History of Medical Waste in the U.S. Healthcare teams are tasked with the responsibility of maintaining a safe and healthy environment for their patients. In order to do this, they must follow strict procedures to prevent medical waste from entering the environment. Medical waste is hazardous to humans and animals alike. Not only does it pose health risks, but it can also lead to environmental contamination.
Medical waste can consist of sharps, needles, biohazards, blood, blood-soaked items, healthcare, and clinical waste. This type of waste has been a concern since needles started washing up onshore of some east coast beaches in 1987. This prompted the U.S. EPA and congress to act and started the Medical Waste Tracking Act of 1988.
Medical waste is mostly generated from the healthcare industry, the industry tasked with making people healthy, can also create waste that makes people ill when improperly handled or disposed of.
Medical waste has had it challenges over the years, processes continue to improve so the healthcare industry that makes people well, does not also make them ill.
Along with the Medical Waste Tracking Act, in 1988 the Ocean Dumping Ban Act made it illegal to dump medical waste into our waters. The section below is Title III from the EPA Archives.
Cited as the “United States Public Vessel Medical Waste Anti-Dumping Act of 1988”, this section prohibits, 6 months after enactment, disposal of potentially infectious medical waste into ocean waters by a “public vessel”. Two narrowly crafted exceptions to this prohibition relating to health and safety of the crew, or times of war or national emergency are set forth.
This title also: defines “medical waste” for purposes of the Ocean Dumping Act; adds medical wastes to the list of materials the dumping of which is prohibited under the Ocean Dumping Act; increases the civil penalties for illegal dumping of medical wastes under the Ocean Dumping Act and includes a provision for forfeiture of the vessel; and provides increased criminal sanctions under the Ocean Dumping Act for illegal dumping of medical wastes; defines “medical waste” for purposes of the CWA using the same definition as for the MPRSA; and, incorporates the term “medical waste” into the list of pollutants for which the discharge is prohibited under sec. 301(f) of the CWA.
Like most people it is hard for me to imagine there was ever a time when we thought this would be OK to do.
Until the late 1980s it doesn’t appear there was much foresight on what to do with medical waste.
After the Medical Waste Tracking Act of 1988 ended on June 21, 1991. The current regulatory rules are under the responsibility of each individual state. They range from being very strict regulations, to having few regulations at all.
Once the medical waste tracking act and ocean ban dumping act was enforced, the medical waste incinerator was a common way to destroy and get rid of medical waste in the U.S.
From the Healthcare Environmental Resource Center.
“Until the mid-1990’s, hospital/medical/infection waste incinerators (HMIWIs) were installed at many U.S. hospitals, other healthcare facilities, and commercial waste disposal companies. They were used to burn infectious wastes, together with a variety of other wastes that found their way into the infectious waste stream.
But while medical incinerators may have helped deal with one problem, they created several others. Medical incinerators were found to be significant sources of airborne mercury. In addition, in 1994, EPA’s Draft Dioxin Reassessment identified medical waste incineration as the single largest source of dioxin air pollution. Pressure from environmental and community groups eventually convinced most healthcare facilities to re-examine their practices. Since 1997, the number licensed HMIWI units dropped from 2,400 to only 111 (2004), a 95% reduction. Several factors have contributed to this decline:
Increasing environmental awareness among healthcare facilities (no doubt stimulated by public concern) has led to improved waste practices, including segregation and non-incineration treatment and disposal of non-regulated wastes.
Clean Air Act (CAA) regulations finalized in 1997 for HMIWIs increased the cost, compliance burden, and potential liability associated with maintaining onsite incineration facilities.
In addition to CAA compliance costs, the expenses of equipment upkeep, labor, and energy have continued to increase.
Several treatment technologies not involving combustion (e.g., autoclave, microwave, chemical and mechanical treatment) have been approved for use in several states.
Problems with Incineration: Air Emissions and Energy Use
Incineration is unquestionably effective, and it remains a legal treatment alternative in most states (check your state rules), but it is associated with serious air quality concerns. Because atmospheric oxygen is used as the reagent, a large volume of air must constantly pass through the system. Unless the exhaust air passes through a control device, all substances that are volatile at the operating temperature of the system will be emitted with the exhaust stream. For example, hospital incinerators were once (and, though to a lesser extent in the U.S., continue to be) significant sources of environmental mercury contamination. In addition, the operating conditions inside incinerators can lead to the formation of organochlorine compounds such as dioxins.
Incinerators are also inherently inefficient from an energy standpoint, particularly when dealing with wastes with high water content. To maintain combustion temperatures, many pounds of fuel must be burned to destroy each pound of waste. Much of that energy is spent simply to boil off the water so that the organic portion of the waste will burn. This has historically been less of a consideration for medical waste, since processing costs are high in any case, but will undoubtedly become more of an issue as the cost of fuel (typically natural gas) increases. Moreover, the burning of large quantities of fuel entails the generation of excessive greenhouse gases (primarily carbon dioxide) relative to the amount of waste material destroyed. This is hardly on the radar screen in the U.S. at present but may also become a significant issue in the not-too-distant future.”
This section is based on The World from PRX (PRX is a 501(c)(3) organization) and an interview on PRI’s Living on Earth with Steve Curwood.
In 1996 Gary Cohen co-founded Health Care Without Harm, an organization that advocates for health-care corporations and hospitals to adopt more environmentally friendly practices, especially regarding climate change. For example, they advocate for increased professional training for staff and doctors and for the cessation of incinerating medical waste.
Cohen believes the industry can and should lead the way toward better energy and environmental practices worldwide, improving both human welfare and helping to reverse the effects of climate change.
“If we’re ever going to turn around the epidemic of chronic disease in our society, we have to get the health care sector to stop contributing to it,” Cohen says. “We have to get the health care sector to show us the way out of this toxics problem, to show us the way out of our addiction to fossil fuels, to be the early adopters of renewable energy sources.”
Cohen has already shown that change is possible. In the mid-1990s, hospitals were the largest source of dioxin contamination in the US. Dioxin is linked to cancer, learning disabilities and problems with brain development.
“The idea that hospitals were poisoning people in service of healing them was crazy, and a clarion call to address that,” Cohen says. He responded with Health Care Without Harm and by advocating for better waste practices.
“We showed the hospitals that burning waste was incredibly inefficient, and it was creating this toxics problem that was ubiquitous around the world,” Cohen explains. “We showed them that they could use alternative technologies, reduce their waste, save money in the process, and it was going to be good for the environment and good for the health of their communities.”
Cohen’s organization achieved tremendous results. In the US, the number of medical waste incinerators dropped from about 4500 to 70 in less than a decade.
At the time, hospitals were also a significant source of mercury contamination, due to all the broken mercury thermometers that were either dumped down the drain or burned in incinerators. The mercury was emitted into the atmosphere, which would then build up in the environment, in fish and then in humans when we ate the fish.
Health Care Without Harm started by convincing one hospital in Boston to eliminate its use of mercury thermometers. Then they convinced the other hospitals in Boston to follow suit and began to bring the idea to other cities across the US.
In the end 5,000 hospitals, 14 pharmacy chains and 28 European countries committed to go mercury free and by 2013 there was a global treaty phasing out all mercury measuring devices by the year 2020, Cohen says.
Now he and his organization are looking to the future. The health care sector, Cohen says, still has all the contradictions built into our modern economy, and that needs to change.
“They’re a major user of energy, which is derived from fossil fuels that have all sorts of public health impacts and are contributing to climate change,” he explains. “They’re one of the largest users of toxic chemicals, which are contributing to cancer and learning disabilities and all sorts of other health issues. And they serve food that’s been drenched with pesticides and meat that’s been grown with the overuse of antibiotics.”
So, Health Care Without Harm is working with hospitals to change their purchasing practices, pushing them to better support renewable energy and to buy products with green chemicals that don’t contaminate their patients or poison their workers.
They are also working with hospitals to change how they buy food, so they can support sustainable farmers in the community that “create healing food environments in their facilities for their patients and their employees, who spend 12 hours a day there,” Cohen says.
“We’re trying to link the idea that food is medicine, and that health care, in its purchasing practices, can be involved in a much larger healing strategy,” he explains. “Not only healing individual patients, but healing communities they serve, and healing the planet. That’s the new mission of health care in the 21st century.”
The world is already learning, Cohen says, that health is a major way we will all experience climate change – whether it’s increased asthma in inner cities, more illnesses related to heat stress, or an increase in infectious diseases like Dengue fever and malaria, which could be carried by mosquitoes to warming climates.
“Climate change is going to impact everyone’s health around the planet,” Cohen maintains. “When we can get the health care industry to rebrand climate change as a public health emergency, people will respond.”
“If people think that climate change has to do only with melting ice caps and polar bears – something very far away – they’re not going to be motivated to act,” he says. “But if they understand that climate change impacts their health and the health of their children and their communities, they’re motivated to act.”
As you can see medical waste regulations and treatment processes have changed over the years always moving towards a more environmentally friendly solution.
Today often medical waste makes its way into the community from sources like hospitals and doctor’s offices. In most cases it is due to an employee’s lack of understanding on what to do with, what waste. Compliance training goes a long way in reducing risk and protecting the environment.
Below are some examples of real-world medical waste violations.
This one case started because neighbors alerted landfill officials, they were seeing red bags in the landfill. The landfill officials in turn notified the State Department of Environmental Protection, whose two-year investigation resulted in assessment of a $451,000 fine against 12 hospitals.
Nearby residents were the first to spot red bags of untreated medical waste being dumped illegally at a local landfill.
12 hospitals were disposing unprocessed and potentially infectious waste in the landfill along with municipal garbage.
Based on that same investigation, DEP fined another health network $86,900 for similar violations of the state Solid Waste Management Act involving medical waste from its hospitals.
DEP spokesman said the investigation found no evidence that the two hospital systems intentionally were disposing of medical waste illegally and attributed the problem to lack of proper training of employees.
That is over a half million dollars in fines due to lack of compliance training. Here at Healthcare Waste Management, we provide an easy to use and manage online compliance training portal that can keep you up to date on the latest training needs for your facility.
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