At the National Centre for Infectious Diseases (NCID), caring for patients safely while remaining prepared for infectious disease outbreaks is part of our everyday work. In such a fast-paced clinical environment, much of the focus is naturally placed on infection control, patient safety, and operational readiness. But a multi-disciplinary team spanning Nursing, Hospitality & Environmental Services and Housekeeping from the NCID Outbreak Intensive Care Unit (ICU) saw an opportunity to also rethink how waste is managed in everyday care. 

Figure 1: Project I-HEAL Team Members 

(From left to right: Muhammad Hisyam Bin Darwin, Magenderan Munsamy, Joel Quek Wee Teck, Haymar, Janice Wong Ying En, Lai Yi Wei, Tan Jia Yi. Not pictured: Cha Pei Pei Eileen, Lim Kewei Daryl James, Ramakrishnan Nadarajah, Lorraine Tan Yee Ching, Dr Sim Wen Yuan, Dr Ng Che Yee Vicky, Tan Ghim Meng)

The project began with a simple observation. During medication preparation, large amounts of plastic waste are generated from items such as wrappers, syringes, intravenous (IV) consumables, and medication packaging. Although some of these materials could potentially be recycled, almost all of them were being disposed of as general waste. The challenge was not a lack of willingness from staff. Instead, recycling was simply not built into the workflow within the ICU. 

In healthcare, waste that has come into contact with patients or the patient environment is treated as potentially contaminated and cannot be safely recycled. However, much of the plastic waste generated during medication preparation is produced before items ever reach the patient. These “clean” materials represent an opportunity for safe recycling, if proper systems could be put in place. 

To better understand the issue, the team studied the medication administration workflow in detail. This included mapping out staff movement, identifying where waste was generated, and reviewing which materials could be safely recycled. The team also engaged nurses and healthcare workers to better understand the practical challenges faced during busy clinical shifts. What became clear was that recycling needed to be made easier and more intuitive within the existing workflow. 

Figure 2: Examples of common recyclable waste from medication administration

The team introduced dedicated recycling bins directly onto medication preparation carts, allowing recyclable plastic waste to be segregated at the point where it was generated. Staff also received education and guidance on sustainable practices and recyclable materials, whilst recyclable waste was tracked regularly to monitor progress. 

Figure 3: A nurse utilising the plastic recycling bins

Over a nine-month period, the amount of recycled plastic waste more than doubled, from 100.3 to 239.2 kilograms per 1000 patient days. This is roughly equivalent to recycling the weight of over 9000 standard plastic drink bottles. Before the project, only about 1 in 4 pieces of recyclable plastic waste were being diverted away from general disposal. After the intervention, this improved to about 2 in 5. 

Importantly, these improvements were achieved without compromising infection control or workflow efficiency. In fact, medication administration process time improved by more than one minute per episode due to easier and more accessible waste disposal processes. 

Figure 4: Results Summary

Beyond the numbers, the project also contributed to a shift in culture within the unit. Staff became more confident in identifying recyclable materials, and conversations around sustainability became more common in day-to-day work. This Initiative reflects how sustainability can be integrated into healthcare through small but meaningful system changes. By redesigning workflows around the realities of clinical care, the team demonstrated that environmental responsibility and high-quality patient care can go hand in hand. 

As healthcare systems continue to evolve, projects like this highlight how practical, ground-up innovation can contribute towards a more sustainable future for healthcare. 

Written by: Nurse Clinician Joel Quek 

For Project I-HEAL 

Since March 2025, the nursing team at NCID has collaborated with PLASTIFY to convert non-contaminated medical plastic waste from the NCID Infectious Diseases Research Laboratory (IDRL) and other clinical areas to produce playing blocks. We now have two sets of playing blocks ready for our patients to utilise in their healing and rehabilitation. 

We believe that small changes like these make a huge impact in our patients' care.

Read more: 三医院环保新尝试 将医疗塑料垃圾化为新用品 | 联合早报

In 2025, a paper led by Dr Stephanie Sutjipto (Consultant, Department of Infectious Diseases, NCID/TTSH) evaluating the impact of Singapore's national personal protective equipment (PPE) de-escalation guidelines on staff COVID-19 incidence and environmental sustainability in NCID and TTSH was published. It was subsequently recognised as one of the prominent papers of the year in infection control at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) congress in 2026. 

The study provided timely, evidence-based insights into system-level factors and measurable outcomes that are directly applicable to real-world quality improvement initiatives. Its findings stimulated meaningful discussion on how robust data and thoughtful implementation - especially around PPE use and infection prevention workflows - can translate into safer, more reliable healthcare practices. 

It was concluded that the national PPE de-escalation guidelines corresponded with the reductions in protective gown use, associated costs, carbon footprint, and plastic waste generation with no apparent compromise to staff safety and health. PPE de-escalation was not associated with an increase in monthly COVID-19 infections among hospital staff, with the trends aligning with population infection rates, in NCID. An estimated 4 gowns per patient-day were saved, totalling 440,532 gowns over 12 months. This equated to an estimated reduction in health care costs by SGD 453,748 (approximately USD 333,970) and reductions of 398,681.46 kg carbon dioxide equivalent in carbon emissions and 66,080 kg of plastic waste.

Figure 1: Impact on Environmental Sustainability and Cost Saving

Read the full paper here: Plastic Waste and COVID-19 Incidence Among Hospital Staff After Deescalation in PPE Use | Infectious Diseases | JAMA Network Open | JAMA Network

In September 2025 as part of the inaugural NCID Symposium 2025, the NCID Committee for Sustainable Healthcare (NCSH) organised a fun-filled sustainability hackathon. Five participating teams (Reduce, Reuse, Recycle, Replace and Rethink) with more than 100 participants across multi-disciplines were posed the challenge statement: 

"How might we reduce the environmental impact of personal protective equipment (PPE) in healthcare without compromising safety or quality of care?" 

and presented their innovative solutions to address this challenge. 

The workshop proceedings were presented as a poster presentation at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) congress in 2026.