Medical Waste Disposal – The Definitive Guide 2021

Medical waste and its proper disposal remain a major concern for America. Here are the primary reasons:

• The safety of healthcare patients and personnel, as well as the legal obligation in handling the waste
• Environmentalists are concerned with the impact of medical waste, whether it’s wasting up on a beach in Jersey Shore or being illegally dumped in landfill sites
• Home producers of medical waste, such as needles and syringes that want to dispose of their tools properly

What Is Medical Waste?

According to the EPA (Environmental Protection Agency), the definition of medical waste is fairly broad “all waste materials generated at health care facilities, such as hospitals, clinics, physician’s offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories.” It fails to include any organization that produces medical waste such as syringes or needles from their employees or customers, or the home producer for that matter.

How Much Medical Waste Is Produced?

In 2012, the United States spent up to $2.5 billion for the proper disposal of medical waste. Moreover, with annual growth of 4.8%, by 2017 the annual market is expected to $3.2 billion. For instance, consider these medical waste statistics:

• Just hospitals in the U.S. produce more than 5.9 million tons of waste annually
• Hospitals produce 33 lbs.of medical waste per day per staffed bed
• Florida alone has approximately 38,000 facilities that generate biomedical waste

In short, almost all healthcare activities related to humans produce medical waste. So, can you imagine the dangers of what would happen if it was disposed of improperly?

The Epidemiology

(How Often Diseases Occur in Different Groups of People and Why) WHO (World Health Organization) even mentioned that in 2000, there were 32% new Hepatitis B infections due to improper way of contaminated syringe disposal. In 2002, WHO conducted a research to review 22 countries about their way of medical waste disposal management and resulting various ranges from 18% up to 64% that used improper methods of biomedical waste management. Dangerous, huh?

Who Are At Risk For Biomedical Waste Exposure?

People who have the highest risk of being the biomedical waste, for instance, healthcare workers, patients, waste collection and disposal staff, and even our environment. The biomedical waste may pose an occupational hazard when managed incorrectly. Therefore, we need special precautions and the well-trained personnel to manage those biomedical wastes and keep the risk low.

Why We Need To Manage The Biomedical Waste In The Right Way?

There are several reasons to manage the biomedical waste in an appropriate way:

• Health – Nobody wants to see blood drops on the floor when they walk into hospital visiting a sick friend because the risk of being infected by any number of diseases
• Infection risk – the risk of infection obtained from sharp injuries can lead to infection
• Environment pollution – The risk of air, water and soil pollution directly from waste due to defective incineration or autoclaving can be harmful.

The biomedical waste treatment and disposal need to be in a complete management to ensure the safety of the workplace and maintain our health. If you maintain the safety process correctly, it will:

• Effectively reduce your legal liability
• Reducing the danger to the community, personnel and patients
• Keep your reputation high

The OSHA (Occupational Safety and Health Administration) has an established procedure for dealing with biomedical waste hazards that can minimize our risk with contaminated articles. Thus, we at BioMedical Waste Solutions, LLC, use OHSA standards as our guidance to dispose the medical waste properly.

Brief History of Regulated Biohazardous Waste Disposal in America:

In 1988, a famous act namely Medical Waste Tracking Act (MWTA) was addressed to handle the disposal of medical waste in coastal areas due to numerous medical and household waste throughout several coastal areas, therefore a two-year program was implemented in the affected areas (New York, New Jersey, Connecticut, Rhode Island, and Puerto Rico). This act was expired in June 21, 1991.

During that time, EPA gathered all information and performed medical waste related studies and together with MWTA, they managed to look at several treatment technologies that was available at that time involving incinerators, microwave units, and several varieties of mechanical and chemical systems that can be used for reducing the waste. Thus, resulting a different local regulation of medical waste management that was implemented to each state, such as Medical Waste Management 2015, as one of the recent medical waste regulation for California State.

Sorry to disappoint our Walking Dead fans, but improper disposal of medical won’t be the cause of the Zombie Apocalypse in America because stringent regulations, laws, and guidelines.

Regulated VS Unregulated

Of all the health care waste (HCW) there is essentially two types: Regulated medical waste (RMW) and unregulated medical waste (UMW). Approximately 75% to 90% of HCW is UMW (unregulated) or known as healthcare general waste (HCGW). This waste is similar to typical household waste consisting of papers and plastics that are not been in contact with patients and is categorized as non-infectious. This type of waste is simply disposed in accordance with municipal regulations. Approximately only 10% to 25% of HCW is infectious/regulated medical waste (RMW).

Naturally this RMW has to be handled with special care as we’ll describe below because it could pose a threat to the health of others, either by contaminating the environment or through direct contact with an individual. Easier way to differentiate the two types is to ask yourself “could this waste kill someone or make them sick?” If yes, then this waste is regulated and must be handled with special care.

NOTE: The use of “medical waste”will be regarded as “regulated medical waste” (RMW), unless otherwise stated.

Eight Categories of Medical Waste

It’s important to know what kind of medical waste your facility produces then you can determine the proper disposal. The WHO classified the medical waste into eight (8) categories of medical waste:

1. Infectious waste – Waste that may transmit infection from virus, bacterial, parasites to human, i.e.: lab cultures, tissues, swabs, equipment and excreta
2. Sharps – Sharp waste, such as needle, scalpels, knives, blades, etc.
3. Pathological – Human tissue or fluids i.e. body parts, blood, other body fluids
4. Radioactive – Unused liquid in radiotherapy or lab research, contaminated glassware, etc.
5. Chemical – Expired lab reagents, film developer, disinfectant
6. Pharmaceuticals – Expired and contaminated medicines
7. Pressurized containers – Gas cylinders and gas cartridges
8. General waste (UMW) – No risk to human health because no blood or any related bodily fluid, i.e.: office paper, wrapper, kitchen waste, general sweeping, etc.

Because the management for every waste categories are different.

Stages of Medical Waste Disposal

Where does medical waste go? How is medical waste disposed of? For purposes of this guide, we are going to focus on disposal in the US. Let’s share with you the cautious and special care process in which medical waste is collected, stored, transported and treated with.

Stage 1 – Collecting & Segregating The biomedical waste has to be collected in containers that are resilient and strong from breakage during the handling process. Do not place sharps, used needles, syringes, or other contaminated tools in common waste disposal or recycle bin because the entire waste will be infectious by doing so. The segregation also needs to be performed between the liquid and solid biomedical waste products. Categorizing the medical waste with correct segregation to isolate and manage each waste in the proper way. For this purpose, the segregations come in colored waste containers, label coding and plastic bags. Stage 2 – Storing & Transporting Specific requirements for storage facilities, such as a secure area that is inaccessible to the general public, as well as separated it from areas for food consumption. The storage facilities also have to be accompanied with refrigerator or freezer unit that can be used with medical waste if necessary. Some facilities even provided special vehicles and protective devices to dispose, handling or transport the biomedical waste products. Remember to observe and keep maintaining the protective devices periodically so it won’t be a source of transmitting the infections.

Stage 3 – Treatment The needs of professional handling that work according the by-law regulation such as the OSHA are needed to ensure that the regulated medical waste (RMW) is handled properly. The treatment process will use several medical waste equipment that ranged from handling, carts, shredding, conveying, size reducing, compactors, to sterilization or recycling. The following equipment is needed to properly process the waste in order to reduce the hazards, and maintain the environment:

• Carts and containers – commonly used to collect the medical waste i.e. dumpers, containers, compactors can be used to collect the medical waste
• Conveyors – this equipment help to segregate the waste
• Sterilizers – such as: autoclave, shredder, and size redactor
• Handling the waste – such as: compactors, containers, pre-crushers, and deliquefying system
• Recycling system – i.e. balers and size reduction equipment

Incineration – Type 1 of Medical Waste Treatment The incineration technology used a high temperature thermal process that can convert inert material and gases with the combustion process. It will process the waste to convert into ash, gas, and heat. There are three types of incinerators that are commonly used for biomedical waste:

1. The Multiple Hearth Type– it has a circular steel furnace that contains solid refractory hearths with a central rotating shaft to convert the waste into ash
2. Rotary Kiln – it is an incinerator, shape like a drum, commonly for medical and hazardous waste
3. Controlled Air – there are two process chambers that will handle the waste. The complete combustion and oxidizing it, leading to a stream of gas with carbon dioxide and water vapor composition. It is commonly used for waste that has organic materials.

In addition, for some cases, performing a shredding for biomedical waste needed as an aid for incineration process.

Non-Incineration System (Autoclaving, Irradiation, Chemical Methods) – Type 2 of Medical Waste Treatment

Aside from the incineration technology, the non-incineration method also provided to dispose the biomedical waste, it contains four basic processes such as thermal, irradiative, chemical, and biological.

The autoclaving system (a photo of our autoclave machine is below) is commonly used for the human body fluid waste, sharps, and microbiology laboratory waste. This system requires high temperature (thermal) that produces steam to decontaminate the biomedical waste. The steam plays a critical role in the medical waste autoclaving process therefore a good waste holding container is required. While most of human body fluid waste can use this method, but the cytotoxic agents that used for chemotherapy cannot use this method due to those types of waste are not degraded with autoclave steams. Beside autoclaving, irradiation is the other thermal method which uses a high frequency microwave for disposal. The wave will generate heat to the waste materials and kill all the bacteria, or any other contamination in the tools.

Another way of performing treatments for biomedical waste is chemical decontamination, this method can be used for microbiology laboratory waste, human blood, sharps and body fluid waste, but cannot be used for treating anatomical waste. Aside from that, biological processes is a method that employ enzymes to destroy the organic matter of the waste, however there are very few non-incineration technologies have been based on this biological method.

On-Site and Off-Site Treatment of Medical Waste
To differentiate which biomedical waste that can be performed on-site and off-site is important. Because in majority of the cases, the biomedical waste is a mixture and can be very difficult to manage it properly or even to segregate it, which is why an accurate simplified management of medical waste in segregating it according to the regulations will reduce the erroneous element. The on-site treatment usually requires expensive equipment. Not all facilities have this due to major infrastructure expenditure, but it is generally cost effective for very large hospitals and laboratories.

Thus most medical waste producers choose off-site treatment known as regulated medical waste disposal companies because these companies have:

• The proper medical waste equipment
• Been state certified operating permits
• OSHA-trained personnel to collect, transport or store the medical waste

Once treated, the medical waste can be disposed of.

Stage 4 – Disposal
In the US, for solid waste, once medical waste producers have adhered to regulations for collecting, storing, transporting, and treating their waste, they may then use their municipal landfill and sanitary sewer system as their final disposal method.

That’s right, your local municipal landfill is commonly used as the final place of your treated decontaminated biomedical waste.
For fluids such as blood, suctioned fluids, excretions and secretions, almost every state and local government has its own regulations and guidelines to provide the best way to dispose it. In general, there are two recommended ways to handle medical waste fluids:

1. Collect fluids in a leak proof container, and solidified for autoclave treatment
2. Thermally (autoclave) fluids then they be disposed into the sanitary sewer system

An extra precaution should be performed before pouring treated fluids in sewer because they may clog and leak.

Conclusion

As you can see from this article, great care goes into disposing of medical waste, and the way it is disposed is dependent on what category of medical waste it is and government regulations. We hope you find it easier to proper dispose of your medical waste.

Dr. Intan Airlina is consulting Director of OSHA Compliance for BioMedical Waste Solutions, LLC (www.BioMedicalWasteSolutions.com). She is an Internist that holds an Internal Medicine Degree from University of Indonesia, learned tropical diseases and infection, also certified in patient safety from a Joint Commission International (JCI) and ISO certified hospital.

Legal Disclaimer. This guide and medical information on this site is provided as an information resource only, and is not to be used or relied on for purposes or substitute for proper OSHA training. Please consult your OSHA trained provider, or contact BioMedical Waste Solutions for a consultation, before making any biohazardous waste disposal decisions. BioMedical Waste Solutions , LLC expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. If you do not agree to the foregoing terms and conditions, you should not enter this site.