US APPROACH TOWARD MEDICAL WASTE MANAGEMENT. BY KRISTINA MESON, OSWER CHEN H. WEN, OPPTS US Environmental Protection Agency

Transcription

1 US APPROACH TOWARD MEDICAL WASTE MANAGEMENT BY KRISTINA MESON, OSWER CHEN H. WEN, OPPTS US Environmental Protection Agency

2 Overview of Presentation US Regulatory Framework Healthcare Waste Generation Management of Medical Waste Treatment and Disposal Options Source Reduction as an Option for Waste Treatment and Disposal

3 Major Environmental Regulations Affecting Healthcare Sector Clean Air Act Clean Water Act Comprehensive Emergency Response Compensation and Liability Act Federal Insecticide, Fungicide, and Rodenticide Act Resource Conservation and Recovery Act Solid Waste Disposal Act

4 Many Other Federal Agencies Also Regulate Healthcare Industry Dept. of Health and Human Services Centers for Disease Control Drug Enforcement Agency Food and Drug Administration National Institutes of Health Occupational Safety and Health Administration Department of Transportation Nuclear Regulatory Administration

5 Healthcare Waste Generation Healthcare Waste consists of multiple waste streams: Infectious/Medical Waste Pharmaceutical Waste Pesticides Cleaners Cafeteria and other municipal solid waste 8-45 lbs. of waste per bed per day Infectious waste is 15% or less of total

6 Waste Audits An analysis of a facilities waste stream has many benefits: Identify sources of waste, their compositions, and rates of generation; Provide information on: waste minimization and handling practices segregation efficiency regulatory compliance costs

7 Waste Handling Getting infectious waste safely to proper treatment and disposal is critical: For worker safety To minimize environmental releases Waste handling procedures should include: Good segregation practices Appropriate containment to protect workers Clear labeling Safe Storage Solid chain of custody

8 Categories of Medical Waste 1. Cultures and stocks of infectious substances 2. Human Pathological waste 3. Used Sharps 4. Contaminated animal wastes 5. Isolation wastes 6. Blood and blood products 7. Unused, discarded sharps

9 Treatment Options Infectious/Medical Waste Incineration Non-incineration technologies Thermal autoclave microwave Chemical/Mechanical Irradiation Medical waste treated by one of these methods can be safely landfilled

10 US Trends for Medical Waste Incinerators Medical Waste Incinerator Rule promulgated in 1997 In September 1997: ~1800 MWI, 80 of which were commercial In May 2003: 110 MWI, 22 of which are commercial Air emissions reduced by 95-99%

11 Size and Capacity On-site small MWIs generally are: dual chamber batch feed; manual handling 200-1,000 lbs./hr; often not operated 24/7 Off-site Commercial MWIs generally are: dual chamber continuous feed; manual handling 1,950 lbs./hr can operate 24/7

12 Considerations Suitable for most waste types Renders waste unrecognizable Significant reduction of volume and weight May be some worker exposure to bioaerosols during loading without proper protection Proper incinerator operation critical to pathogen destruction Need for continuous operations to achieve efficiency (burn everything) Costs

13 Thermal Destruction Autoclave/Steam Sterilization Thermal inactivation of microbes using: Moisture Heat Pressure

14 Size and Capacity Small bench top (e.g., dental office), size of small microwave Mid-size lab and on-site hospital, holds several trays of culture plates to several red bags Large commercial, 8 diameter x 30 length; 96 tpd

15 Considerations Generally achieves sterilization Appropriate for most waste types except large pathological waste Able to change time duration of treatment to accommodate load characteristics Few residuals Does not render waste unrecognizable No significant reduction of volume or weight Costs ($200,000 - $400,000)

16 Microwave Steam-based, low heat thermal technology Use waves in radio-frequency range to denature proteins within the microbial cell Waste is shredded prior to heating

17 Size and Capacity Batch or semi-continuous lbs/hr Approximately 22 L x 18 H x 10 W

18 Considerations Substantial microbial inactivation Appropriate for most waste types except large pathological waste, metal objects, chemotherapy waste Few residuals Renders waste unrecognizable Significant reduction of volume Costs ($500,000 - $600,000)

19 Pyrolysis High temperature non-combustion treatment Forms glassy aggregate as residual Requires energy to operate Relatively new technology - requires careful consideration

20 Considerations May achieve sterilization Appropriate for most waste types Lower emissions than incineration (still dioxins) Renders waste unrecognizable (glassy aggregate) Significant reduction of volume or weight Large size High costs ($750,00 - $3.3 million)

21 Chemical/Mechanical Mechanically shred and mix waste to increase exposure to chemical Use disinfectants to kill microbes Most common disinfectant used is sodium hypochlorite Others include: peroxyacetic acid, glutaraldehyde, sodium hydroxide, ozone gas, and calcium oxide Range in size in capacity

22 Considerations Substantial reduction in microbial load Appropriate for most waste types except pathological waste*, large metal objects, chemotherapy waste Potential chemical hazards/worker safety issues Renders waste unrecognizable Significant reduction of volume Costs

23 Irradiation Electron beam interacts with cells at DNA level Examples are Cobalt 60, UV-C Technology has been around for decades; application for medical waste still in development stage

24 Summary:Factors to Consider Throughput Types of waste treated Microbial inactivation efficacy Environmental emissions and waste residues Occupational safety and health waste reduction Noise and odor

25 Factors to Consider Regulatory acceptance Space requirements Automation, reliability Level of commercialization Background of technology manufacturer or vendor Cost Community and staff acceptance

26 But Destruction Isn t Always the Best.. The healthcare sector generates a lot of waste! Medical waste incinerators identified as 4th large source of mercury release into the air (1990 Report to Congress); Healthcare sector generates approx. 1,000,000 pounds of waste per day. Economically or environmentally, there are alternatives to destruction.

27 Hospitals for a Healthy Environment Going Beyond Disposal There are roughly 7000 hospitals in U.S. Voluntary program between EPA, American Hospital Association, and other institutional partners Currently attracted 780 hospital Partners Major goals of program include: Virtual elimination of mercury Significant reduction of overall waste volume

28 H2E s Approaches Toward Mercury Elimination and Waste Reduction Show the impact of mercury and waste on patient and staff health; Show the expense in not eliminating mercury, and not reducing waste; Promote design and sale of better products with manufacturers; Promote better training of healthcare workers to waste reduction and proper disposal.

29 H2E Provides Its Partners.. Web page - updated bi-weekly with latest technical information; Listserv of healthcare professionals for peer-to-peer advise; Monthly teleconference training calls; Awards and recognition for outstanding Partners.

30 Examples of Partner Acheivements 66 Partners have eliminated mercurycontaining products altogether; Beth Israel Hospital in New York saved $500,000 a year from waste segregation and reduction; University of Michigan Hospital: Recovered 2000 pounds of Hg Saved 8 million gallons of water Saved 8 million kilowatts of energy

31 Benefits of Segregation, Source Reduction & Recycling Minimizes the amount of infectious waste that needs to be treated; Minimizes costs for handling hazardous waste; Reduce natural resources consumption; Create healthier environment for patients and staff.

32 On-line Resources EPA s webpage on medical waste, with links to EPA and state regulations EPA s rule for medical waste incinerators, related fact sheets Non-Incineration Medical Waste Treatment Technologies August 2001

33 On-line Resources, cont. Hospitals for a Healthy Environment s website, with numerous documents and links Clearinghouse on cleaner healthcare supplies 03.pdf CDC Guideline for Environmental Infection Control in Heath-Care Facilities