medical waste treatment and disposal: an overview just some of the environmental, community, and...
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Medical Waste Treatment and Disposal: An Overview
Just Some of the Environmental, Community, and Occupational Safety & Health Issues to Consider
Jackie Hunt Christensen and Monica Rohde BuckhornHealth Care Without HarmSeattle, WA July 31, 2002
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The Mission of Health Care Without Harm
To transform the health care industry so it is no longer a source of environmental harm by eliminating pollution in health care practices without compromising safety or care.
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We will accomplish this mission by:
• Promoting pollution prevention.
• Supporting environmentally safe materials, technology and products.
• Educating and informing about the environmental and public health impacts of the health care industry and solutions to its problems.
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Why work on medical waste?
• Medical Waste Incinerators = Major sources of dioxin & mercury
• Ethics: Physicians’ oath to “First, do no harm”
• Irony that the place people go to be healed could be making them sick
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Problems with Hospital Waste
• Toxicity - Dioxin (from PVC and other chlorinated items)
- Mercury and other heavy metals
• Increasing Volume
- Large amounts of single-use, disposable items
- Recycling not being utilized in many cases
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Why is HCWH Opposed to Incineration?
MWIs = 3rd largest known source of U.S.
dioxin air emissions, produce about 10% of
U.S. mercury emissions
Incineration produces both toxic air
emissions and toxic ash residue.
Burning medical waste actually creates
new toxic compounds such as dioxins.
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Why is HCWH Opposed to Incineration?
Many MWIS also burn
readily recyclable items.
Wastes with high energy
value, such as plastics,
may contain chlorine &
contribute to dioxin
formation.
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Most Hospital Waste Is Simply “Trash”
Hospital
Waste
(Trash)
85%
Hazardous
Waste
5%
Regulated
Medical
Waste
10%
Includes 2%pathologicalwaste
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Hospital Waste, Like Household Trash, Is Largely Recyclable
Food Waste10%
Metals10%
Wood3%
Glass7%
Other10%
Plastics15%
Paper & Paperboard
45%
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Some Problem Products
• Polyvinyl chloride (PVC) plastic materials
• Mercury-containing products
• Cadmium-containing red bags & sharps containers
• Chlorine-bleached paper products & packaging
• Pesticides used in and around HC facilities
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How to Address Problem Products?
• Waste Management approach: Recycle/reuse products
• Pollution Prevention approach: Avoid purchasing problem products in the first place
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PVC in Medical Products
• IV bags
• Blood bags
• IV and respiratory therapy tubing
• Venodyne sleeves
• Patient ID cards
• Water bed liners
• Rigid packaging trays
• Mattress covers
• X-Ray folder holders
• Shower curtains
• Dialysis bags
• Thermal blankets
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PVC Alternatives
• Non-PVC IV Bags (e.g.,
McGaw Bags )
• Non-PVC blood bags
(under development)
• Non-PVC Sharps
containers (e.g.,
reusable polyethylene
• Non-PVC tubing
• Non-PVC ID bands
• Non-PVC suction
liners
• Nitrile gloves (Instead of vinyl or latex)
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Mercury-Containing Products and Their Alternatives
Product
– Hg batteries
– Esophageal devices, Cantor & Miller-Abbott tubes
– Hg thermometers
Alternatives
– Lithium, zinc air, alkaline
– Products w/ tungsten tubing Anderson AN-20
– Digital, expansion or aneroid
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Mercury-Containing Products and Their Alternatives
Product:– Hg-based blood
pressure monitoring devices
– Lamps & lighting devices
– Hg switches– Hg dental
amalgams
Alternative:– Electronic vacuum
gauge, expansion or aneroid
– Non-Hg based-sodium vapor,glow lights, optical
– Non-Hg switches– Gold, ceramic,
porcelain
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Opportunities for Reuse in Health Care
• Built-in eggcrate mattresses
• Reusable dishware and cutlery
• Reusable cloth underpads
• Reusable inter-office mailers
• Plastic or steel emesis and wash basins
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Opportunities for Reuse in Health Care
• Reusable personal protection gowns
• Double-sided copies
• Reusable respiratory therapy equipment
• Rechargeable batteries
• Reusable packaging units -- tubs, totes, sharps containers
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What about the rest?? Treating “Red Bag” Waste
• 10-15% of health care waste is “regulated medical waste (RMW);” a small fraction of that is pathological waste
• RMW generated can vary widely be facility type
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Treating Regulated Medical Waste
• Contrary to popular belief, the Centers for Disease Control and Prevention does not REQUIRE incineration for either RMW or pathological waste
• A few individual states require incineration of path waste or chemo
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Questions to Ask Before Choosing Treatment Technology
• Has your facility done a waste audit?
• What measures are staff already taking to minimize amount & toxicity of waste?
• Does your facility have staff, expertise & space to allow for onsite technology?
• What are your state’s regulations re: onsite treatment?
• How long has treatment technology been in use? Where? (any comparable facilities?)
• What is the estimated life of the equipment?
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More Questions to Ask …
• Cost: have you factored in utilities, down time for repairs, cost of alternate treatment during down time, permitting, tipping fees, supplies, etc.?
• Emissions: what are the known emissions to air, water, land from this technology? Which pollutants are regulated?
• What is the reputation of the technology company?
• Have you involved the local community in the decisionmaking process (for both on- and off-site), and if so, how?
• What contract conditions are negotiable?
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Choosing Treatment Options
• There is no “magic box” to make all waste & liability disappear
• Facilities may need to utilize more than one type of technology
• Involve diverse group of stakeholders, including local community
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On-Site Treatment Options
• Autoclave
• Microwave
• Chemical treatment
• All have risks and benefits
• Costs vary by size of treatment unit, supplies, reliability of equipment, ease of operation, etc.
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If You Opt for Off-Site Treatment …
For many hospital waste treatment services, from sharps to regulated medical waste, your facility may have only one choice nearby: Stericycle
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Off-site treatment: Stericycle
• For most health care facilities, Stericycle is “the only game in town” for off-site treatment for RMW
• HCWH is working to make sure that Stericycle lives up to its mission -- To be the leading company dedicated to the environmentally responsible management of infection control and compliance services for the healthcare community
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Stericycle: #1 Commercial Medwaste Treatment Provider
• 11 times the size of its nearest competitor, Med/Waste Inc., which filed for bankruptcy earlier this yea r
• Worth $620.6 million in assets as of January 2002
• Bought Browning-Ferris Industries’ medwaste assets in 1999
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Stericycle: Medical Waste Giant
• Purchase of BFI assets moved Stericycle from small company using alternative technology (“electrothermal deactivation”) to big company with many commercial medical waste incinerators
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Community Opposition to Stericycle Facilities
• Saint Louis, Missouri
• Gila River Indian Community, Arizona
• Haw River, North Carolina
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Stericycle’s Worker Health & Safety Performance
• Woonsocket, RI – OSHA alleged Stericycle mishandled pathological waste at ETD facility, knowingly exposing workers to potentially dangerous pathogens
• Company paid $400,000 in fines for falsification of data, failure to treat waste properly, failure to sterilize RMW containers & improper use of equipment
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More Worker Health & Safety Issues
• Morton, WA – Three workers at ETD facility developed tuberculosis between May and September, 1997
• Washington State OSHA fined Stericycle $1,100 for serious violations. NIOSH investigated as well. Stericycle claims that any problems identified by regulators have been fixed.
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Practicing Dioxin- and Mercury-Free Medicine
• Environmentally sound
procurement policies
• Minimization of
packaging
• Reusables instead of
disposables
• Recycling
• Ongoing “Red Bag”
reduction education
• Waste segregation
• Non-incineration
treatment technologies
for all wastes
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HCWH Resources for Treatment Technology Discussions
• Medical Waste Treatment Technologies: Evaluating Non-Incineration Alternatives. A Tool for Health Care Staff and Concerned Community Members
• Non-Incineration Medical Waste Treatment Technologies: A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members
• Available through www.noharm.org
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Resources for Health Care Facilities:
–Health Care Without Harm www.noharm.org or 202-234-0091
–Hospitals for a Healthy Environment www.h2eonline.org or Laura Brannen [email protected]
–Sustainable Hospitals Project (UMASS Lowell)
www.sustainablehospitals.org or Catherine Galligan: 978-934-338 or [email protected]