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GRI 306/103-1

Natural resources are becoming increasingly scarce all over the world. We can only operate sustainably if we use the raw materials available to us efficiently. This also includes the responsible handling of waste – because it contains valuable resources that can be returned to production. Through systematic waste management, we aim to reduce our material consumption and minimize the amount of waste produced. In the health sector, strict hygiene requirements apply to the materials used and to the safe disposal of hazardous waste. With clear internal guidelines and comprehensive controls, we ensure that these are complied with.

Our approach

GRI 306/103-2, GRI 306-1

For Fresenius as a health care Group, professional, safe waste disposal goes hand in hand with the requirements of hygiene and sterility in production processes and treatments in hospitals. Our approach extends from the selection of suitable disposal containers to cleaning and sterilization procedures and the occupational safety of our employees in the disposal of hazardous, e.g., infectious, waste.

The handling of waste in the health sector is strictly regulated. Fundamentally, waste must not pose a danger to our patients, our employees, or the environment. Our production processes and our treatments in health care facilities must be hygienic and sterile at all times. All business segments must always dispose of their waste professionally and safely. As the business models of our business segments are different, Fresenius conducts waste management on a decentralized basis. The four business segments are responsible for assessing individual risks and, where necessary, establishing internal guidelines for dealing with waste. The business segments provide training to their employees and carry out checks to ensure that the standards contained therein are adhered to.

Fresenius Medical Care

Waste is managed on a local and regional level, allowing Fresenius Medical Care to adhere to all applicable laws and regulations. The business segment has ongoing waste initiatives that help to reduce its environmental footprint. For instance, the Reusable Sharps Container Program in the United States enables Fresenius Medical Care to reuse each container up to 600 times, thereby reducing the amount of plastic ending up in landfill. Thanks to this program, in 2021, the business segment has reused more than 1.2 million containers, diverting more than 1,000 t of plastic waste from landfill and preventing more than 400 t of carbon emissions.

Progress and measures in 2021

In 2021, Fresenius Medical Care continued to analyze the waste streams of its production sites and dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemo­ dialysis the membrane of the dialyzer – is used to clean a patient’s blood. clinics in all regions. In the context of the company’s Global Sustainability Program, Fresenius Medical Care is planning to develop a global approach to consolidating waste data and to defining reduction targets. As part of this, in 2021 the company introduced new measures to improve waste data collection processes at four pilot production sites. Fresenius Medical Care plans to roll these measures out to all sites at the beginning of 2022. Additionally, the business segment is assessing opportunities at its sites for stepping up the recycling or reuse of resources.

Fresenius Kabi

Waste at Fresenius Kabi is mainly generated as a byproduct of production processes or packaging material of the product containers in hospitals, private households, or nursing homes. This includes both non-hazardous and hazardous waste, i. e. solvents, cytostatics, or antibiotics.

The business segment’s global environmental standard operating procedures include global requirements for waste management. The instructions constitute a global framework for the business segment’s waste management and set minimum requirements for Fresenius Kabi’s own facilities. As part of waste management, the business segment has established a sequence for the measures to be taken: waste prevention, preparation for reuse, recycling, other recovery, in particular energy recovery and backfilling, and disposal of the resulting waste. The measures taken must always be in compliance with applicable laws and regulations.

Each of Fresenius Kabi’s manufacturing sites is required to separate its waste according to local regulations and to store the waste under consideration of measures to protect the environment, e. g., to avoid contamination. The local Fresenius Kabi organizations are responsible for the disposal of waste in accordance with the applicable local regulations. In general, local EHS managers or dedicated waste managers are responsible for waste management at the respective organizations. Where necessary, local training courses on waste management are conducted. Regular audits of the commissioned waste disposal companies are conducted by the local organizations to ensure compliance with the applicable regulations.

As part of the ISO 14001 requirements, certified organizations evaluate processes that significantly contribute to the generation of waste as well as identifying potential for improvement. The business segment also considers the conservation of resources and options for recycling or reuse of the generated waste. Based on the evaluation, measures are implemented to reduce waste or increase the recycling rate.

If the design of a product is under the control of an ISO 14001-certified organization, as part of the life cycle perspective, the design phase of the product must take environmental aspects into account. The influence of the organization on pharmaceutical products can be limited due to the importance of patient safety and product quality requirements.

Furthermore, in 2021 the business segment began to take sustainability criteria into account in decision-making processes for new projects, such as the development of products or capacity expansions. ISO 14001-certified organizations set local targets for their waste management.

Fresenius Kabi records the waste volumes generated at its production sites, logistics centers, compounding centers, and the further ISO 14001-certified organizations and categorizes them by waste type and disposal method. Plastic waste represents the largest portion of classified non-hazardous waste. Hazardous waste is, to a large extent, processed and reused for a different or similar purpose. To a large extent, the internally generated waste is recycled. Non-recyclable hazardous waste is mainly incinerated and a large part if it is led into energy recovery.

The business segment also receives feedback, e.g., from customers or patients, on its product packaging. This feedback is passed on internally to the relevant departments so that it can be considered when improving product packaging and in order to prevent unnecessary waste.

Progress and measures in 2021

In 2021, the management approach and the governance structure of Fresenius Kabi remained as reported in 2020. Progress focused on recovery as well as the control of waste, e. g., in storage, handling, and waste disposal.

Fresenius Helios

Fresenius Helios sees waste disposal management as a process. This begins with waste avoidance and continues through to consistent recycling or environmentally friendly disposal. In hospital operations, the business segment must always meet strict hygiene requirements: medical instruments and aids are cleaned and packed separately so that they can be reused as sterile items. In addition, various disposable medical products are used. This results in waste, the professional and safe disposal of which must be guaranteed.

The Fresenius Helios facilities are subject to strict regulations. In Spain, the Law 22 / 2011 on Waste and Contaminated Soils applies, for example, which sets out requirements for different types of waste applies. Specially trained staff in the hospitals are responsible for ensuring that the respective requirements are met. In particular, if hospitals in Germany generate more than two tons of hazardous waste per calendar year, they must appoint a company waste officer or an external waste officer and report this to the responsible authority. For this purpose, the waste officer requires the relevant expertise, which is regulated in the Closed Substance Cycle Waste Management Act (Kreislaufwirtschaftsgesetz) in conjunction with the Ordinance on Waste Management Officers (Verordnung für Betriebs­beauftragte für Abfall). When disposing of waste, Helios Spain and Helios Germany must take into account not only the requirements of environmental protection, occupational safety, and infection control, but also specific hospital hygiene requirements. Appropriate disposal containers and cleaning and sterilization procedures must be used.

As the largest private hospital operator in Germany, Fresenius Helios has the option of using multiregional companies for waste disposal. There are dedicated disposal channels and procedures for handling waste from hospital operations to ensure safe disposal. In addition to the Closed Substance Cycle Waste Management Act (Kreislaufwirtschaftsgesetz), the type of waste disposal in Germany is strictly regulated by the states, districts, and municipalities in which the facilities are located. Furthermore, the regulations of the Federal/State Working Group on Waste (LAGA) and the Technical Regulation for Biological Substances in Health Care and Welfare (TRBA 250) apply. Helios Germany bundles the various types of waste in clusters and assigns them to the respective disposal companies. For three clusters – Helios has assigned central framework contracts to disposal companies. Disposal for two other clusters is commissioned decentrally by the hospitals, as they are required by law, due to municipal tendering obligations, to cooperate with special waste management companies. Helios does not currently collect data on material recycling at the disposal companies.

Progress and measures in 2021

In 2021, Helios Germany began to implement or prepare for the implementation of the new regulatory requirements of the German Packaging Act 2021 (VerpackG). For instance, an initial concept for reusable packaging in the restaurant and catering segment was drawn up.

Helios Spain is also currently working to reduce single-use plastic in line with European and Spanish legislation. Large packs, e. g., with dispensers or dosing aids, are increasingly being used to prevent packaging waste. The business unit has also been working with a supplier to improve the labeling of recyclable primary packaging.

Fresenius Vamed

The waste generated in all of Fresenius Vamed's business processes is disposed of in accordance with regional, national, and industry-specific regulations. The local management of each health care facility is responsible for ensuring compliance with these guidelines. Reusable waste is processed in the required recycling processes. Other waste is disposed of by composting or incineration or is sent to landfill. For clinical and hazardous waste, the individual facilities of Fresenius Vamed cooperate with local disposal companies, who ensure that the waste is disposed of in compliance with the law.

The most important legal basis for waste management in Austria is the Waste Management Act (AWG 2002), which is supplemented in the federal states by state laws to include local aspects, such as the fees to be paid. There are also a large number of legal provisions under European law. All of these regulations create the legal framework to ensure an efficient waste management industry in Austria.

The health care facilities built by Fresenius Vamed use construction and sanitation technology that enables optimal resource management adapted to local regulations. The provision of technical management services is a major business segment of Fresenius Vamed. One focus of our activities is to ensure the longevity of technical systems through maintenance and repair.

The innovative containerized sewage treatment plant uses purely biological means to treat the wastewater from the hospital in Point Fortin, Trinidad and Tobago, which was newly constructed by VAMED Engineering. The treatment plant consists of a 40-foot ISO standard container, a pump station, and excess sludge dewatering. This technology, called the Moving Bed Bio Reactor (MBBR), is based on what are known as bio-chips, to which bacteria adhere and where the biological treatment takes place. By means of a special separation process, the solids settle and the biologically treated wastewater can drain off. The use of this innovative biopurification system is in line with Fresenius Vamed’s principle of also applying sustainable, resource-saving solutions in economically and infrastructurally disadvantaged regions.

Progress and measures in 2021

In 2021, the decentralized management approach and governance structure in the waste and recycling management area of Fresenius Vamed remained as reported in the previous year.

Waste volumes

In 2021, the share of recycled waste1, at Fresenius Kabi changed as follows: for non-hazardous waste, the recycling rate increased from about 68% to 72% compared to the previous year; for hazardous waste, it increased from 55% to more than 56% over the same period.2,3 The share of recycled waste in total waste includes waste that is sent for recycling, reuse, and recovery, but does not include incineration with energy recovery. In 2021, Fresenius Kabi generated a total of about 96,800 t of waste, of which 72% were non-hazardous, and 28% were hazardous waste, such as solvents, cytostatics, or antibiotics.

In 2021, Helios Germany produced about 18,700 tons of waste (2020: 19,900 t), of which about 98% was non-hazardous (2020: 98%) – this includes, e.g., wound and plaster bandages, disposable clothing, and household garbage. The remaining 2% (2020: 2%) comprise waste that poses a threat to health and the environment – such as infectious waste, dangerous chemicals, or critical pharmaceuticals. Special procedures ensure safe disposal.

Helios Spain classifies its waste into non-sanitary waste such as paper, plastic, or glass; non-hazardous sanitary waste such as medical gloves or bandages; biological waste; chemical waste; and cytostatic – particularly hazardous, cell-growth-inhibiting – waste. Helios Spain generated around 18,800 t of waste in 2021 (2020: around 17,000 t), thereof 85% non-hazardous and around 15% hazardous waste. This waste is separated for further processing. Helios Spain controls cooperation with waste management companies centrally. Waste classified as hazardous was disposed of by specialist service providers. Biological sanitary waste is incinerated or treated in a way that makes it less hazardous (inert), depending on the hazard, and sent to a safe landfill. The waste management systems of all Helios Spain clinics are regularly reviewed in self-evaluations and annual internal and external independent audits.

1 As some confirmations, e.g., of the recovery quantity, only become available after the report has been prepared, these figures are estimated in some cases.

2 Calculation of the recycling rate has been updated according to the GRI standard 306-4 (2020) for waste by category and disposal method applied as of 2021 for both, 2020 and 2021 data; waste disposed for energy recovery is no longer categorized
as recycled waste.

3 Hazardous/non-hazardous waste in accordance with Annex III of the the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal of March 22, 1989.

Hospital waste per bed1

Download(XLS, 35 KB)
2021 2020 2019 2018 2017
in tons (t) 1.01 1.01 1.09 1.07 0.75
1Applies to all hospitals in Germany and Spain of Fresenius Helios; 2017 only Germany.

Hazardous hospital waste per bed1

Download(XLS, 35 KB)
2021 2020 2019 2018 2017
in tons (t) 0.09 0.08 0.07 0.05 0.02
1Applies to all hospitals in Germany and Spain of Fresenius Helios; 2017 only Germany.


GRI 306/103-3, GRI 306-3

No Group results are available for waste management in fiscal year 2021. Although no effects can yet be reported at Group level, we report on the measures initiated in 2021 and related progress in the business segments.

Fresenius Kabi’s total waste volume increased in 2021. Fresenius Kabi is continuously working to increase recycling rates¹ and has been able to make progress on hazardous and non-hazardous waste in order to be able to put valuable resources to further use. The COVID-19 pandemic has increased the generation of waste related to protective hygienic measures, although this was partly compensated for by the increased amount of remote work carried out by administrative employees.

In our health care facilities and our clinics, the waste volume caused by disposables and protective gear has increased due to COVID-19. Especially in the hospitals, the amount of (potentially) infectious waste requiring special disposal increased.

1 Calculation of the recycling rate has been updated according to the GRI standard 306-4 (2020) for waste by category and disposal method applied as of 2021 for both, 2020 and 2021 data; waste disposed for energy recovery is no longer categorized as recycled waste.