Do you realize any developments in enduring medical waste management?
Developments are taking place, in monitoring, gathering and assessment data and in pilot approaches to possible solutions. However, it is far too early at this point of time to set out regulations, because of knowledge and experience base first has to be broadened. This is why initiatives like the PILLS project (with partners from France, Germany, Luxembourg, Netherlands, Switzerland and the United Kingdom) or the cooperation of Rhine basin countries within the International Rhine Commission[1] (contracting parties: France, Germany, Luxembourg, Netherlands, Switzerland and the EU) are of crucial importance.

On the website it is stated that the amount of pharmaceuticals that are nowadays in our waters isn’t dangerous to humans yet. Because the project got EU funding it is assumed that the amount of pharmaceuticals in our water will rise. Do you agree with that?
There seems now increasing awareness of pharmaceuticals and other micro-pollutants entering our water cycle, not least because the traditional pollutants have been reduced to a considerable extent. To give an example, the Rhine river had in the 1970s still the nickname “sewer of Europe”, whilst today it is home again to the salmon, one of the symbols of cleaner waters. Experts opinion e.g. from the International Rhine Commission would support the assumption that the amounts of pharmaceuticals in the aquatic environment is likely to increase. This is why solutions will have to be considered in an integrated way, not simply a traditional ‘end-of-pipe’ approach. The PILLS project has got the chance to provide a major contribution towards shaping out future thinking on pharmaceuticals in the water cycle.

What is the place of medical waste management on the agenda of hospitals in France?
Waste management is a real concern for French public and private hospitals. We have been enforcing restrictive laws for many years. French speaking readers may have a look at the methodology guide allowing trusts to deal with heavy legislative duties. It is edited by our ministry of health on our website.
The French National Authority for performance (ANAP) has also published a video film.
French regulatory framework is rather tough: hospitals have both to sort out medical waste and to organise waste disposal. They are no longer allowed to use internal incinerators. Criminal penalties threaten offenders. They have to organise infectious health waste management according to a national classification guidance and they have to deal with additional costs. They have to improve segregation, to be aware of different waste streams, to cut the amount of waste and to emphasize on correct waste receptacles. The question of disposables is to be seriously examined with doctors. These are common issues in European countries.

What could the added value be of the EMWC to the French healthcare waste management?
EMWC will give an extended and global view of management of HCW presenting infectious risks in Europe and will give us the opportunity to share experiences and good practices. The conference should contribute to the creation of a network of specialists and on a longer term, to initiate pilot actions.

You will be presenting at the 2011 conference on the reprocessing of single-use items –the US versus the EU perspective. What is the status of reprocessing of single-use devices in the US? Are there differences within the EU?
The reprocessing of single-use devices has been an ongoing practice in the US for almost a decade. It is however a practice that was not quickly accepted when it was initiated. It is clear that guidance and regulations needed to be established to ensure patient safety. A recent study published by researchers from the Johns Hopkins University School of Medicine stated the practice “could save hospitals hundreds of millions of dollars annually and curb trash at medical centers, the second-largest waste producers in the United States after the food industry”.
However, the same view is not shared by the EU. A recent document was published on this issues by the Commission to the European Parliament and the Council entitled “Report on the issue of the reprocessing of medical devices in the European Union, in accordance with Article 12a of Directive 93/42/EEC.

The report reached one of the following conclusions…”In the absence of quantitative data, it is not possible to quantify the risk associated with the use of reprocessed single use medical devices. The number of documented incidents is very little, although it can be speculated that the reporting of incidents is incomplete. Regarding adverse events there may be a “grey” area for which the recognition and reporting of incidents is difficult. In addition, long-term effects may not be identified and attributed to the use of reprocessed medical devices”.

So at this moment, I see a very different approach to the management of these devices in the US and the EU. I look forward to presenting my findings at the meeting in February.

What are your expectations from the European Medical Waste Conference that takes places in February in Amsterdam?
I am again excited about the conference in February. This is truly the only conference on healthcare waste management in Europe that attempts to attract participants from throughout the EU and beyond. Each country within the EU does have unique issues, just like states have in the USA or the provinces and major cities of China. Any other part of the world can be used as a example as well. This is the forum to attend, to learn, listen, and to challenge the speakers on the topics being presented. Interest in healthcare waste management continues to grow as we look more closely at all the waste streams in the healthcare environment. I look forward to seeing old colleagues and making new friends.