According to the Environmental Protection Agency, medical waste has not been regulated by the EPA since the 1988 Medical Waste Tracking Act expired in 1991. Instead, state environmental and health departments are responsible for the regulation of medical waste. Other federal agencies such as the CDC, OSHA, WHO, and the FDA do have regulations regarding medical waste.10 The need for regulation, specifically concerning the environmental and potential health implications, arose after medical waste was found washed up on beaches across the east coast.7 There was a two-year federal program enacted by congress, but the EPA concluded during that time period, that the risk of disease to humans from exposure to the waste was less than that of healthcare workers. Therefore, once it expired states were left to develop their own regulatory programs on proper treatment and disposal of medical waste.7
Figure 1. Medical waste washed up on beaches
Proper disposal of needles has gained serious attention in recent years. Discarded needles pose a serious threat to the public, more specifically waste workers. If needles aren’t properly disposed of and end up in garbage trucks there is risk of injury and infection to the people that could come in contact with them.10 Needles can also penetrate through plastic garbage bags to those handling the waste. We know that used needles can transmit infectious diseases and cause serious health implications, such as HIV.10 There are many community options for safe and proper disposal of needles and sharps. In healthcare settings, the CDC has put many regulations in place to ensure the safe disposal of these items.
According to the EPA, more than 90% of potentially infectious medical waste was incinerated before 1977. Once there became concerning evidence that the emissions had detrimental effects to air quality and human health, the EPA created tighter emission standards for medical waste incineration. The EPA’s Office of Air Quality Planning and Standards has continued to review and revise the Hospital Medical Infectious Waste Incinerator standards as needed, but the last revision was only made in 2013. With these tighter standards, there has been a significant reduction in the use of HMIWIs in the U.S.7 As a result, alternative treatments and technologies have increased for medical waste disposal. Typically, this is used in order to determine whether the medical waste is non-infectious, because if so it can still be disposed of in landfills or incinerators. According to the EPA, most states then will require medical treatment technologies to be certified, licensed, or regulated. The official website states, “EPA has jurisdiction over medical waste treatment technologies, which claim to reduce the infectiousness of the waste (i.e. that claim any antimicrobial activity) by using chemicals.”7
According the World Health Organization, the total amount of waste generated by health care activities is about 85%, non-hazardous waste and the remaining 15% is considered material that is potentially infectious, chemical or radioactive. The major sources of health care waste come from hospitals, laboratories, other health facilities like medical device companies, research centers, mortuary and autopsy centers, nursing homes, and blood collection locations. With the United States being such a high-income country, the amount of hazardous waste generated is significantly higher than others, but we do have the ability to separate the waste and make more conscious decisions about the effects on the environment and human health.10
In Living Downstream, Steingraber mentions that open burning and incineration of waste results in the emission of dioxins, furans, and other particulate matter with many serious indirect health implications. If the incinerated material contains or has been treated with chlorine that is when dioxins and furans are generated, which are both carcinogenic to humans.6 Waste from landfills can contaminate drinking and ground water. This harmful waste and chemicals can then be ingested through the water we drink or even just the water we shower with. The hot water and chemicals are entering through our skin and also just the steam we are breathing in.6 Modern incinerators have been put in place in order to comply with emission standards for dioxins and furans.10 Autoclaving, microwaving, and steam treatment are used as alternatives to incineration. Autoclaving is probably the most popular or common, in which elevated pressure and temperature are used in order to perform the sterilization of products, so that they can be re-used in a lab setting or in most hospital settings just properly disposed.11 Autoclaving is a reliable method of killing all forms of microorganisms. An autoclave is unlikely to give off harmful gases, so overall it is substantially safer for waste handlers, the public, and the environment.10
Overall, waste management has failed in many ways and for many reasons. There is an obvious lack of awareness about the health hazards as well as inadequate training in proper waste management. There is very low priority given to the topic and many countries don’t even have appropriate regulations or really enforce them. In order to determine the proper classification of specific waste items hospitals and facilities base their understanding of disease transmission and hazardous chemicals.8 Health care waste assessment and generation data is based off of quantitative data. This data is normally obtained over the span of a year in order to get an accurate data collection to analyze and provide recommendations to the facility. This provides health care organizations with the opportunity to improve current practices, educate health care workers about waste, and come up with a plan for minimization of waste.10 In order to avoid adverse health outcomes associated with poor waste management and disposal, government support is need for long-term improvement, although there is immediate action being taken locally.
One of those organizations taking action now is Supplies Over Seas, which is a Kentucky-based nonprofit organization. They provide critical health care needs in impoverished communities around the world by redistributing medical supplies and equipment. SOS has partnered with hospitals to recover materials that would otherwise go to landfills in order to improve the environment and public health. “Since 1993, SOS has saved more than one million pounds of medical equipment and supplies from landfills, while bringing health to 105 countries around the globe, including the United States.” Since hospitals in the United States generate nearly 6 tons in medical surplus each year and a large portion is unused or “under-used” SOS is making a significant impact.9 According to the World Health Organization an estimated 12.6 million deaths each year are attributed to an unhealthy environment.10
In summary, there are very serious health and environmental implications of medical waste around the world, but how is this effecting our everyday lives? Are there things that we can do in order to reduce the amount of waste generated from these locations? In Bloomington, IU Health Systems as well as Cook Medical are two very large and well known facilities that generate a substantial amount of waste. There is a need for more awareness on this topic to facilities and the general public. It is important to our health and well-being to know the waste management practices going on around us. The government also has a responsibility to protect public health and the environment.
Medical waste proper disposal continues to be a challenging issue healthcare companies around the world face every day. Minimizing waste in order to reduce and promote sustainability are practices that companies are trying to incorporate into their facilities in order to better protect the environment and public health. Waste management methods such as treatment and disposal have gained large attraction in the public eye as we learn the negative health implications of improper disposal.
In recent years, Cook Medical has done a significant amount of reduction throughout their facilities regarding medical waste. They are also always looking for new ways to be more efficient in their facilities. This even includes the design of their packaging and distribution services that they use to get their products out to patients. A lot of material gets reused in Cook facilities, but if it can’t they’re always looking for ways to recycle the material. Consumption isn’t going away, but Cook Medical has adopted new methods to reduce pollution and waste. Whenever Cook builds a new facility, they seek out and plan for the reuse of materials. One of their goals includes tracking and assessing improvements for waste management.1 In their packaging, Cook doesn’t use hazardous materials and they also always try to remove materials that would generate nonessential, excess waste.1 From the beginning, Cook Medical has always had the mission of making healthcare more sustainable. Cook Ireland received the International Organization for Standardization in 2019 for minimizing their negative environmental effects and meeting energy efficiency requirements.1 Cook Denmark received a similar ISO award in 2020 for their continuous work to improve the environment through their business choices.1 Cook Medical is striving to make positive changes, not only in the United States, but around the globe. Cook Medical also has the WEEE directive, which applies to the placement of electrical or electronic equipment in the EU.2 All of their products are marked with WEEE in the EU in order to ensure that all waste electrical and electronic equipment is properly disposed and treated in all countries. Their customers can then properly recycle waste free of charge as it is all marked with the same symbol.2 There is a phone number for more information on proper disposal methods of their products, customers can also arrange for the collection of items or find dedicated disposal drop off bins at a variety of some municipal locations.2 There is still a significant need to reduce waste and always adopt better disposal practices, but they’re constantly monitoring their facilities and keeping up with governmental policies and guidelines.
Figure 2. Medical device company logo in Bloomington, IN
“Indiana University is a large generator of hazardous waste, generating approximately 45 tons of hazardous waste each year and an additional 20 tons of waste that cannot be managed in the municipal trash due to other regulations and landfill or recycling facility restrictions.”5 In order to keep up with EPA standards. IU Environmental Health and Safety has established procedures to minimize waste volumes.5 IU also has managed to reduce the amount of toxic/hazardous waste and come up with the most responsible waste disposal practices possible. The IUEHS has developed the Waste Minimization and Pollution Prevention Program in order to put in place procedures to reduce waste from the university.4 This program is aimed to apply to all IU faculty and staff who generate waste, which includes hazardous/chemical wastes in lab settings. In laboratories, chemical usage is always minimized by the instructor through the use of different techniques when applicable. Laboratories are required to reclaim and reuse materials as much as possible. They also utilize less toxic alternatives to most chemicals and preservatives. Biodegradable glass and specialty cleaning detergents are also used in place of harmful sulfuric acid cleaners. The mixing of hazardous and non-hazardous waste is strictly enforced in laboratory settings with respective labels and bins for each. IU fully participates to the fullest extent in sponsoring recycling and reusable materials. IU has adopted environmentally friendly recycling, reusing, disposal, and the treatment of medical waste in their labs on every campus. Proper disposal of hazardous waste is critical for the health and well-being of IU faculty, staff, students, and the Bloomington community. It is important that every individual is educated on the proper management of waste and how it effects our health and environment.4,5
IUEHS has developed specific waste collection schedules and procedures for each type of waste generated. A lot of the time biological waste can be disposed of as normal waste after proper disinfection or sterilization. Biohazardous waste that cannot be put into a regular trash are then collected on campus, according to a pick up schedule.3 This waste can also be delivered to IUEHS locations on campus with the procedures in placed followed. Chemical waste is collected by EHS staff also by request at laboratory buildings, but the Waste Management Guide is to be consulted in order to properly prepare and label the waste before the collection date.3 Radioactive waste is only disposed of by appointment and communication with Greg Couch. Regardless, all waste must be put into non-leaking and closed containers free from outer contamination. The waste must also all be labelled and tagged with a date and signature. The pH of certain solvents in the chemical waste must also be marked, so that it is disposed of properly. The IUEHS has the right to reject any waste that is nor properly prepared, packaged, or labeled when delivered or picked up.3
Medical waste is continuously generated every day and while even we may not be the ones specifically generating the waste, we do face the negative repercussions that may follow. Medical waste has a sufficient potential risk of causing infection when handling or disposing and also harming the environment. Facilities here in Bloomington as well as around the globe are adopting new practices and guidelines to minimize their waste for the betterment of the environment and public health. There is still a significant amount of awareness and reduction that needs to take place regarding medical waste and its negative implications, because health care isn’t going anywhere.
Resources:
1.“Sustainability & Environmental Practices.” Sustainability & Environmental Practices | Cook Medical. Accessed November 18, 2020. https://www.cookmedical.com/about/sustainability-environmental-practices/.
2.“Waste Electrical & Electronic Equipment Directive.” Accessed November 18, 2020. https://www.cookmedical.com/about/sustainability-environmental-practices/waste-electrical-electronic-equipment-directive/.
3.“Waste Management Guide.” Protect IU. Accessed November 18, 2020. https://protect.iu.edu/environmental-health/environmental-management/waste-management/waste-guide/index.html.
4.“Waste Management.” Protect IU. Accessed November 18, 2020. https://protect.iu.edu/environmental-health/environmental-management/waste-management/index.html.
5.“Waste Minimization.” Protect IU. Accessed November 18, 2020. https://protect.iu.edu/environmental-health/environmental-management/waste-management/waste-guide/minimization.html.
- Steingraber, Sandra. Living Downstream: An Ecologist’s Personal Investigation of Cancer and the Environment. Da Capo Press, 23 March, 2010.
- “Medical Waste.” United States Environmental Protection Agency,
https://www.epa.gov/rcra/medical-waste.
- Chariter, Yves, et al. ”Safe Management of Wastes from health-care activities.” World Health
- “Delivering a World of Health & Hope.” Supplies Over Seas 1991,
https://soshealthandhope.org/what-we-do/.
- “Health-care Waste.” World Health Organization, 8 Feb 2018, https://www.who.int/news- room/fact-sheets/detail/health-care-waste.
- “Infectious Waste.” Indiana Department of Environmental Management,
https://www.in.gov/idem/waste/2414.htm
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