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Bloody Business
Connecticut produces up to two million tons of medical waste each month — and yet has no facility for treatment.
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Business New Haven
8/7/2000
By: Susan Froetschel
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The fact that Connecticut does not have a treatment facility adds to the cost, ranging up to a 25 percent premium, according to medical waste handlers.
The state literally has hundreds of producers of medical waste, with hospitals producing the most. However, nursing homes, veterinarians, pharmaceutical firms, funeral homes and others also collect waste in labeled containers and submit detailed reports monthly to the state Department of Environmental Protection.
“Medical-waste handlers must undergo training and follow the regulations,” says Rich Geisser, an area vice president for Stericycle Inc., based in Lake Forest, Ill. Geisser is responsible for Stericycle's New England and Midwest regions. “Management of medical waste relies on a manifest system, with cradle-to-grave tracking,” he adds.
Medical waste is the second-largest known source of dioxin and the fourth-largest known source for mercury releases, according to the U.S. Environmental Protection Agency. Amounts of medical waste are largely population-driven, with greater amounts produced by areas with good hospitals.
The state's minimum fine for illegal dumping of any type is $1,000, and major violations associated with hazardous waste can entail fines of up to $25,000 per day.
Environmental Hazard
The federal government imposed tough standards on the health care industry, through the federal Medical Waste Tracking Act in the late 1980s, following complaints of stray needles and other medical waste being found along public beaches and along public highways.
The act was in effect for only two years, but many states quickly followed suit with regulations and heavy fines. In the early 1990s, disposing medical waste cost up to 20 times what it cost to dispose of normal waste.
The legislation started a new industry, says Tom Pregman, with the Waste Division of the state's Department of Environmental Protection (DEP). “Early on, any object with a drop of blood or associated with infectious disease was classified as medical waste,” says Pregman. “At first, the public was concerned about every Band-Aid. But in reality, the school nurse does not generate medical waste.”
Increased regulation also prompted more firms to sell off their medical waste divisions gradually, creating single-focus companies.
Decreasing Costs
Costs associated with medical waste disposal have declined in recent years, largely because state regulations redefined what was medical waste, eliminating items such as Band-Aids, diapers, disposable gowns and gloves, as well as packaging for medical supplies. Also, waste-collection firms trained clients to segregate waste.
For example, when signing up a new client, Stericycle provides detailed definitions of medical waste and directions on how to comply with regulations. Firms also provide training and suitable containers.
“We conduct waste audits,” explains Kent Zergiebel, director of environmental services for Yale-New Haven Hospital, which produces and collects about 35,000 pounds of medical waste per month, less than ten percent of its total trash output. “If we find an employee tossing newspaper into the medical waste container, we will hold an in-service [training].”
Employers are responsible for exposure control plans and policies, including personal protective equipment and management of waste, reports Lisa Corriveau, manager of quality improvements, education, projects, equipment and supplies at the Hospital of Saint Raphael in New Haven.
Waste at St. Raphael's is divided into general, recyclable, medical, chemical, chemotherapy and radioactive streams. Medical waste specifically includes cultures and stocks of infectious agents; human tissues, organs, body parts or blood; used and unused sharp objects; animal waste; and isolation waste from patients with highly communicable diseases.
All containers include orange labels with the universal biohazard symbol and the facility's name and address. A daily log is maintained for all medical-waste boxes stored for shipment, containing the number, size and weight of each box, and all manifest forms are retained for at least three years.
Up to ten percent of all hospital waste can be infectious, with plastics comprising 30 percent of the medical-waste stream - four times that of normal household plastics. However, Zergiebel suggests that medical waste poses no more environmental hazards than typical household trash, especially when households are not careful about removing batteries, solvents and other chemicals.
“It does not take much to destroy the infectious materials in blood or body fluids,” Zergiebel notes. He also adds that he anticipates technology to improve the disposal of plastics, just as engineers have developed ways to change IV tubings without changing needles. “We have reduced the need for needles, but we can't escape the need completely,” he says.
Currently, large hospitals pay three to five times more for disposal of medical waste than normal trash. Hospitals and firms in New England are more conscientious about segregating waste than facilities in other parts of the country, suggests Geisser.
High-volume producers, such as hospitals, can negotiate rates or place contracts out for competitive bid. Yale-New Haven Hospital currently uses Med-Waste Management of Hartford - and all that waste ends up at a treatment facility, Bridgeview Inc., in Morgantown, Pa., east of Lancaster.
Smaller producers cannot negotiate fees, yet a typical funeral home pays $75 to eliminate about 15 pounds of medical waste per month. “I wish all my bills were that low,” says one Hamden funeral director.
Home Medical Waste
A small but rising fraction of medical waste enters the regular waste stream through the home health-care market. “Nurses train the patients in proper disposal techniques, because we're not in the home all the time,” explains Nancy Humiston, chief operating officer of Regional Visiting Nurse Agency, in Hamden.
For example, if a patient is diabetic, he may have to inject insulin at least once a day. Visiting nurses advise the patients to dispose used needles directly into a heavy-duty plastic detergent bottle, marked with a red bio-hazard sticker. When two-thirds full, the capped bottle is disposed with household trash.
Used dressings are placed in plastic bags before disposal in household trash. Humiston has heard of no reports of mishandled home medical waste. “The trick is educating people,” she suggests.
Out-of-State Disposal
Twelve waste handlers, three based in the greater Hartford area, are licensed with DEP for collecting or transferring waste in Connecticut, though only six firms are active. “I would love to see more competition,” says Zergiebel. He would also like to see a treatment facility built in the state. “More states are looking at interstate transportation regulations,” says Zergiebel. “Suppose New Jersey decided to prohibit trucks transporting such waste through the state - we would be in trouble.”
A proposal by Med-Waste Management to build a treatment plant in Fair Haven was dropped following vehement protests by residents at public hearings. Med-Waste Management continues to pursue a treatment facility in the Hartford area. The state application fee for a treatment facility permit is $30,000.
Stericycle, the other major waste handler for the New Haven area, has a treatment plant in Woonsocket, R.I., but that plant does not have the capacity for all the waste generated in Connecticut. Therefore, medical waste collected by Stericycle goes to a Hartford transfer station before being shipped to Weston, N.Y., near Buffalo.
Vehicles that transport the waste throughout the state carry emergency spill equipment, including tools for cleanup, disinfectants and the means to re-package the material safely.
As the amount of waste declined along with disposal prices, most New England facilities eliminated their on-site waste incinerators in anticipation of more restrictive air emission standards imposed by the EPA. Few large producers, such as hospitals, do in-house sterilization or treatment of medical waste, because the equipment can cost more than $500,000, and breakdowns are common.
Over-Regulation?
A multitude of federal, state, and local agencies oversee the handling and disposal of waste, including the city health department, the federal Occupational Safety & Health Administration, state and federal environmental agencies, state and federal transportation departments, the U.S. Postal Service, as well as the Joint Commission on Accreditation of Hospitals.
In addition, the federal Nuclear Regulatory Commission oversees the removal of radioactive waste. Radioactive materials are stored in secure areas with radiation alarms, allowed to dissipate, before disposal.
Despite all the regulation, the state DEP has received no major complaints about medical waste in recent years, other than a few intentional acts by individuals who were charged with criminal acts.
A May 1998 issue of Yale Practice, a staff newsletter for Yale faculty and the Yale School of Medicine, urged readers to show respect for custodians and fellow staff members by immediately and properly disposing sharp materials.
“People who handle medical waste - the sharps or the blood - they're usually careful,” says Zergiebel. “But in the operating room or a department where they are working with sharps or blood all the time, the sheer numbers, 50 times a week or even a day, can they be 100-percent certain that they are never distracted? That is always the risk.” BNH
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