Pioneering New “Hotels for the Sick”

Purification specialist Pharmafilter and industrial biochemicals company Cellulac are teaming up to provide a sustainable supply chain for energy and wastewater recovery in hospitals

By Adrian Wilson, European Correspondent

Over the past 3-4 years, Amsterdam-headquartered Pharmafilter has pioneered a unique system for the advanced disposal of hospital waste at the Reinier de Graaf Hospital in Delft in the Netherlands.

It is based on an in-room waste disposal unit called The Tonto – now in its third iteration, as the company learns from practical experience – which feeds to an on-site filtration and separation plant.

As such, the Pharmafilter system can make a significant contribution to cleanliness and reducing hospital-acquired infections, while improving patient comfort.

Having proven its value at Reinier de Graaf, the company now anticipates taking its system nationwide, with at least eight other hospitals in the Netherlands ready to commit to it, and health systems in other countries also showing a keen interest.

Pharmafilter, however, has not been content to just deal with existing hospital waste but is now working to ensure that what ends up as waste can be more effectively filtered into different streams and more efficiently utilized.

In March this year, the company signed a five-year co-operation deal with Cellulac, an industrial biochemicals company based in Dundalk, Ireland, valued at Ôé¼35 million

The aim of the two companies is to deliver the first sustainable and vertically integrated supply chain solution for energy and wastewater recovery in hospitals.

Mission

The background of Pharmafilter founder Eduardo van den Berg is in hotel management and his company is on a declared mission to make tomorrow’s hospitals resemble simply “hotels for the sick” as much as is realistically possible.

Van den Berg was aware that stringent waste management procedures were crucial in ensuring the safe and efficient disposal of the waste generated in hospitals, but having examined existing protocols and how things were done, decided there had to be a better way of dealing with it.

Pharmafilter's plant at the Reinier de Graaf Hospital in Delft in the Netherlands.

Pharmafilter’s plant at the Reinier de Graaf Hospital in Delft in the Netherlands.

“He outlined his ideas for a new concept to a number of stakeholders and the general response was that it might work on an episode of “Star Trek,” said Peter Kelly, Pharmafilter’s international director for healthcare waste.

Waste

A tremendous amount of waste is generated in hospitals – from used sharps and dressings to materials contaminated with blood, pharmaceuticals and chemicals, in addition to food and the other organic waste.

And at most hospitals today, there’s strict segregation at the point of its generation, in order to keep the risk of contamination to a minimum.

“Inevitably, there’s a lot of buffering involved, first in segregating it all and then in transporting the different waste streams in carts through the place,” Kelly explained. “In doing so, of course, you’re potentially exposing hospital staff, patients and visitors to the risk of exposure to the hazardous materials. The Pharmafilter concept is simply to treat all of the waste – with the exception of materials for which there are already traditional recycling systems such as cardboard and PET – as biowaste and a single stream to be treated altogether.”

In practice

With the enthusiastic help and backing of the staff at Reinier de Graaf and funding from the European Commission’s LIFE program, Pharmafilter set about putting its concept into practice.

The company made use of the hospital’s internal sewage system to dispose of all waste via its Tonto shredders strategically placed on all wards – eliminating, for one thing, the need for traditional bedpan washing stations.

There is no odor from these units on the wards due to their highly effective air extraction and treatment systems and 100% sterilization to prevent potential pathogens entering the environment is achieved.

All waste was fed into the Tontos without needing to be separated and filtered through the drains and sewers of the hospital to Pharmafilter’s installation within the hospital grounds.

The system has ensured the hospital staff have had no contact whatsoever with waste once fed into the Tonto and it was effectively eliminated from the hospital immediately and at source. The feedstock coming out of it proved consistent and had a high calorific value.

Within Pharmafilter’s plant, the water was separated out and the waste was ground up, sieved and anaerobically digested to produce biogas. This was used to run the installation.

What fraction of the solid waste that remained was further decontaminated at 100┬░C and compressed into briquettes that can be used for industrial fuel.

All outputs were free of viruses, pathogens harmful bacteria, pharmaceuticals and other trace contaminants.

Water

The waste water, meanwhile, was completely purified – filtered using a membrane bioreactor, ozonified and subjected first to activated carbon filtration in order to remove any metabolites resulting from the ozone treatment, and then to UV radiation.

It was then reused by the hospital as process water, taking the weight from the facility’s overall water system by running the central heating system and the toilets, as well as general cleaning activities.

“The purification process used by Pharmafilter has proven to be highly effective in eliminating pharmaceuticals and other chemicals -more so even than most waste water purification plants,” said Kelly. “This system is an economical viable solution and it has to be considered in terms of long-term benefits, although once it’s in place the savings are being achieved from Day One.”

During 2015, Reinier de Graaf Hospital is being rebuilt and Pharmafilter is currently commissioning a new purification plant to service it, building on its positive experience with the first over the past three years.

“The latest Tonto units that will now be installed are much more intelligent, robust and efficient than earlier versions,” said Kelly.

Bioplastics

Pharmafilter had already developed certain bioplastic-based consumables such as bedpans and disposable urinals and introduced them at Reinier de Graaf.

These could be easily disposed of in the Tontos and once digested, made a positive contribution to the organic fraction of the waste to generate more biogas to run the Pharmafilter system.

“The staff at Reinier de Graaf were enthusiastic about them because they reduce cross-contamination risk and are convenient, while saving costs. And also because they’re pleasingly designed products that are highly effective,” said Kelly. “But commercially-available bioplastics are still too expensive and there is also the issue of security of supply. It’s for these reasons we decided to become a stakeholder in teaming up with Cellulac.”

Cellulac

Cellulac has developed a combined chemical and process engineering technology to produce lactic acid and associated industrial scale biochemicals from second generation feedstocks, including lignocellulosic materials, such as wheat straw, distilled dried grains with soluble and spent brewers’ grains, as well as lactose whey. The process can use agricultural and brewery waste, as well as dairy by-products. It covers 136 granted or pending patents in over 23 patent families, covering a combination of biochemical proprietary enzyme and bacteria-based biochemicals and hydrodynamic cavitation (HDC) technology and allows Cellulac to remove up to two thirds of the energy consumed for the production of PHA, D- and L+ lactic acid and ethyl lactate.

The company acquired the Great Northern Brewery in Dundalk, Ireland, and has retrofitted it to produce optically pure lactic acid for use as PLA for biodegradable plastics at 40% below the current market price.

“Through this commercial partnership, Cellulac will produce up to 90% of the core ingredients for disposable single use items and personal hygiene products compatible with the Pharmafilter recovery system in hospitals,” said Gerard Brandon, CEO of Cellulac.

“Producing at volume, our low-cost, thermostable and high strength bioplastics become transformative when combined with Pharmafilter’s hospital recovery system.”

The Great Northern Brewery in Dundalk, Ireland has been retrofitted to produce optically pure lactic acid for use as a PLA for biodegradable plastics.

The Great Northern Brewery in Dundalk, Ireland has been retrofitted to produce optically pure lactic acid for use as a PLA for biodegradable plastics.

“Central to our solution is the requirement to secure a sustainable low cost and low carbon, high energy, end-of-life solution for single use bioplastics and Cellulac’s operational cost base opens the door for us to meet our targets,” added Kelly.

Fermentable

Rijnstate in Arnhem is one of the other hospitals planning to install the Pharmafilter system on its wards and spurred on by a feasibility study carried out by research institute Wageningen UR, has drawn up a long list of items that could in the future be made from fermentable waste materials.

What products can be replaced with fermentable alternatives is currently under investigation, and Rijnstate is also looking at co-operating with other hospitals to increase volumes and stimulate the market. Hospitals in Rotterdam and Terneuzen are among the others now actively exploring the system.

“We have a take-off agreement with Cellulac, which is currently moving from a pilot supplies to commissioning a first full-scale plant, which is in line with our time scales for volume,” Kelly concluded. “We have designed and are currently starting to introduce disposable service and tableware into these hospitals based on our own ergonomic designs, to be suitable for patients of all ages. We’ve identified around a hundred and ten further products that are currently widely used and could effectively be replaced with bio-based alternatives, but of course, hospitals – even forward thinking ones – are cautious about introducing new products. We need to ensure these are quality products and that we have a knife, for example, that an elderly person can hold and grip properly. Effecting change in the health industry is notoriously slow, but we’re now making solid progress.”