The future of medical waste
by Jackie Farwell and Sharon Kiley Mack
The atmosphere in the operating
room was focused but relaxed as Dr. Robert Cambria guided a thin
tube into a varicose vein in a man’s thigh on a recent morning
at Eastern Maine Medical Center in Bangor.
Two spotlights illuminated the
patient’s leg in the otherwise darkened room as a hunched
Cambria used radio frequency to heat and cauterize the potentially
harmful vein. Queen’s “Bohemian Rhapsody” played
softly in the background.
Just behind the doctor, long
strips of white gauze used to mop up blood during the procedure
were draped over the side of a small, stainless steel bucket on
wheels. The operating room scrub, a technician who hands tools
and supplies to the doctor during surgery, carefully separated
the bloody gauze from the rest of the waste generated during the
The overhead lights flipped on
as Cambria finished the procedure, guiding the catheter back out
of the man’s leg and stitching up the small incision. The
scrub counted the stained strips of gauze, a routine precaution
to catch any missing bandages that could be left inside a patient,
and tied up the plastic bag lining the stainless steel bucket.
Operating room technicians flooded
into the room to clean up as the nurses coaxed the man awake,
and the scrub tossed the bag into a red, plastic bin marked with
a biohazard symbol that sat just outside the door.
A hospital employee trained in
handling biomedical waste later collected the red bin and sent
the bloody gauze and other waste on its way for eventual collection
at a loading dock one floor down. After being dumped into yet
another red bin - this one larger and reusable - the trash was
loaded onto a truck and shipped to a new treatment plant in Pittsfield.
The disposal of biomedical waste,
like the bloody gauze generated during the morning’s surgery
at EMMC, happens hundreds of times a day at hospitals throughout
What is changing is where it
all ends up.
Maine’s hospitals are embarking on a new way to
dispose of their biomedical waste through a collaborative effort
that is the first of its kind in the nation.
Instead of shipping their blood-soaked
surgical sponges, tubes and gowns out of state, where the waste
is incinerated and sent to a landfill with regular trash, all
of Maine’s hospitals have joined together to treat and dispose
of the waste themselves.
Through the Maine Hospital Association,
the state’s health care facilities have constructed a waste
treatment plant in Pittsfield that by this time next year is expected
to process all 2.4 million pounds of the state’s annual
Maine Waste Facility, a wholly
owned entity of the Maine Hospital Association, is geared to handle
as much as 6 tons of the waste per day.
“This is a never-ending
business. There will always be hospitals and there will always
be waste,” Michael McIntyre, facility manager, said recently.
Borne as a response to rising
out-of-state disposal costs and stricter environmental regulations,
the effort now includes 33 of the state’s 39 hospitals.
The remaining six hospitals are expected to join by this time
The statewide collaboration is
unlike any other in the nation, though it is similar to a decade-old
cooperative in Virginia that has yet to include all of that state’s
hospitals as owner-operators.
Still in its early stages, the
Maine initiative is expected to save $300,000 annually, savings
that eventually will trickle down to hospital customers, John
C. May, president and chief executive officer of Sebasticook Valley
Hospital in Pittsfield, said.
“This is 39 hospitals working
together,” said May, who served on a task force that developed
the new program. “All of them said, ‘If you build
it, we will come.’”
In addition to the cost savings,
the collaboration has eliminated hospitals’ vulnerability
to trucking strikes by private waste disposal contractors, as
well as many weather delays, Tom Kohlmeyer, a fire and safety
officer who oversees waste disposal at EMMC, said recently.
“If any one of us has a
problem, we all have a problem,” he said.
The biomedical waste can be infectious
in its raw form, but it is rendered nonhazardous at the Pittsfield
plant through a pressurized steam sterilization process. Machines
heat the waste - much of it gowns and plastics - and then shred
it for eventual disposal at Hampden’s Pine Tree Landfill.
The small percentage of pathological
waste, which includes body parts and other anatomical waste, and
materials used in chemotherapy procedures still are sent out of
state for incineration.
The hospital association owns
the waste disposal operation and equipment, positioning Maine’s
hospitals as both owners and customers in the system. SteriLogic
Waste Systems Inc. of Syracuse, N.Y., owns and operates the facility,
and Hydroclave Systems Corp. of Kingston, Ontario, maintains the
While not explicitly outlawed
in Maine, the burning of biomedical waste became economically
unfeasible a decade ago after the federal Environmental Protection
Agency tightened testing requirements, Scott Austin, an environmental
specialist with the state Department of Environmental Protection’s
biomedical waste program, said recently.
The process of autoclaving rose
to the attention of Maine environmentalists, hospital administrators
and lawmakers as part of a biomedical waste task force convened
several years ago.
Hospitals found themselves at
the mercy of Illinois-based Stericycle Inc., the only biomedical
waste disposal company serving the state at the time, said Tammy
Butts, Maine Hospital Association director of business development
“There was a monopoly,”
she said. “They were seeing price increases, dramatic price
increases, every year.”
Maine environmentalists have
praised the new program, noting that although Maine’s biomedical
waste was burned in Massachusetts, the harmful dioxins produced
during incineration blew back across state lines.
“We were being impacted
regionally by the burning of our waste just outside our state’s
borders,” Michael Belliveau, who represented the Natural
Resources Council of Maine on the biomedical waste task force,
Cooking the waste
The first thing a visitor notices while visiting the
Maine Waste Facility in Pittsfield is the smell. While not overpowering
nor unduly unpleasant, there is a definite, and hard to describe,
odor. It’s a stew of wet dog, burned casserole and mildew,
with possibly a sprinkling of dirt.
The second reaction is surprise
at the small size of the two autoclaves that handle 9,000 pounds
of medical waste a day. No bigger than the washers at a commercial
laundry, the autoclaves tumble, superheat and then dry the waste.
“We originally began looking
to site this plant in the Newport, Palmyra, Pittsfield area,”
explained McIntyre, the facility’s manager. “We selected
Pittsfield because it is so close to Interstate 95 and there was
already a building here.
“This site is unique in
the country in that the Maine Hospital Association both owns the
plant and are the customers,” he pointed out.
The facility, a fairly small
and nondescript warehouse, was constructed by the MHA in conjunction
with SteriLogicME and Hydroclave Systems Corp. and through the
town of Pittsfield’s efforts to create a Pine Tree Zone
around its Industrial Park.
Even though this is a mechanical
process, there is a lot of manual labor going on here. Workers
lift 38-gallon tubs of waste over their shoulders to dump the
contents inside the autoclaves.
The waste is a combination of
gowns, linens, vials of blood, paper cups, operating room sponges
and sheets. No pathological, anatomical or chemotherapy waste
goes into the autoclaves. Although the facility is allowed to
pick up those items, they are handled and treated separately.
They are clearly marked in yellow containers and diverted from
a trip to the autoclaves.
“There is no sorting here,”
McIntyre said. Everything is color-coded: Red bags are biomedical
waste; yellow containers are chemotherapy residual waste; and
gray is other chemotherapy waste. Only the red bags head to the
autoclaves - 800 pounds of waste per unit.
Steam is then pumped into the
autoclaves and a 250 degrees Fahrenheit sterilization process
takes 25 minutes to treat the waste. Emptying the autoclave tub
is a complicated process because much of the waste has become
twisted around - gowns caught by electrode wires - and must be
removed by hand tools often found in a garden: hoes, rakes, small
“It is hard work, hot and
it stinks,” commented an employee.
A conveyor belt then carries
the waste up to the ceiling where it drops into a shredding machine.
This turns the waste into smaller pieces. The shredder is noisy,
but it is the autoclaves that generate the heat that forces the
workers to keep the large garage-style doors opened all day. “We
will probably keep them open in the winter,” McIntyre said.
Nearby there is a small bucket
for collecting the titanium bits, nuts and bolts - used in joint
replacement surgery - that occasionally show up in the waste by
Meanwhile, the plastic containers
in which the waste is transported are collected, washed, sterilized
and dried before being sent back to the hospitals for reuse. More
than 250 38-gallon containers are processed each day.
Before MWF came along, all those
containers were being thrown out after use, McIntyre said. “We
are saving an enormous amount of material from the waste stream,”
The facility, operating at maximum
capacity, can handle more than 5 million pounds of biomedical
waste per year.
“From here, everything
goes directly to Hampden,” McIntyre said.
At the landfill
On a recent morning at Pine Tree Landfill in Hampden,
a truck arrived from the Pittsfield treatment plant loaded with
approximately eight tons of sterilized and shredded biomedical
waste. After the truck was weighed, the load was dumped, its multicolored
chunks steaming in the cool morning air.
The commercial landfill, situated
next to Interstate 95 and Cold Brook Road, was licensed in June
by the Maine DEP to accept approximately 2,000 tons, or 4 million
pounds, of treated biomedical waste per year, becoming the first
waste disposal site in the state to accept such waste.
The trucks from Pittsfield arrived
one or two more times that week to dump their loads, which represent
only a small percentage of the nearly 570,000 tons of solid waste
received at Pine Tree each year.
Sterilized and rendered safe
by the time it arrives, the biomedical waste is treated like most
any other type of waste received at the landfill, Don Meagher,
manager of planning and development for Casella Waste Systems
Inc., which owns the landfill, said as the biomedical waste was
“It’s no different
than a lot of the other material we take,” he said.
After the waste was spread, a
landfill employee operating a compactor with spiked metal wheels
drove back and forth over the garbage, packing it down as sea
gulls picked through other bits of trash nearby.
According to the DEP license,
the biomedical waste must be shredded into 3/4-inch strips, rendering
it unrecognizable, Scott Austin of the DEP said. Much of the hospital
waste dumped at the landfill recently was unrecognizable, though
linens and crushed red bins could be identified before the trash
was spread and mixed with other waste.
Not only does the shredding reduce
the risk of a needle puncturing those who handle the waste, but
it also indicates the garbage has been treated, Austin said.
The shredding of biomedical waste
also removes the possibility that a hospital’s name could
be read on the material in event that the waste is dumped improperly,
environmentalist Michael Belliveau noted.
The biomedical waste leaving
SteriLogic and arriving at Pine Tree Landfill does not yet meet
the 3/4-inch standard, though operators plan to install new shredding
blades that should tear the material to the required size.
“We want to work with them
on it,” Austin said.
A look ahead
While still in the early stages of its cooperative waste
disposal effort, the Maine Hospital Association has pondered the
future of the operation that so far is unlike any other in the
The Maine Waste Facility in Pittsfield
is working at about half its maximum capacity, treating 2.4 million
pounds of biomedical waste per year when the plant could handle
more than 5 million pounds per year.
After the final six hospitals
join the effort by this time next year - when their existing waste
disposal contracts have run out - the association will look to
add more laboratories, doctors’ offices, veterinary clinics,
dentists’ offices and nursing homes to the mix, said Butts,
the Maine Hospital Association official.
“We obviously want to use
the facility to its capacity,” she said.
Beyond that, the association
plans to start a complementary program to reuse and recycle the
plastic containers that are used to dispose of needles and other
sharp instruments, Butts said.
Through the waste disposal collaboration
and other efforts, Maine hospitals are at the forefront of an
emerging nationwide movement toward more environmentally responsible
health care, Stacy Malkan, a spokeswoman for Virginia-based Health
Care Without Harm, said recently. The organization works to make
the health care industry more environmentally friendly.
“Hospitals around the country
will be looking to Maine to see how it works out,” she said.
The hospital garbage has to go
somewhere, and Maine might as well employ its own people and methods
to do so, May of Sebasticook Valley Hospital said.
“This is our waste, and
it’s our responsibility to find a way to dispose of it,”
©2005 Bangor Daily News,
used with permission.