A publication of Work On Waste USA, Inc., 82 Judson, Canton, NY 13617 315-379-9200 March 28, 1991


“A clever person solves a problem, a wise one avoids it.”
Albert Einstein

Hardly a day goes by that Waste Not does not receive a call from a community confronting a proposal to build a regional medical waste incinerator in their midst. We have had calls from nearly every state and as far away as Wagga Wagga, Australia. The proposals fall into a fairly predictable pattern. A newly formed company, usually with a very environmental-friendly name, like Safety Medical Systems or Bio-Safe or Never-Burned Better, Inc., comes to a town, usually near a major highway or railway, usually with a small population, and usually economically depressed and desperate for jobs, any kind of jobs. They promise a “perfectly safe” facility and “economic development and jobs.”

If this really was “good economic development and jobs” then there would be competition for such facilities from Alaska to New Mexico. However, there is no competition -or rather the competition is to keep them out! So what then is the motivation? Well, it is good economics for the developers. With equipment that they would normally get about $30-$40 a ton to burn trash, they can get as much as $3,000 to burn medical waste: the difference being very enticing profit! So who is prepared to pay this money, and why? Hospitals and other medical waste generators are prepared to pay as much as $1.50 per pound (it looks much cheaper like this than $3,360 per ton!) to get the stuff off their hands: it’s called shifting the responsibility. In other words they are prepared to pay what it takes to get another community to take the risks that their own is not! And once again, we are seeing a crisis being used to promote a technology and not a solution. But what is that crisis? There are about 5,000 hospital waste incinerators, operating in densely populated areas, with short stacks, no air pollution equipment, burning at low temperatures, and operated by poorly trained staff. Moreover, these incinerators designed essentially to burn body parts and other organic waste, are now attempting to destroy a complicated waste stream involving a high percentage of plastics. Emission measurements from eight hospital waste incinerators in California (ref California Air Resources Board report of May 25, 1990 - available free, from CARB, 1102 Q Street, PO Box 2815, Sacramento, CA 95812) show high levels of dioxins and the toxic metal cadmium. Health risk assessments prepared for these emission levels and considering only a few possible routes of pollutant exposure, predicted incremental cancer risks for cadmium and dioxins (strictly dioxins and furans) ranging from a low of 2.8 to a high of 261.7 per million. In the context of the so-called “politically acceptable” incremental cancer risk of 1 in a million, these risks are unacceptably high.

Many states are toughening up the air emission regulations for hospital incinerators. These tougher standards will inevitably result in either retrofits with costly air pollution control equipment, or the pressure to build regional facilities. And that sounds all very reasonable doesn’t it? Except that modern air pollution control equipment doesn't always do what it is supposed to do, especially when the main motivation of the company operating the facility is to make as much profit as it can. However, the greater problem is that high temperature incineration is a great mismatch of the process with the problem. The basic problem of medical waste is a biological one - we are anxious to destroy the bugs than can spread disease. Under most circumstances a high temperature incinerator is going to take that problem in its stride, but only at the expense of creating several formidable chemical ones. Because incineration not only takes on the problem of destroying bugs, it takes on the more daunting task of destroying plastics. When plastics are burned, several things can happen. First, any metal, such as the toxic metal cadmium which is often added to plastics as either a pigment or a stabilizer, will be liberated from the otherwise stable plastic matrix as the plastic is burned away. The metals -indestructible by any burning or other chemical process - emerge from the stack as gases, tiny particles that can penetrate deep down into the lungs, or are captured in the air pollution control devices and leave the facility either in the waste water (wet scrubber) or the fly ash (dry scrubbing system). Second, many plastic objects used in hospitals, like intravenous tubing, are made of poly vinyl chloride (PVC) which contains 58% by weight of chlorine. Chlorine, too, is an element and cannot be destroyed. The best that can happen is that it forms hydrochloric acid, which is probably the origin of the frequent complaints of respiratory problems and eye soreness from citizens living near incinerators without acid scrubbers. However, scrubbers can take care of this problem to a large degree. The greater concern is that some of the chlorine can combine with a partially burned material to form some very toxic byproducts, including the very toxic families of compounds: dioxins and furans. It has been shown that ton for ton, of waste burned, a badly run hospital waste incinerator can put out 100 to 1000 times more dioxins and furans, than a well run trash incinerator. The third problem is that as better air pollution control devices are used to capture the toxic metals and the dioxins and furans, the waste water or ash becomes more toxic and more difficult to get rid of. While combustion engineers struggle to solve these problems with improved combustion and better air pollution control devices, it is important for the rest of us to take a larger view of this issue and make sure that we address the right questions. As Einstein said: “A clever person solves a problem a wise one avoids it.” The problems of medical waste incineration are totally avoidable. We do not need regional medical waste incinerators. Hospitals can solve the problems on site with better strategies and technologies.

What should our hospitals be doing? First, have a little more faith in the community. The hospitals are not the enemy. We all want the best medical service we can get and most recognize that no activity can be entirely risk free. The first step therefore is for the hospital to set up a committee drawn from their doctors, nurses, and other staff, and the community, especially the environmental activists. Sit down together and discuss the problem and together find the most rational solution which is acceptable to both the hospital and to the community. One important principle to hang on to is that the hospital should solve its own problem and not simply export it to somewhere else, because in the context of the waste issue that simply reduces to the rich dumping on the poor, or the powerful dumping on the weak. Such a discussion would quickly reveal that infectious medical waste is only a small part of the total waste stream from the hospital -about 10% or less. Pathological waste (body parts, etc) is less than 1%. (Incineration is acceptable for the disposal of pathological wastes, such as body parts, tissues and blood from surgical procedures and autopsies.) This is an extremely important observation because the red bag waste issuing from hospitals is often more than this, and the amount being burned in incinerators is far greater than this. The first task is to keep the genuinely infectious waste separate from the non-infectious waste. The second task is to have a very strict handling policy for sharps (needles, scalpels, broken glass, etc.) because this is the most likely way that disease can be accidently transmitted to the public. Most hospitals do have special containers for sharps and it is not difficult to design a system whereby these sharps need never cut anyone, without consigning them to a high temperature incinerator. The third task is to look at all the technologies which can address the biological problem of medical waste without creating unnecessary chemical problems. There are three technologies currently operating in a number of hospitals in the USA and other countries: a) Autoclaving (steam sterilization) coupled with compaction before landfilling the residue; b) Shredding and chemical disinfection (sodium hypochlorite solution or hydrogen peroxide); c) Shredding and microwaving. These technologies are safer than incineration, and less expensive, especially when modern air pollution control devices have to be fitted on to the incinerator. Fourthly, do everything possible to keep the throwaway items to a minimum. Unfortunately, there is a $50 billion industry selling disposable plastics to hospitals. We need to cut out the trivial and use stainless steel, ceramics, cottons, and other reusable materials whenever possible.

For those wishing to pursue these alternatives in more detail, Dr. Shirley Lindell, the former safety officer of the Iowa State Medical School is an excellent source of impartial information. Tel: 319-356-1616. A report from the Citizens Clearing House on Hazardous Waste, “Medical Waste: Public Health vs. Private Profit”, costs $8.50 for community groups, and $99.99 for business/agencies/consultants, address: PO Box 926, Arlington, VA 22216, tel: 703-276-7070. Clean Water Action will soon publish a report on medical waste.

WASTE NOT # 144 A publication of Work on Waste USA, published 48 times a year. Annual rates are: Groups & Non-Profits $50; Students & Seniors $35; Individual $40; Consultants & For-Profits $125; Canadian $US45; Overseas $65. Editors: Ellen & Paul Connett, 82 Judson Street, Canton, NY 13617. Tel: 315-379-9200. Fax: 315-379-0448.