Non-Incineration Medical Waste Treatment Technologies

Non-Incineration Medical Waste Treatment Technologies A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members August 2001 Health Care Without Harm 1755 S Street, N.W. Unit 6B Washington, DC 20009 Phone: 202.234.0091 www.noharm.org Health Care Without Harm 1755 S Street, N.W. Suite 6B Washington, DC 20009 Phone: 202.234.0091 www.noharm.org Printed with soy-based inks on Rolland Evolution, a 100% processed chlorine-free paper. Non-Incineration Medical Waste Treatment Technologies A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members August 2001 Health Care Without Harm www.noharm.org Preface THE FOUR LAWS OF ECOLOGY . Meanwhile, many hospital staff, such as Hollie Shaner, RN of Fletcher-Allen Health Care in Burlington, Ver- 1. Everything is connected to everything else, mont, were appalled by the sheer volumes of waste and 2. Everything must go somewhere, the lack of reduction and recycling efforts. These individuals became champions within their facilities or 3. Nature knows best, systems to change the way that waste was being managed. 4. There is no such thing as a free lunch. Barry Commoner, The Closing Circle, 1971 In the spring of 1996, more than 600 people – most of them community activists – gathered in Baton Rouge, Up to now, there has been no single resource that pro- Louisiana to attend the Third Citizens Conference on vided a good frame of reference, objectively portrayed, of Dioxin and Other Hormone-Disrupting Chemicals. The non-incineration technologies for the treatment of health largest workshop at the conference was by far the one care wastes. Vendors of particular technologies have pre- devoted to stopping incineration because of concerns sented self-interested portrayals of their technologies. about dioxin emissions and other pollutants. A smaller Other groups such as the World Health Organization group emerged from that session to focus specifically on (WHO) have presented very generic overviews, usually medical waste. They were struck by the irony that hospi- equating them on par with incinerators. For those health tals entrusted to heal the sick and maintain wellness could care facilities and communities looking for a tool to re- be responsible for such a large share of the known dioxin ally evaluate their options for going beyond incineration air emissions, for at that time, the United States Envi- for the effective treatment of health care wastes, the search ronmental Protection Agency (EPA) had listed medical for information has been problematic. It is our hope that waste incinerators (MWIs) as the number-one identified this publication will provide a sound tool for all inter- source. ested parties. That summer, the EPA issued its first-ever regulations Long before the Health Care Without Harm campaign for medical waste incinerators. These “Maximum Achiev- had a name or members, a number of prescient people – able Control Technology” (MACT) rules, issued under including Barry Commoner, Paul and Ellen Connett, Tom the Clean Air Act, sought to control – but not eliminate Webster and many others –realized that the growing vol- – the emission of dioxins, furans, mercury, and other pol- ume of trash from all economic sectors was a huge problem, lutants to the environment. and that burning the evidence would not make it go away. Indeed, by the mid-1980’s, incineration had already been At the September 1996 inaugural meeting of what be- linked to air emissions of heavy metals and particulates came the Health Care Without Harm campaign as well as dioxins. They realized that the health care sec- (HCWH), more than 30 people met to discuss the topic tor presented a uniquely difficult situation because public of medical waste incineration. Some came from national perception, greatly influenced by images of needles wash- or grassroots environmental groups or environmental ing up on New Jersey beaches and concerns about HIV justice organizations; other were involved in health care. and hepatitis, fed the dual notions that “disposable is One thing that the representatives of the 28 organiza- better” and “burning is better.” tions who attended the meeting shared was a desire to stop the incineration of medical waste. While some of Anti-incineration experts like Commoner and the the attendees had specific experience with the internal Connetts sought to inform community leaders and regu- workings of the health care waste management system, lators in the United States that, as with municipal solid many knew very little about what options a hospital might waste, one should systematically view what comes into a have for dealing with its waste. So the campaign set about health care facility and what leaves it – “everything is the process of getting its questions answered. connected to everything else” and “everything must go somewhere” – rather than trying to focus only on waste. ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ PREFACE G iii In the intervening four years, the members of HCWH Health Care Without Harm has not been able to find have learned a great deal. This knowledge has not been such a technology, and it seems likely that this machine limited to the various technologies. As the campaign has does not exist. Indeed, as the campaign has grown and grown from 28 organizations to 330 groups in 33 coun- considerable research has been undertaken, HCWH has tries, HCWH members have become aware of unique learned that the vast majority of waste generated in health challenges that some of their colleagues face regarding care is very much like household waste, and therefore can waste treatment and disposal. For instance, while medi- be reduced, reused or recycled instead of treated and cal waste incinerators become less common in the United landfilled. States, the technology is still being exported. As HCWH and this report have evolved, the campaign HCWH research has discovered a number of things about encountered the perception that if Health Care Without the U.S. health care industry that were rather surprising Harm is against incinerators, it must be for landfills. This to many in the campaign: is not the case. For one thing, this assertion does not ad- ◗ In 1996, literally hundreds of hospitals had onsite dress the need for landfilling of incinerator ash residues, incinerators, which many of them used to burn all of which can be of considerable volume and toxicity. Nor their waste; does it note that some non-incineration technologies can ◗ A systematic approach to materials management is achieve significant volume reductions. HCWH’s goal is lacking for many facilities. Purchasing staff in a health to have facilities minimize the amount and toxicity of all system or hospital do not often interact with their waste to the greatest degree possible. If steps are taken to peers in the housekeeping/environmental services do this, the amount of waste requiring treatment will be department and so are generally not aware of prob- considerably less. By reducing the quantity and toxicity lems that arise from the volume and/or toxicity of of waste, hospitals can not only stop incinerating waste, the medical supplies they buy for the facility. Like- they can minimize the health and environmental im- wise, many product-evaluation teams in hospitals do pacts of landfills as well. The campaign realizes that every not currently take into account the environmental treatment technology has some environmental impact. impact of the products they choose. For example, one- quarter of all disposable plastic medical devices used This report seeks to achieve three primary goals: ◗ in the U.S. are now made of polyvinyl chloride (PVC). to encourage health care staff and the public to view Scientific research continues to tell the world more the management of health care-generated waste as a about the hazards of PVC, yet staff are often unaware process or system of materials management instead of information about the disposal problems associ- of a single step; ated with such products; ◗ to supply the reader with information to aid her/him ◗ Regulators and facility managers alike have not asked in evaluating non-incineration technologies for regu- what HCWH considers to be basic questions about lated medical waste; and the emissions of non-incineration technologies, and ◗ to raise questions about the public health and envi- moreover, emissions testing that does occur does not ronmental impacts of all methods and technologies seem to be modified to reflect changes in waste com- used to treat regulated medical waste. position; At an American Society of Healthcare Engineering conference in 1999, one engineer listed What this report will not do is specify any one technol- the criteria for the “perfect” treatment technology ogy for a facility. The tremendous variability in local as one that: conditions (including, but not limited to, environmen- 1. does not require a permit; tal, economic, regulatory, social and cultural factors) 2. does not require a public hearing; means that different technologies will be appropriate in 3. can handle all types of waste; different parts of the world. Health Care Without Harm 4. does not break down easily, and if it does need does not endorse any technologies or companies, but more repair, is easy to fix; importantly, the campaign believes that those decisions 5. requires only one full-time employee (FTE) to must be arrived at by the facility staff and the affected operate it, and that employee doesn’t require any community where the technology will be located. special training; 6. does not take up much space in the physical plant; Jackie Hunt Christensen 7. has no emissions; and, of course, Co-coordinator, Health Care Without Harm 8. costs less than what s/he had budgeted for the machine. ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ iv G NON-INCINERATION MEDICAL WASTE TREATMENT TECHNOLOGIES CONTRIBUTORS ACKNOWLEDGEMENTS This resource book is the culmination of efforts by sev- Health Care Without Harm acknowledges financial sup- eral individuals.

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