Medical Waste Treatment
and Disposal: An Overview
Just Some of the Environmental,
Community, and Occupational Safety &
Health Issues to Consider
Jackie Hunt Christensen and Monica
Rohde Buckhorn
Health Care Without Harm
Seattle, WA
July 31, 2002
The Mission of Health
Care Without Harm
To transform the health care industry
so it is no longer a source of
environmental harm by eliminating
pollution in health care practices
without compromising safety or care.
We will accomplish this
mission by:
• Promoting pollution prevention.
• Supporting environmentally safe materials,
technology and products.
• Educating and informing about the environmental
and public health impacts of the health care
industry and solutions to its problems.
Why work on medical waste?
• Medical Waste Incinerators = Major
sources of dioxin & mercury
• Ethics: Physicians’ oath to “First, do no
harm”
• Irony that the place people go to be
healed could be making them sick
Problems with Hospital Waste
• Toxicity
- Dioxin (from PVC and other chlorinated
items)
- Mercury and other heavy metals
• Increasing Volume
- Large amounts of single-use, disposable
items
- Recycling not being utilized in many cases
Why is HCWH Opposed to
Incineration?
 MWIs = 3rd largest known source of U.S.
dioxin air emissions, produce about 10% of
U.S. mercury emissions
 Incineration produces both toxic air emissions
and toxic ash residue.
 Burning medical waste actually creates new
toxic compounds such as dioxins.
Why is HCWH Opposed to
Incineration?
 Many MWIS also burn
readily recyclable items.
 Wastes with high energy
value, such as plastics, may
contain chlorine & contribute
to dioxin formation.
Most Hospital Waste Is
Simply “Trash”
Regulated
Medical
Waste
10%
Includes 2%
pathological
waste
Hospital
Waste
(Trash)
85%
Hazardous
Waste
5%
Hospital Waste, Like Household
Trash, Is Largely Recyclable
Food Waste
10%
Metals
10%
Paper &
Paperboard
45%
Wood
3%
Glass
7%
Other
10%
Plastics
15%
Some Problem Products
• Polyvinyl chloride (PVC) plastic materials
• Mercury-containing products
• Cadmium-containing red bags & sharps
containers
• Chlorine-bleached paper products &
packaging
• Pesticides used in and around HC
facilities
How to Address Problem
Products?
• Waste Management
approach:
Recycle/reuse
products
• Pollution Prevention
approach: Avoid
purchasing problem
products in the
first place
PVC in Medical Products
• IV bags
• Rigid packaging trays
• Blood bags
• Mattress covers
• IV and respiratory
therapy tubing
• X-Ray folder holders
• Venodyne sleeves
• Patient ID cards
• Water bed liners
• Shower curtains
• Dialysis bags
• Thermal blankets
PVC Alternatives
• Non-PVC IV Bags (e.g.,
McGaw Bags )
• Non-PVC blood bags
(under development)
• Non-PVC Sharps
containers (e.g.,
reusable polyethylene
• Non-PVC tubing
• Non-PVC ID bands
• Non-PVC suction
liners
• Nitrile gloves
(Instead of vinyl
or latex)
Mercury-Containing Products
and Their Alternatives
Product
– Hg batteries
– Esophageal devices,
Cantor & MillerAbbott tubes
– Hg thermometers
Alternatives
– Lithium, zinc air,
alkaline
– Products w/
tungsten tubing
Anderson AN-20
– Digital, expansion or
aneroid
Mercury-Containing Products
and Their Alternatives
Product:
– Hg-based blood
pressure
monitoring
devices
– Lamps & lighting
devices
– Hg switches
– Hg dental
amalgams
Alternative:
– Electronic vacuum
gauge, expansion
or aneroid
– Non-Hg basedsodium vapor,glow
lights, optical
– Non-Hg switches
– Gold, ceramic,
porcelain
Opportunities for Reuse
in Health Care
• Built-in eggcrate
mattresses
• Reusable interoffice mailers
• Reusable dishware
and cutlery
• Plastic or steel
emesis and wash
basins
• Reusable cloth
underpads
Opportunities for Reuse
in Health Care
• Reusable personal
protection gowns
• Double-sided
copies
• Reusable
respiratory
therapy equipment
• Rechargeable
batteries
• Reusable packaging
units -- tubs,
totes, sharps
containers
What about the rest??
Treating “Red Bag” Waste
• 10-15% of health care waste is
“regulated medical waste (RMW);”
a small fraction of that is pathological
waste
• RMW generated can vary widely be
facility type
Treating Regulated Medical
Waste
• Contrary to popular belief, the Centers
for Disease Control and Prevention
does not REQUIRE incineration for
either RMW or pathological waste
• A few individual states require
incineration of path waste or chemo
Questions to Ask Before Choosing
Treatment Technology
• Has your facility done a
waste audit?
• What measures are
staff already taking to
minimize amount &
toxicity of waste?
• Does your facility have
staff, expertise &
space to allow for
onsite technology?
• What are your state’s
regulations re: onsite
treatment?
• How long has treatment
technology been in use?
Where? (any
comparable facilities?)
• What is the estimated
life of the equipment?
More Questions to Ask …
• Cost: have you factored
in utilities, down time
for repairs, cost of
alternate treatment
during down time,
permitting, tipping fees,
supplies, etc.?
• Emissions: what are the
known emissions to air,
water, land from this
technology? Which
pollutants are
regulated?
• What is the reputation
of the technology
company?
• Have you involved the
local community in the
decisionmaking process
(for both on- and offsite), and if so, how?
• What contract
conditions are
negotiable?
Choosing Treatment Options
• There is no “magic box” to make all
waste & liability disappear
• Facilities may need to utilize more than
one type of technology
• Involve diverse group of stakeholders,
including local community
On-Site Treatment Options
• Autoclave
• Microwave
• Chemical treatment
• All have risks and
benefits
• Costs vary by size
of treatment unit,
supplies, reliability
of equipment, ease
of operation, etc.
If You Opt for Off-Site
Treatment …
For many hospital waste
treatment services, from sharps
to regulated medical waste, your
facility may have only one choice
nearby: Stericycle
Off-site treatment:
Stericycle
• For most health care facilities, Stericycle is
“the only game in town” for off-site
treatment for RMW
• HCWH is working to make sure that
Stericycle lives up to its mission -- To be the
leading company dedicated to the
environmentally responsible management of
infection control and compliance services for
the healthcare community
Stericycle: #1 Commercial
Medwaste Treatment Provider
• 11 times the size of its nearest
competitor, Med/Waste Inc., which
filed for bankruptcy earlier this yea r
• Worth $620.6 million in assets as of
January 2002
• Bought Browning-Ferris Industries’
medwaste assets in 1999
Stericycle: Medical Waste
Giant
• Purchase of BFI assets moved
Stericycle from small company using
alternative technology
(“electrothermal deactivation”) to big
company with many commercial medical
waste incinerators
Community Opposition to
Stericycle Facilities
• Saint Louis, Missouri
• Gila River Indian Community, Arizona
• Haw River, North Carolina
Stericycle’s Worker Health
& Safety Performance
• Woonsocket, RI – OSHA alleged Stericycle
mishandled pathological waste at ETD facility,
knowingly exposing workers to potentially
dangerous pathogens
• Company paid $400,000 in fines for falsification
of data, failure to treat waste properly,
failure to sterilize RMW containers &
improper use of equipment
More Worker Health &
Safety Issues
• Morton, WA – Three workers at ETD facility
developed tuberculosis between May and
September, 1997
• Washington State OSHA fined Stericycle
$1,100 for serious violations. NIOSH
investigated as well. Stericycle claims that
any problems identified by regulators have
been fixed.
Practicing Dioxinand Mercury-Free Medicine
• Environmentally sound
procurement policies
• Minimization of
packaging
• Reusables instead of
disposables
• Recycling
• Ongoing “Red Bag”
reduction education
• Waste segregation
• Non-incineration
treatment technologies
for all wastes
HCWH Resources for Treatment
Technology Discussions
• Medical Waste Treatment Technologies:
Evaluating Non-Incineration Alternatives. A
Tool for Health Care Staff and Concerned
Community Members
• Non-Incineration Medical Waste Treatment
Technologies: A Resource for Hospital
Administrators, Facility Managers, Health
Care Professionals, Environmental Advocates,
and Community Members
• Available through www.noharm.org
Resources for Health Care Facilities:
– Health Care Without Harm
www.noharm.org or 202-234-0091
– Hospitals for a Healthy Environment
www.h2eonline.org or Laura Brannen
laura.brannen@valley.net
– Sustainable Hospitals Project (UMASS
Lowell)
www.sustainablehospitals.org or Catherine
Galligan: 978-934-338 or shp@uml.edu