities. Whenever it is possible to produce a single-material and clean stream of plastic, the plastic recyclables are usually shredded and worked into pellets, which are then used to produce new products. Oftentimes products which are themselves made from recycled plastic are no longer recyclable, due to the structural toll the recycling process takes on the material.

https://www.statista.com/statistics/1228851/us-plastic-waste-recycled-by-resin/

The difficulty of the plastic-recycling process is reflected in the amount of plastics recycled. According to a survey in the U.S. in 2021 an estimated 40.1 to 51 million tons of plastic waste were generated, of which only between five and six percent of total plastic were recycled. The majority of U.S. plastic waste is land filled.

The demand for recycled plastics and therefore the market volatility for waste handlers is affected by the price of virgin commodity plastics. Specifically the mixed material healthcare plastic waste streams in addition to the low mass per unit area of plastics relative to other materials, leads to a high logistic cost associated with the recycling process. The European Recycling Industries Confederation (EuRIC) wrote a position paper on the capital investment required to use heavy chemical recycling plants that process mixed waste streams (i.e. through processes such as pyrolysis). It concluded that this would be economically viable at a crude oil price of $65-75/barrel. Over the last five years, oil prices have not been above this range. On the other hand the vast amount of recyclable plastics that are currently ending up in landfill in addition to the momentum behind advanced recycling technologies could work to minimize the cost of the recycling process and ensure market volatility.

While the recycling of plastics has to of course be economically viable, it should also be environmentally viable. The Dutch firm CE Delft analyzed the greenhouse gas reduction and concluded that purification and depolymerization technologies were comparable to mechanical recycling whereas thermal conversion technologies (e.g. pyrolysis), while generating greater greenhouse gas emissions than mechanical recycling, still fell below what would be expected from incineration.

Especially medical waste bears the additional risk of being infectious. Using various sterilization processes we could get rid of that risk, but add to the logistic and economical barriers for waste handlers.

https://www.sciencedirect.com/science/article/pii/S2542504821000348

There are essentially four common plastic recycling routes:

1. Primary recycling is the process of reusing single type plastics which are clean or uncontaminated or converting plastic scraps into products with similar characteristics of the original material. Oftentimes waste plastics can be mixed with virgin material to ensure the required product quality. This is considered a closed loop process, as can be seen in the figure.
2. Secondary recycling is the recovery of plastic wastes by mechanical means. It involves washing the plastic to remove contaminants and grinding the material. Repeatedly processing plastic in this way leads to slowly building contamination and thermal degradation over time.
3. Tertiary recycling is the (often chemical) process of converting the material into smaller molecules (liquids or gasses) to generate chemicals and fuels. It involves chemical processes such as purification, wherein polymers are chemically separated from unwanted additives, decomposition/depolymerization, which breaks the molecular bonds of plastics into monomers and intermediates by biological, chemical, or thermal means, and thermal conversion, which brings plastics back to their most basic petrochemical building blocks by breaking their molecular bonds. The most popular methods of thermal conversion is pyrolysis, where medium temperatures are applied in the absence of oxygen or air to convert plastic waste into liquid and gaseous products and a char byproduct. This process is very useful since it allows for the recycling of material blends.
4. Quaternary recycling is the process of recovering energy from waste plastic by incineration. This method is applied whenever wastes are highly contaminated and cannot be recycled by normal means. The process results in waste residues and ultimately pollution as well as harmful gasses that are released during combustion. It reduces the volume of waste to 1% and effectively decomposes toxic or contagious waste.

Design concept

MoSCoW List

In order to define our design requirements, we created a list which prioritizes these using the MoSCoW method.

- this is a draft -

Must Haves	Should Haves	Could Haves	Won't Haves
Opening that people throw the trash into	Sensor for fullness detection	(interactive) Display for more detailed fullness indication	Mechanism to recycle plastics
Sensor Mechanism that can sense characteristics of plastics	Simple fullness indication	System for relaying fullness information to relevant staff	Connection to underground storage
Algorithm or Software that can use sensor data to categorize plastics	Way of identifying emptied plastic types for easy storage (e.g: color coded bags)	Odor remover to remove unpleasant odors	Mechanism for detecting contagious waste
Different compartments to store the respective types of plastic	Compartment for general waste	Wheels to move through the hospital	Mechanism for sterilizing contagious waste
Mechanism that puts incoming trash into appropriate compartment	Easy access to controller and mechanical parts for maintenance	Mechanism that compresses the trash
Must follow the hospital regulations	Updatable over the air
Proper isolation of compartments, trash may not mix under any circumstances	Mechanism that makes bin inaccessible when full
Once trash is inside it stays inside unless a professional empties the bins
Accessible at all times, unless it is full, or someone is unloading the trash
Accessible, lockable additional opening that full bins can be emptied through
Appropriate dimensions, fits through doors and inside corridors
Be easy to use: Requires no training Requires minimal decisions
Be safe to use: No sharp edges No contact with mechanical parts

Use Cases

1. Disposing garbage. The bin allows the access of the piece into the inside of it. The garbage is scanned, în order to figure out which kind of plastics it contains. The piece of garbage is then placed în the compartment for the specific type of plastic. Then the bin s
2. Classifying garbage. Upon receiving garbage, it is scanned and classified in the correct category.
3. Sorting the trash. Upon classifying the trash correctly, the dustbin uses the sorting mechanism to sort the trash into it’s respective compartment
4. Signaling fullness. When the bin gets full, a sensor will activate. The bin closes temporarily until an employee empties it. A signal is sent to the management team to let them know the bin is full.
5. Disposing non-plastic. The bin allows the access of the piece into the inside of it. The garbage is scanned, and it is noticed that the piece does not contain plastic. The piece of garbage is then placed în the compartment for unknown substances.
6. Compressing the trash. The dustbin can use a combination of weight and IR sensors to determine if the trash is compressible or not, and if it is, it can compress the trash to fit more plastics in it
7. Sterilizing the trash.

Argumentation design choices

non-infectious vs infectious

For the bin, the choice was made to only focus on non-infectious plastics for the bin. This will result in the product only sorting the non-infectious plastics. It is important to make a decision on whether to collect non-infectious or infectious plastics. When the two are mixed, all the plastics need to be treated like infectious waste. The treatment of infectious waste is a lot more expensive than the treatment of non-infectious waste, so a mixture of the two will only result in more, unnecessary costs. There are some reasons why the choice was made to sort the non-infectious plastics with this bin instead of the infectious plastics. First, about 85% of medical waste is general, non-infectious waste. This means that when the bin focuses on the non-infectious waste it will have a lot more impact than when it focuses on the infectious waste because there will be a lot more waste to sort. Furthermore, non-infectious plastics can immediately be recycled in the Recycling stream of general waste. When the plastics are infectious, the plastics first have to be sterilized. This will not be possible with just this bin, which results in an even harder process because an extra machine should be added.

Separating Between Different Types of Plastics

According to a report by the Healthcare Plastics Recycling Council (HPRC), most healthcare plastic products, that qualify for recycling, fall within five primary applications:

• Sterilization Wraps
• Irrigation Bottles
• Basins, Pitchers, Trays
• Flexible Primary Packaging
• Rigid Primary Packaging

These products can be further categorized into seven different plastic types:

• polypropylene (PP)

• high density polyethylene (HDPE)
• polystyrene (PS)
• multi-materials (HDPE, polyester, polyethylene (PE), polyamides, PP, ionomer)
• polyethylene terephthalate glycol (PETG)
• polycarbonate (PC)
• low density polyethylene (LDPE)

According to our user research the best way of sorting our plastics in a way that maximizes the chances of it being recycled is by creating single material waste streams. If done reliably and with little to no contamination with other materials, this provides waste handlers with high quality material that requires minimal processing before recycling. However there exists a trade-off with regard to the detail of separation between the quality of the waste stream on the one hand and the logistic cost of storage and transportation on the other. If we separate the plastics into all seven categories of healthcare plastics, we create additional costs for both the hospitals and the waste handlers in having to store and transport these plastic types separately. We might consider grouping plastic types together, based on their role in traditional mechanical recycling processing.

The recycling industry commonly differentiates between seven resin types, of which five overlap with our medical plastics categorization: PET, HDPE, LDPE, PP and PS. These plastics are easily recyclable in the current recycling system.

While separating the plastic waste into these resin types is possible, either through manual labor or automation, it can be very inefficient. Especially when mixed with the municipal waste stream, as it is currently often done, a lot of contaminants and lots of inefficiencies are introduced.

By separating the waste at the source and providing uncontaminated, single material streams of these plastics we provide waste handlers with a clean, direct source of high quality, recyclable plastics. While some of these plastics are compatible with traditional mechanical recycling possessing, others (especially multi materials) are only recyclable through more advanced technologies (chemical recycling). These chemical ways of recycling are a lot less established in the U.S. and demand a high upfront investment, but could be highly profitable, considering the vast amounts of plastics that currently go unrecycled.

In addition to our five mechanically recyclable categories we therefore also introduce a sixth multi material category. This category outputs a multi material plastic waste stream that could be processed by a chemical plastic recycler.

At last we also need a seventh category for non-plastic waste. While our bin should serve as a plastics-only solution, human error will most likely introduce non-plastic materials into our system.

This leaves us with seven categories along which we separate the waste:

1. PET
2. HDPE
3. LDPE
4. PP
5. PS
6. Multi Materials
7. Other

Design Choices

Hyperspectral spectra for the studied plastics.

To sort the different types of plastics correctly, we have chosen to make the plastic classification via in-line hyperspectral camera analysis and unsupervised machine learning. This technology has been developed by Aarhus University together with the Danish Technological Institute and a team of Danish companies; Dansk Affaldsminimering, Makeen Energy and Dansk Retursystem. It is a brand new , innovative technology that differentiates between the types of plastic based on the chemical composition of the waste, thus increasing the accuracy of the sorting process. In order to do this, the system applies unsupervised machine learning on short wave infrared hyperspectral data to build a model for classification of plastics.

A good way to work with materials, identify them or define their properties is to study how light interacts with them. The hyperspectral camera recognizes materials based on their spectral signatures (how much light is absorbed/ reflected/ transmitted). A spectrum represents the amount of light in different wavelengths. The hyperspectral sensors collect information as a set of 'images'. Each image represents a narrow wavelength range of the electromagnetic spectrum, also known as a spectral band.

The data collected by the hyperspectral sensors is processed using principal component analysis (PCA) and K-means clustering for differentiating the types of plastic.

When it comes to the setup of the hyperspectral system, a 29 cm wide conveyer belt is planned on being used, together with two rows of four halogen spots (12 V, 20 W) illuminating it at a 45° angle. The line-scan hyperspectral camera should be equipped with a spectrograph (QiSpec, QT5022K-I320-SWIR, Qtechnology, DK).

Besides increased accuracy, we have also chosen this model for the future perspective of replacing any kind of manual sorting with an automated one. The system currently is capable of differentiating among 12 types of plastics, however we want to adapt it to our 7 categories of plastics. The bin will also have another bin, besides the 7 plastic ones, for any waste not fitting into the 7 plastic types.

For the mechanism that puts incoming trash into appropriate compartment we decided to use a conveyor belt, as it is a reliable, easy to control mechanism that was also tested alongside the aforementioned hyperspectral camera system.

The bin has also a digital signaling system for the case in which at least one of the bins is full. When the bin is full, the bin will close and a warning signal will be sent to the waste management of the hospital. We want to achieve this by using a distance sensor. After doing some research , we have found two types of distance sensors specifically designed for waste bins:

• The Benewake TF Series Distance Sensors
• The Benewake CE30 Series 3D LiDAR Sensors

Ram of a Vertical Compactor

How Benewake TF Series Distance Sensors work for tall and narrow waste bins

The two categories of sensors are specially created for a specific type of bin, asshown in the two figures on the side. Having in mind that our product must have the most efficient space design for the 8 bins, we chose to use the Benewake TF Series Distance Sensors, as the bins will be tall and narrow.

One of the features that could be added to the design is a trash compressing mechanism. The best solution to achieve this would be by using a vertical compactor. These compactors have a small footprint and are perfect to use in small, crowded spaces, like hospitals. When the compactor chamber is full, its ram is activated by a switch causing the ram to move down on the waste and compress it.

The process of a vertical compactor creates a bale or block that can be used for recycling. After the containers are full, they can be kept on site to decrease the frequency of pickups and therefore, also transportation and disposal costs.

How Benewake CE30 Series 3D LiDAR Sensors work for large and wide waste bins

Appendix

Logbook

Week	Name	Total	Breakdown of hours
1	Luta Iulia Andreea		Team formation + sending emails
	Sonia Roberta Maxim	3	Team formation + sending emails (1h), research ideas for first meeting (2h)
	Marie Spreen	1	Team formation + research for ideas
	Fenna Schipper	1	Team formation + research ideas for first meeting (1h)
	Hakim Agni	1	Team formation + reading course info
	Lazgin Mamo	1	Team formation
	Dhruv Manohar		Team formation
2	Luta Iulia Andreea	6	online meeting (1h), first meeting + tutorial (2h), literature study (3h)
	Sonia Roberta Maxim	6	first meeting + tutorial (2h), literature study (3h), online meeting (1h)
	Marie Spreen	6	research + meeting + online meeting
	Fenna Schipper	6	literature study (3h) and 2 meetings (3h)
	Hakim Agni	4	Research (3h) + online meeting (1h)
	Lazgin Mamo	6	Literature study (3hours) and meetings (3 hours)
	Dhruv Manohar
3	Luta Iulia Andreea	8.5	Research + State of the art, tutorial + 2 meetings (3.5h),
	Sonia Roberta Maxim	8.5	Research + State of the art (5h), tutorial + 2 * meetings (3.5h),
	Marie Spreen	10	survey research + Meetings + general research + contact hospitals
	Fenna Schipper	8.5	research + problem statement + meetings + start MoSCow
	Hakim Agni	6	Research (3.5h) + online meeting (1.5h)
	Lazgin Mamo	5.5	meetings(3 hour) + research paper for importance of recycling bin (2 hours)+ writing the objective on wiki (0.5 hour)
	Dhruv Manohar
4	Luta Iulia Andreea	9	meetings, tutorial, beginning research on design
	Sonia Roberta Maxim	11	structuring wiki page, research on users, meetings
	Marie Spreen	12	contact hospitals + meetings + research on tertiary users
	Fenna Schipper	11	research + writing secondary users + meeting
	Hakim Agni	8	meeting (1 hour) + research current workflow (4 hours) + research medical waste (3 hours)
	Lazgin Mamo	7	meetings (3 hour)+ research primary users need and writing the wiki (4 hours)
	Dhruv Manohar
5	Luta Iulia Andreea	12	3 meetings, tutorial, designing moscow requirements and usecases, reasearch
	Sonia Roberta Maxim	12	Tutorial + 3 * meetings, Research + Helping with moscow list and use cases, updated wiki
	Marie Spreen	10	meeting + design-research + meeting + argument write up
	Fenna Schipper
	Hakim Agni	7	research (2 hours) + finding hospitals (5 hours)
	Lazgin Mamo
	Dhruv Manohar
6	Luta Iulia Andreea	12	2 meetings, tutorial, research on must haves design, writing findings in wiki + argumentation
	Sonia Roberta Maxim
	Marie Spreen	16	2 meetings, tutorial, edit moscow, flowchart, blender model bin, generate blender animation
	Fenna Schipper
	Hakim Agni
	Lazgin Mamo
	Dhruv Manohar
7	Luta Iulia Andreea	12	2 meetings, research on how the hyperspectral system works, writing findings in wiki
	Sonia Roberta Maxim
	Marie Spreen
	Fenna Schipper
	Hakim Agni
	Lazgin Mamo
	Dhruv Manohar

Research and Literature study

Fenna:

Recycling of medical plastics - ScienceDirect [1]

Conclusion:

Plastics have revolutionized medical industry, especially the single use plastic. The common method adopted for disposing medical plastics is incineration that can lead to the release of toxic chemicals and gases. Many of the plastics end up in marine ecosystems detrimentally affecting their survival. Usually, medical plastics are assumed to be infectious and cannot be discarded with the common municipal waste. Moreover, lack of sufficient landfills available have persuaded mankind to think of sustainable recyclable options. Most of the medical plastics have the potential to be recycled back into the petrochemical industry as a feedstock for the production of new plastics or refined fuels. There should be better awareness about recycling possibilities among the healthcare workers and the commitment to collect and recycle the plastic wastes is essential for a sustainable future. Most importantly the plastic devices should be designed such that it is easily recyclable. The outbreak of Covid 19 has increased our dependence on plastics in an unpredictable manner. The outcome would be drastic, finally affecting our future generations. Urgent measures should be taken to properly segregate, sterilize and recycle medical plastics. Multilayer plastics can be replaced by single layer plastics wherever possible. Current recycling strategies can be scaled up and integrated with new sustainable alternatives. This can reduce the accumulation of plastic waste to a certain extend.

Improving waste separation in hospitals - insights for intervention design | Project | BehaviourWorks Australia [2]

Findings:

• One key influence was their access to the appropriate bins. Sometimes bins were placed far away in a corner, blocked by equipment or another (less appropriate) bin would be closer. With regards to recycling, we also learned that available recycling streams in the operating suites not only differed between hospitals but also between rooms within a hospital operating suite. This was sometimes due to a lack of space, where another bin simply wouldn’t fit into an already crowded room.
• We also found out that often by default large rather than small clinical waste bags were used in the operating rooms (even though exceptions exist).
• Time could work as a barrier or facilitator depending on whether nurses felt they had sufficient time to sort waste or had more pressing tasks to attend.
• Nurses’ self-assessed knowledge on correct waste sorting behaviour was fairly high, however, there was still room for improvement.
• Waste support staff also played a role in nurses’ waste separation behaviour. Nurses relied on support staff to line bins appropriately, empty them when full and transport waste out of the operating suite. Unsurprisingly, nurses also identified their colleagues as another key social influence.
• While nurses recognised the positive outcomes of reducing landfill and materials being reused if recycled, they expressed some lack of trust in the overall recycling process, wondering if the items they placed in the recycling bin would actually get recycled once they left the operating suite or the hospital.

Health-care waste (who.int)[3]

Key facts

• Of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous waste.
• The remaining 15% is considered hazardous material that may be infectious, toxic or radioactive.
• Every year an estimated 16 billion injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards.
• Open burning and incineration of health care wastes can, under some circumstances, result in the emission of dioxins, furans, and particulate matter.
• Measures to ensure the safe and environmentally sound management of health care wastes can prevent adverse health and environmental impacts from such waste including the unintended release of chemical or biological hazards, including drug-resistant microorganisms, into the environment thus protecting the health of patients, health workers, and the general public.

A Study on AI‐based Waste Management Strategies for the COVID‐19 Pandemic - PMC (nih.gov)[4]

Conclusion

Overall, it can be seen that AI/ML‐based methods can be employed to improve the performance of several different activities in the waste management process that can provide a safe and scalable setup together with the physical measures as laid out in the discussion a long‐term waste management ‐strategy.

Hospital Waste Recycling: The Great Waste Recycling Revolution (tradebe.com) [5]

Waste produced by hospitals and other medical facilities is a largely invisible contributor to environmental degradation. However, when one considers the wide array of establishments that produce medical waste, and the use of single-use sterile equipment across these facilities, their impact quickly becomes apparent. An incredible amount of waste is produced by health clinics, nursing homes, medical research laboratories, dentists, offices, veterinary clinics, and of course hospitals. Incredibly, around 85% of hospital waste is non-hazardous and non-infectious, according to the World Health Organization. The majority of that waste is recyclable, highlighting the need for a robust hospital waste recycling initiative to prevent these safe waste materials from reaching landfills.

AGV Scheduling Optimization for Medical Waste Sorting System

Key facts:

• Traditional manual order picking is extremely susceptible to infection spread among workers and picking errors, while automated medical waste sorting systems can handle large volumes of medical waste efficiently and reliably. Medical waste is infectious, toxic, and hazardous, thus, the application of automated sorting systems can greatly reduce the infection rate of operators and improve the efficiency of medical waste disposal compared with traditional manual sorting.
• The disposal process of medical waste mainly includes classification and collection, transportation, and recycling.
• Due to the large amount of medical waste that needs to be sorted, medical waste recycling and processing centers (MWRPC) face the requirements for small orders, high volume, and strict work schedules, which are similar to e-commerce warehouses.
• The recent outbreak of the novel coronavirus has stimulated the demand for medical services and protective equipment, causing the amount of medical waste to increase exponentially.
• Medical waste is usually divided into five categories: infectious waste, pathological waste, injury waste, pharmaceutical waste, and chemical waste.
• A vertical sorting system might be an optimal solution for sorting medical waste.

Medical Waste-Sorting and Management Practices in Five Hospitals in Ghana

Hospital waste management in Ghana faces the risk of cross-contamination from the lack of thorough sorting of the waste at the points of generation. This has increased the potential for the spread of infections and chemical pollutant.

Conclusion:

A cross-sectional study of waste-sorting and management practices in five hospitals in Ghana has shown that even though there were attempts to segregate hospital waste, particularly in the high-risk areas, the lack of a uniform color coding and labeling system for the different categories of hospital waste affects the efficiency of collection and handling and the integrity of the final waste treatment processes. Significant differences in waste-sorting behavior among health staff were apparent only on the basis of occupation or work area. A number of incinerators for burning infectious waste are either not functioning or are operated outside their capacities or appropriate uses. Current incinerators are unable to inactivate pathogens. Chemical agents like PCDDs/Fs and PCBs are likely released in the exhausts, which calls for the need to install air pollution control devices (APCDs). It is recommended that refresher training courses are periodically organized for health workers to conscientize them on laboratory and general health safety. There is a need for an integrated approach to healthcare waste management in Ghana that will entail the coordinated efforts of the assemblies as well as the Ministry of Health and private companies contracted to collect, transport, and dispose of waste. Since 80–85% of wastes generated in health facilities are of no risk and comparable to domestic waste, they can be separated and handled together with the municipal waste streams while the infectious ones are treated specially, either on-site or sent to designated engineered incinerators.

Machine Learning and IoT-Based Waste Management Model

The waste-collecting trucks collect waste just once or twice in seven days. Due to improper waste collection practices, the waste in the dustbin is spread on the streets. Thus, to defeat this situation, an efficient solution for smart and effective waste management using machine learning (ML) and the Internet of Things (IoT) is proposed. In the proposed solution, there have used an Arduino UNO microcontroller, ultrasonic sensor, and moisture sensor. Using image processing, one can measure the waste index of a particular dumping ground. A hardware prototype is also developed for the proposed framework.

Module 2: The Healthcare Waste Management System

A PowerPoint presentation about Waste Minimization in Health Facilities. For example:

• Inventory control in pharmacy and stockroom
• Employing reusable and recycled products
• Solvent recovery in the hospital laboratory
• Silver recovery in the x-ray department

Classification of Trash for Recyclability Status

Conclusion:

The classification of trash into various categories; glass, paper, plastic, cardboard, metal and trash, is possible through machine learning and computer vision algorithms. Trash classification based on images of trash has been trained using both a support vector machine (SVM) and a convolutional neural network (CNN). However, in order to create a more accurate system, there needs to be a continuously growing data source and the optimal hyperparameters for the CNN must still be found.

Sonia:

Managing barriers to recycling in the Operating Room, The American Journal of Surgery

• It is very often unclear which Operating room items are recyclable and the greatest barrier to recycling is lack of knowledge.
• Up to 90% of “red-bag” waste does not meet criteria for “red-bag” waste - common items are mistakenly disposed of in red bags are vent tubing, suction tubes, IV bags, foley bags, foley catheters, masks, casts and splints, urinals, and bedpans.
• Addressing this issues could significantly reduce waste and save a lot of money

A circular healthcare economy; a feasibility study to reduce surgical stainless steel waste, Sustainable Production and Consumption. Elsevier.

Talks about reducing surgical stainless steel waste by recycling and sterilizing it. Presents several statistics on this topic and an experiment which in the end proves that a circular approach towards reusing discarded hospital instruments and stainless steel waste is indeed feasible and furthermore, it saves money.

Where does hospital waste go? medical waste disposal explained, CleanRiver.

• 85% of hospital waste is noninfectious – most of these materials end up in landfills or get burned.  
• One of the biggest issues facing hospital waste challenges is “Over-classification” of waste related to “red bag” waste – they are filled incorrectly.“Over-classification” of waste refers to a large issue occurring in most medical facilities - regular waste, such as pop cans, bottles, paper, food waste, etc. end up being tossed in the “red bag” bins by patients or staff which are reserved to collect medical waste only.
• Problem: Red Bag waste can be up to 20X more expensive to haul than a hospital’s regular waste streams! Red bag waste is for anything contaminated with blood, infectious material, or other bodily fluids.

The recycling of medical waste (no date) Frst Solutions GmbH.

• 2 million tons of medical waste produces yearly – best way to deal with this: shredded then wet steam sterilization.

There are companies specializes in this:

1. AMB, a company based in Belgium
2. ECODAS based in France
3. WastinnovaIn, a company in Zimbabwe

A review on Medical Waste Management: Treatment, recycling, and disposal options, MDPI.

Lazgin :

•   the wastes from hospitals and health-care systems are not required to be treated to remove health-care chemicals. Municipal wastewater treatment plants are not designed to remove these chemicals and at best result in incomplete removal and lead to formation of transformation products, which may still be a concern in the environment. In some instances, the transformation products may even be more toxic than the parent compounds.
• Once released into the waste stream, the contaminants from health-care system are subject to several processes that affect how they move around the natural environment and how long they persist in the environment such as sorption, transformation, and degradation (both abiotic and biotic)
• Segregation and categorization of wastes are critical to minimize risk during handling and identify safe transport and treatment requirements.
• The concept of the “circular economy” is gradually being introduced across Europe. The circular economy moves away from a linear economy (make, use, and dispose) in theory enabling products and materials to last longer and virtually eliminating waste (The Waste and Resources Action Programme (WRAP), 2016).
• Identify if the waste needs to be classified—almost all health-care waste would need to be classified unless the material either is not waste or is identified in Article 2 of the Waste Framework Directive 2008/98/EC as being excluded as it is covered by other legislation
• Determine the chemical composition of the waste to determine if it has a hazardous property, which can be found through product manufacturer's safety data sheets,
• Assess the hazardous properties of the waste to see if it contains any of the following hazardous descriptions at relevant concentrations (Jones and Tansey, 2015): H1: Explosive H2: Oxidizing H3A: Highly flammable H3B: Flammable H4: Irritant H5: Harmful H6: Toxic H7: Carcinogenic H8: Corrosive H9: Infectious H10: Toxic for reproduction H11: Mutagenic H12: Substances that release toxic gases H13: Sensitizing H14: Ecotoxic

Plastic Waste Recycling in Hospitals

Plastic waste recycling in hospitals is an important issue as medical facilities can generate a significant amount of waste. By weight, the plastic content of medical waste is around 25%. Included in this plastic waste is medical equipment, single-use items and packaging. All of these contribute to the overall waste stream. Historically, medical wastes have been disposed of in landfills or treated in incinerators. These incinerators were poorly designed and inadequately controlled and as a result, some hazardous pollutants were produced from the incineration of medical waste. So it seems that landfills are a better solution for disposing of medical waste. An issue with this, however, is that plastic has a low recovery rate. This leads to plastic waste occupying most landfill space, which is already limited. Therefore recycling the plastic waste is ideal, as to preserve landfill space for other medical waste.

In reality, recycling programs in hospitals are often limited. Some facilities do not have any recycling infrastructure in place. For the most part this is due to the difficulty in separating and processing medical waste. More and more hospitals are implementing recycling programs for certain types of plastic waste, such as plastic bottles and packaging materials. In most cases these programs require the staff to take some training to ensure proper sorting and disposal of recyclable plastic. Luckily, with more research being done on the topic, there are guidelines for enhancing the recycling potential for plastic waste in hospitals. Hospitals can now implement the positive design practices and the negative design practices in order to recycle more plastic.

Recycling of plastic starts with identifying the materials for recycling, and sorting the materials. Manual sorting is possible but very labor intensive. Therefore, automated sorting techniques are preferred. Near infra-red (NIR) is an identification technique that provides high speed. Separation is then done using one of many technique, to name a few: density separation, froth flotation and electrostatic sorting. Now that the plastic is separated, the recycling process can start. Depending on the type of plastic, the recycling process will following one of four paths: primary, secondary, tertiary or quaternary recycling.

Primary recycling refers to the reuse of plastics scraps into product similar to the original material, such as a bottle being reused as a bottle, When possibly, this type of recycling is preferred as the waste is easily integrated back into the production cycle. However, this process is not possible for contaminated plastics.

Secondary recycling uses mechanical systems to collect, separate and sort the material. After that, the system washes contaminants on the plastics and grind it down. Some variants of secondary recycling are screw extrusion or blow molding. This process is not effective with highly contaminated waste, so it cannot be always used.

Tertiary recycling or chemical recycling converts plastic materials into smaller molecules, usually liquids or gases. This type of recycling uses a chemical process to recover the petrochemical components in plastics. Innovative solutions are being developed for this process, and example of this is pyrolysis. After tertiary recycling the plastic waste is converted to usable materials, therefore reducing overall amount of waste that needs to be disposed of.

Quaternary is synonymous to incineration, the technique we mentioned earlier. This technique incinerates the plastic waste and recovers energy. However, the combustion usually releases harmful gases. For medical waste that cannot be recycled otherwise, this is a good option.

An important note is that there are some types of medical waste that cannot me recycled, examples are sharp and biological materials. These types of medical waste must be disposed of using specialized methods, we will elaborate on these specialized methods later.

User Study

Nurses :

Medical waste produced in hospitals is mainly disposed by the nurses . This group op users is trained to separate and throw waste in the corresponding bin. Nevertheless , there are many problems that faces the nurses which makes medical waste management inefficient. In a study published in the "Journal of nursing management" , nurses were interviewed and the following problems are expressed: Firstly, medical and nursing students that temporarily work in a hospital lack the knowledge about recycling management process. Secondly, emergency cases which require immediate intervention leads to mistakes in throwing the waste in the correct disposal unit. Thirdly, lack of personnel leads to a heavy workload which again causes inevitable human mistakes. The biggest obstacle facing recycling was a lack of information about recyclable and contamination of materials .

The nurses expressed the need to frequent training for new and old medical staff. Others has emphasized that it would be beneficial to have a single person responsible for medical waste and recycling control and to design the service management accordingly.

Current workflow (USA) :

In the USA, the current workflow of medical staff regarding plastic waste management varies depending on the facility and region. However, there are generally accepted guidelines and best practices that medical staff follow to manage plastic waste.

Firstly, medical staff are trained to segregate waste at the point of generation, which means that they sort the waste into different categories such as infectious, hazardous, pharmaceutical, or general waste. This helps to ensure that each type of waste is managed appropriately and safely. Once segregated, the plastic waste is typically collected in specialized containers that are labeled and color-coded to indicate the type of waste they contain. For example, infectious waste may be collected in red containers, while hazardous waste may be collected in yellow containers. Medical staff are also encouraged to minimize the amount of plastic waste they generate by using reusable or sustainable alternatives whenever possible. This includes using cloth gowns and towels instead of disposable ones, using reusable containers for sharps disposal, and minimizing the use of single-use plastics in the medical setting. Overall, the workflow of medical staff regarding plastic waste management in the USA involves careful segregation, labeling, and disposal of plastic waste, as well as a focus on minimizing the amount of waste generated.

5. https://www.sciencedirect.com/science/article/pii/B9780444638571000012