Sarah Kalin
LCS 122
5/13/12
Medical Waste
When thinking society’s impact on the environment, many people associate it
with ideas such as car pollution, nuclear waste, global warming, habitat destruction,
diminishing resources, or even overpopulation. While all of these factors do affect the
environment, often times an additional concern that often goes unnoticed spawn the illeffects of medical waste on our environment. Just think of the millions of syringes,
scalpels, scissors, bandages, and pill bottles, along with the plastic packaging these items
are contained in that are discarded each and every day. What happens to the waste and
where does it go? How greatly does medical waste impact our environment? Through an
examination of these two questions, one may further understand the current actions taken
to diminish this particular problem, in addition to different ways concerning how to
possibly recycle and reuse medical supplies to limit the amount of waste.
Medical waste can be looked at as all waste materials produced at health care
facilities. These facilities include hospitals, clinics, physicians’ offices, dental practices,
blood banks, veterinary clinics, and various medical research facilities.1 The Medical
Waste Tracking Act of 1988 defines medical waste as “any solid waste that is generated
in the diagnosis, treatment, or immunization of human beings or animals, in research
pertaining thereto, or in the production of testing of biologicals.” This definition
includes, but is not limited to:

Blood-soaked bandages
United States. U.S. Environmental Protection Agency. EPA. Environmental Protection Agency. Web. 17
May 2012
1

Culture dishes and other glassware

Discarded surgical gloves

Discarded surgical instruments

Discarded needles used to give shots or draw blood
o i.e., sharps

Cultures, stocks, or swabs used to inoculate cultures

Removed body organs
o i.e., tonsils, appendices, limbs

Discarded lancets2
As one may observe, there are many products that a hospital uses that cannot be
reused, and instead needs to be disposed of in the appropriate manner. It has been
estimated that American hospitals generate about 6,600 tons of waste everyday3, and of
these 6,600 tons, about eighty-five percent of hospitals’ waste is general refuse, while the
remaining fifteen percent is contaminated with infectious agents.4 Expanding on this
notion, simple arithmetic trains of thought shows that 6,600 tons of waste generated by
American hospitals each day, about 990 tons are of infectious nature. Supplementary
research and estimates show that waste ranges from eighteen to twenty-five pounds per
bed each day, with regulated medical waste estimated at two to three pounds per bed per
day.5 Although disposing of hazardous material properly would naturally be a common-
United States. U.S. Environmental Protection Agency. EPA. Environmental Protection Agency. Web. 13
May 2012
3
Donald Bernstein "Hospital waste management: an informational assessment". Academy of Health Care
Management Journal
4
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
5
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
2
sense concern, unfortunately there are many institutions and individuals that do not
follow proper protocol.
Poor management of health care waste potentially exposes health care workers,
waste handlers, patients, and the community at large to infection, toxic effects and
injuries, and further risks polluting the environment. Despite the risks, there are two
problems consistently observed with the correct ways to dispose of medical waste.
Astonishingly, the most shocking part of this research was how many mistakes the United
States has faced even with all the rules and regulations. One noteworthy example of this
problem took place in Southern California only a few years ago.
Christus St. Vincent Regional Medical Center in Sante Fe, California has paid
about $65,000 in fines to the state’s Environment Department since 2007 for dumping
medical waste, such as blood syringes, at the Caja Del Rio landfill in Sante Fe.6 The
hospital is a serial offender having been caught and fined in 2006, 2007, 2010, and 2011.
The latest incident in 2011 was because workers at the Caja Del Rio round a used syringe
in the trash from the hospital at the dumpsite. The hospital was fined $2,025 by the Solid
Waste Bureau, but these fines are obviously not working since it has been an ongoing
problem for years. The St. Vincent Chief Executive Officer Alex Valdez blamed the
problems on staff turnover, and simple human error. He says the hospital holds
orientation sessions about the proper disposal of medical waste four to six times a year,
and hospital staffers go through the trash before it is taken away. Even with the supposed
precautions being taken by the hospital, these habitual mishaps cannot be excused any
longer.
"SF Hospital Dumps Illegal Medical Waste." KRQE TV. Web. 17 May 2012.
<http://www.krqe.com/dpp/news/on_assignment/sf-hospital-dumps-illegal-medical-waste>
6
While the hospital in Sante Fe provides an example of institutional error, it is also
important to note that individuals are capable of making the same mistakes. A dentist
from Pennsylvania was sentenced to four years of probation and a $100,000 clean up fine
after pleading guilty to dumping medical waste into the Atlantic Ocean in Cape May
County. The dentist, who had no past history of regulatory infractions, dumped 260
needles, 180 cotton swabs and several capsules that held filling material7 off of his boat
and into the water near Townsend Inlet. A few days later the waste started to wash
ashore, ultimately resulting in local action by the authorities, as they were forced to close
the beaches around the immediate area to ensure the public’s safety. Assemblyman
Matthew Milam said the sentence was too lenient, and later passed a new law that created
more stringent consequences for any institution or individual that disposed of medical
waste in an unauthorized manner. It is hard to imagine why an institution or individual
would pollute the environment with such dangerous products when the United States
makes it so easy to dispose of medical waste correctly.
Medical waste management practices that should be employed include strictly
segregating, packaging, labeling, and tracking the waste according to state requirements
or through private agreement with transporters or disposal facilities.8 In theory, strict
regulation within these various levels of medical waste movement such as this would
prevent medical waste from harming the environment. The establishment of this waste
"Dentist Who Dumped Medical Waste in Jersey Shore Waters Avoids Prison Term." The Star-Ledger. Web.
17 May 2012
8
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
7
management plans stem from the recommendation of the Environmental Protection
Agency (EPA) in its publication “Guide for Infectious Waste Management.”9
Infectious waste and other potentially harmful material at any medical facility
must be segregated directly at the producing facility. It may not be held at the
establishment it was produced at for more than four days at temperatures above thirtytwo degrees. Infectious waste may not be stored for more than ninety days at the
generator’s facility, or more than 96 hours off site of the facility without the written
approval of the Department of Toxic Substances Control.10 Separating waste in this
manner will also prove to be more cost effective to the medical facilities. Mixing
hazardous with non-hazardous material to be dumped at a site, if found, can cause the
hospital to pay expensive fines. To avoid that, hospitals should just segregate their waste.
According to united States Protection Agency (US-EPA) recommendations, the
segregation of infectious waste should never occur at the point of infectious origin.
Containers of medical wastes must be properly labeled and marked, and infectious waste
containers must have the universal biological hazard symbol on them.11 So infectious
medical waste does not accidentally get thrown in with the non-infectious trash, there
should always be proper labels telling the personnel handling the trash it is. As one
would most likely agree with, infectious waste should also be placed in the right
containers so as to not be potentially harmful, with supplementary guidelines for other
waste like bandages that should be double-bagged and marked accordingly.
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
10
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
11
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
9
If the waste has been handled properly, the next step in preventing contaminated
materials from entering the environment is make sure it is disposed of in an acceptable
fashion. By California Law, there are four ways to dispose of medical waste:
1) Incineration in a controlled-air, multi-chambered incinerator that provides
complete combustion
2) Burial in a Class I or Class II disposal site, as regulated by the state
3) Discharge to a sewage system if the waste is liquid or semi-liquid
4) Sterilization in a steam sterilizer
Although this may seem like great options, even these California regulated laws
still pose a threat to the environment and general public. A closer look at the stateregulated policies shows that the current disposal methods may fall short of their
environmentally friendly goals.
The use of steam sterilization is extremely curbed as to what it can treat. It is
mainly used for laboratory cultures and/or materials that have been tainted with
transmittable organisms. The liquid formed by the steam may be drained into the sewer
or sent for further processing. When performed in the correct manner, studies show this
disposal method as potentially effective, this method is only beneficial when precise time
and temperature requirements are met.12 If these particular elements are not met,
infectious waste that has not been sterilized could be released back into the water supply
unknowingly. This could cause unthinkable damage to the water supply or the general
public.
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
12
Another problem is that the public is highly sensitive to incineration. Incineration
reduces the weight and volume of the waste as much as ninety-five percent, and is
especially appropriate for pathological wastes and sharps13, but air pollution becomes a
liability. The public has been particularly concerned over the siting and permitting of
incinerators because of problems with air emissions, air toxins, and the ultimate disposal
of ash at sanitary landfills.14 The main concern has been for the potential emissions of
codium, mercury, and lead emitting from the stack gas and ash. These emissions could
settle in the water supply around an area of incineration causing the water to become
potentially poisonous for the animals living in and around an area of incineration, causing
the water source, and for the people using it as their main water supply. Although some
of these waste management disposal services pose some threats to the environment and
general public, the companies disposing the waste are doing their best to be
environmentally friendly.
A biohazard medical waste disposal service, stericycle, maintains the nation’s
largest network of medical waste transport vehicles, collection sites, and treatment
facilities. The company specializes in the proper disposal of medical waste, including
waste services such as:

Appropriate red containers, labels, and online manifestos (shipping
records) for the collection of biohazards

Professional pickup, removal and transport of other people’s biohazardous waste
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
14
United States. Board of Public Works. HTM Office. Fact Sheet: Medical Waste Management. Web. 13 May
2012.
13

Compliant treatment and disposal of biohazard and red bag waste

Complete chain of custody documentation for the collection and treatment
of medical waste

Training programs from medical staffs to understand regulated medical
waste handling requirements15
To ensure the services above are in accordance with the environment, stericycle
employs a large team of environmental, safety and regulatory specialists who keep
current with the ever-changing federal, state, and local requirements. By having such a
team, this company is able to handle infectious waste in a way that is healthy for the
environment, and will minimize the business risk of the hospital. Stericycle also offers
training services for employees of the medical facility to make sure every one is up-todate with new medical waste disposal protocol.
If a medical establishment wants to further reduce their risk to the environment
and the general population, they have the option to minimize their waste. Waste
minimization includes any source of reduction or recycling activity that results in
reducing either the quantity or the toxicity of the hazardous waste, consistent with the
goal of minimizing present and future threats to health and the environment.16 If a
hospital or any other type of medical facility just reduced their waste by recycling, the
threat to the environment would lessen. Taking this idea one step further, one may
perceive the potential benefits of utilizing a “recyclable” system.
"Biohazard Medical Waste Disposal Services." Medical Waste Disposal. Web. 17 May 2012.
<http://www.stericycle.com/medical-waste-disposal.html>.
16
Cheremisinoff, Paul, and M.K. Shah, 1990. "Hospital Waste Management." Pollution Engineering, April
1999. pp. 60-66
15
A recycling system that some hospitals have implemented is the reusable
container system. The process for handling reusable containers requires the containers be
taken to a permitted medical waste transfer station or offsite treatment facility for
processing.17 Reusable containers can significantly reduce the medical waste stream and
decrease storage and disposal costs.18 A reusable container would be considered the
plastic box sharps go in, or sample containers. If these types of plastics could be reused,
and not incinerated with the rest of the plastics, it would also cut down on the harmful air
emissions.
Another system to protect the public and the environment from potentially
infectious disease causing agents is the Medical Waste Management Program (MWMP).
This program oversees the generation, handling, storage, treatment, and disposal of
medical waste by providing oversight for the implementation of the Medical Waste
Management Act.19 This newly instated policy has helped many hospitals correct their
errors concerning medical waste. Instead of the hospitals or other medical establishments
trying to implement the correct waste disposal by themselves, the Medical Waste
Management Program serves as an authoritative overseer of the medical waste initiative.
Considering the relationship between the program and policy combatting the same
problem, this coupled combination has offered a great deal of insight that has allowed the
hospital, and the program to thrive. Even though multiple programs have been set-up to
aid hospitals and other medical facilities to dispose of medical waste properly, some
United States. California Department of Public Health. Medical Waste Management Program. 2010. Web. 13
May 2012.
18
United States. California Department of Public Health. Medical Waste Management Program. 2010. Web. 13
May 2012.
19
United States. California Department of Public Health. Medical Waste Management Program. 2010. Web. 13
May 2012.
17
institutions or individuals choose to dispose of the waste improperly, like the previously
state examples.
The dangers of improperly disposed medical waste poses to society and the
environment are immense. If infectious waste is not disposed of properly it has the
potential to spread diseases such as Hepatitis A, Hepatitis B, AIDS, Typhoid, Boils, and
other infectious diseases. These are not illnesses that should be spread around by the
very institutions people go to in order to get healthy. Hospitals are held at different
standards than other businesses because hospitals hold the power to heal. This reputation
should not be tainted by hospitals inadvertently spreading more disease through the world
by being careless of their waste.
Medical waste poses a larger threat to the environment, and to the general
population than what people realize. We generally think of waste being plastic bottles,
wrappers, paper, and all different other kinds of generic trash, but no one has ever shined
a spotlight on infectious waste. As technology and public awareness of the dangers of
poorly disposed infectious waste increases, so will the management institutions
specifically designed to handle medical waste in a more environmental-friendly way. It is
up to the general population to demand that the institutions, and people that have been
created to keep us healthy keep up their end of the bargain by properly disposing of their
waste in the appropriate manner. We do not want our world to be cluttered by waste, and
especially by waste that has the potential to be carrying infectious diseases along with it.
Ultimately, the prevention of medical waste’s negative impact on the environment
depends on the advancement of technology, policy regulation, institutional cooperation,
and public education.