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Medical
waste disposal meets humanitarianism
Regulated medical waste (RMW) is a far-reaching
term that encompasses everything from syringes to prescription
drugs, new and used medical supplies to human and animal parts,
to laboratory and hospital equipment. That just begins to describe
an entire universe of constituent components.
Adding to the scope of this category is the
exploding size of the American healthcare market due to the aging
of baby boomers, new technologies requiring ever more supplies,
the mushrooming use of prescription drugs and the increased generation
of home medical waste. For instance, the obesity problem has
triggered more use of onset Type 2 diabetic supplies, like blood
testing and insulin syringes, leading to a surge in RMW disposal.
RMW is a complex, ultra sensitive branch
of the solid waste stream. It is subject to special regulatory
compliance depending on where it is generated, comes with legal
liabilities throughout the flow of the waste stream and requires
higher collection and disposal costs.
Reuse for humanitarian relief
Because of the challenges facing RMW and
the desire of the healthcare industry to ensure public safety
and to be environmentally responsible, keeping as much of these
wastes out of landfills as possible and recycling whenever practical
have become high priorities. As a result, there have emerged
a number of innovative alternatives.
Over the past decade, for example, the recovery
and reuse of medical supplies and biomedical equipment has grown
from virtually nothing to a well-established national supply
chain that is now exporting hundreds of thousands of tons annually
for reuse to developing countries around the world. Materials
that would have been landfilled are now relieving pain and saving
lives.
An example is MedShare, a non-profit humanitarian organization
founded in 1998 and headquartered in Atlanta. It pioneered the
concept of recycling American medical supplies and equipment
for people in needy countries.
MedShare has established bin collection programs in the Atlanta
and San Francisco metro area hospitals to recover medical supplies
that otherwise would be trashed due to hospital regulations.
“Since our founding we estimate that we have saved in excess
of 1.7 million cubic feet from going into landfills. On average,
we recover about 2,500 pounds of surplus medical supplies each
week from hospitals in Atlanta and Northern California, thus
diverting them from landfills,” said A.B. Short, CEO and cofounder
of MedShare.
Hospitals generate large volumes of medical waste, much of it
perfectly good medical supplies and equipment. This is partially
a result of our litigious society. Once an item is ordered for
a patient’s room, the patient is charged for it, and if unused,
it must be disposed of. There are also hundreds of different
medical-surgical kits used. Often there are separately packaged
leftovers as well as damaged packaging, inventory clearances
and equipment disposals due to upgrades.
MedShare collects these items, as long as the ones with expiration
dates have a shelf life of 12 to 18 months, and receives product
donations from medical supply manufacturers and distributors
– mostly cosmetically damaged products, overstocks and discontinued
lines. It also receives products and equipment from other humanitarian
organizations that have found MedShare an efficient conduit to
distribute their donations.
With a small staff and approximately 1,000 volunteers per month,
MedShare sorts and repackages nearly 25,000 product codes, repairs
and refurbishes biomedical equipment ranging from hospital beds
to X-ray machines and packs 40 foot containers for export.
Thus far they have shipped nearly 600 containers to hospitals
and clinics in the developing world valued at more than $70 million
dollars, and have provided medical supplies to more than 1,000
international medical missions worth over $2.3 million.
This recycling model has led to the formation of similar non-profit
efforts across the country. In 2008, the MedSurplus Network was
established. “The MedSurplus Network is a growing alliance of
five medical surplus recovery organizations working together
to improve the quality of medical supply and equipment donations
here and abroad,” Short explained.
Hospitals are enthusiastic about recovery and reuse organizations.
Many are actually paying for the collection service. It’s consistent
with their humanitarian efforts and green agendas, plus has the
bottom-line benefit of reducing RMW volume thereby reducing disposal
costs. 
Recovery
The bulk of medical waste is biohazardous. It includes potentially
infectious materials such as blood and other biologics, dressings,
pharmaceuticals, laboratory waste, and contaminated glassware
and sharps – things like needles, syringes and surgical instruments.
Virtually any material generated from the medical industry by
labs, hospitals, clinics, physicians, dentists, pharmacies and
veterinarians can fall into the category of biohazardous.
Laws, regulations, standards and guidelines governing biohazardous
materials abound. Many aspects are regulated at the state and
local level. Many regulations are based on the United States
Environmental Protection Agency’s (EPA) Model Guidelines for
State Medical Waste Management. Others are governed by federal
regulations issued by the EPA, the Occupational Safety and Health
Administration (OSHA), the Department of Transportation (DOT)
and United States Postal Service (USPS). The federal government
also regulates hazardous elements used in medicine such as mercury
and radioactive elements. The EPA’s Medical Waste Tracking Act
has established guidelines for the segregation, handling, containment,
labeling and transport of medical waste. Most states have developed
their medical waste regulatory framework around these guidelines.
Disposal
In the old days, most hospitals used on-site incinerators to
dispose of medical wastes, but for the most part those times
have passed due to the Clean Air Act, the costs for pollution
control systems and the poor environmental image of smoke. Today,
hospitals and healthcare practitioners send RMW out to private
companies for disposal.
According to the EPA, currently over 90 percent of potentially
infectious medical waste is incinerated, but this used to emit
highly toxic pollutants like acid gases, carbon monoxide and
nitrogen oxides, and are major sources of dioxins and metals
such as lead, mercury and cadmium. This caused public opposition
to medical waste incineration and many healthcare facilities
looked for more environmentally friendly alternatives, primarily
industrial sized autoclaves using steam sterilization and often
combined with post-processing shredding, microwaving or chemical
treatment. Once properly sterilized and shredded, if so required
to meet local landfill regulations, RMW can be landfilled as
non-hazardous.
Costs for medical waste disposal are much higher than regular
solid waste because of the special handling mandated by regulations
and the extra treatment required. Like many services, the costs
go down as the volume generated goes up. Competition among service
providers level out prices of disposal. Medical waste disposal
companies are reluctant to talk about costs because it largely
depends on volume and nature of the collection customer; frequency
and distance for pickup, or if delivered by mail.
But that leaves the perplexing question of how much more does
it cost to dispose of biohazardous medical waste than regular
solid waste. The only extensive study found on this issue was
conducted by Frost and Sullivan, a respected international research
and consulting firm. Published in November 2004, ‘U.S. Medical
Waste Management and Disposal Markets’ said in part: “…the cost
of disposing medical waste is currently over $480 per ton, compared
to municipal waste at a cost of around $24 per ton.”
American Recycler spoke to George Winters, manager of marketing
and corporate communications for XMED Medical Waste Disposal
about typical biomedical collection and disposal practices. Headquartered
in Huntsville, Alabama, XMED uses a fleet of trucks to make regular
collections of biohazardous waste at hospitals and clinics throughout
North Alabama and Southern Tennessee, and has a nationwide mail-back
program.
Like most, XMED provides services to anyone who generates sharps
or regulated medical waste – from large hospitals to tattoo parlors.
Hospitals use small autoclaves to sterilize reusable instruments,
but all other contaminated materials must be put in approved
biohazard containers.
“We charge by the container, generally 28 or 32 gallon plastic-rubberized
containers. Inside the container is a red biohazard bag that
must be tied up and the container sealed before pickup,” said
Winters.
Smaller containers are used with XMED’s mail-back program – three
smaller sized packages for sharps disposal and a five gallon
container for regulated medical waste. Biohazardous materials
must be mailed in a puncture proof container that is sealed inside
a 4 mil plastic liner to meet USPS and DOT regulations.
Materials arriving at XMED’s facility go to industrial autoclaves
that handle hundreds of pounds of material and are sterilized
using high pressure steam. Sterilized materials are compacted
and disposed of according to state and federal regulations.
“We are very environmentally and regulatory compliant in our
activities and make sure our process is clean. When we send containers
back they are cleaned and sanitized because our customers want
it that way,” Winters concluded.
A mobile solution?
American Recycler also spoke with Nicholas Esposito, director
of marketing for MedClean Technologies, headquartered in Bethel,
Connecticut. Although his company outfits treatment facilities
and provides custom built solutions for its customers, MedClean
has developed a patent-pending, mobile, self-contained approach
for regulated medical waste sterilization and volume reduction.
“To my knowledge, we are the only company offering a mobile or
stationary self-contained unit that utilizes autoclave and shredding
technology with all utilities on board. It has the ability to
be a disaster relief unit because it is self-contained and delivered
on demand. With steam and electricity already onboard, the only
additional requirement is a simple garden hose, he explained.
The MedClean system uses an onboard steam sterilization unit
followed by a separate inline shredder that reduces sharps down
to one eighth of an inch size, and red bags to confetti. Once
processed, it can go into municipal solid waste dumpsters as
non-hazardous.
“The costs associated with operating a MedClean system is under
a penny per pound. The total cost to a hospital will depend on
the volume of medical waste being addressed. Further, the MedClean
System can be acquired as a lease, purchase or rental with no
capital outlay. The biggest cost-reduction comes with the ability
to address multiple waste streams onsite; red bags, sharps, and
confidential documents, with a MedClean System,” said Esposito.
Chemical conversion
It has not escaped the attention of scientists, engineers and
entrepreneurs that medical waste is a potentially rich source
of chemicals that can be converted into fuels and a wide range
of other chemicals. It’s a sound concept: medical waste is totally
destroyed, and the energy content is recovered and converted
into a synthetic gas which can be reformulated into any number
of chemical derivatives such as ethanol. A number of companies
are following this path with various technologies, but the volume
being processed today is very minimal.
Last year a major development occurred – a joint venture called
S4 Energy Solutions was formed between Waste Management, Inc.
and InEnTec LLC to develop and operate a series of plasma gasification
plants. Initially, the facilities will process medical and industrial
waste streams.
Education must begin at home
While collection practices and disposal methods differ, the healthcare
industry appears to do a good job of disposing of medical waste
driven by regulations, liability issues and professional responsibility.
The industry is trending away from incineration to autoclaves.
In most states, however, home generated medical waste is not
regulated. This does not apply to regulated medical waste produced
by home healthcare workers such as visiting physicians, nurses,
therapists or aides. They are supposed to provide for proper
disposal.
Home medical waste created through the personal administration
of injectable medications, other invasive or noninvasive procedures
and surplus or expired prescription drugs are handled differently
depending on jurisdiction.
Many counties and municipalities recommend that sharps and other
materials be put into a heavy plastic container, closed with
a top, sealed with tape, be clearly marked as hazardous medical
wastes and put into household trash. This protects waste handlers
and segregates hazardous material for incineration or sterilization.
Other communities have designated drop off locations or special
pick up days.
The sad truth, though, is that far too much medical waste is
improperly comingled with household trash, either through laziness
or because communities have failed to provide adequate consumer
education and convenient means for disposal.
These materials pose serious safety, health and environmental
problems. For example, over four billion prescriptions are written
annually in the United States. Up to 40 percent dispensed outside
hospitals go unused, generating approximately 200 million pounds
of pharmaceutical waste each year. Much of this waste goes into
sewer systems contaminating water supplies or in landfills doing
the same. People often flush disposable syringes down toilets.
Because they float, they are difficult to remove at the wastewater
treatment plants and can wind up in rivers, the oceans and wash
up on beaches.
In fact, it was medical waste washing up on East Coast beaches
that first prompted Congress to enact the Medical Waste Tracking
Act in 1988. This landmark legislation eventually led to the
comprehensive federal and state regulations in place today.
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