Medical waste is solid waste from medical or clinical uses at hospitals, clinics, physician offices, dental offices, blood banks, medical research facilities, and veterinary facilities. Medical waste is a form of hazardous waste that is stained or soaked with blood or includes body tissues or organs. Medical waste also can be deemed hazardous because it contains certain toxins or is radioactive.
Waste from medical practices and facilities can include used needles, syringes, surgical gloves, surgical instruments, blood-soaked bandages, lab samples, or body parts. This type of waste can expose people who handle it, and in turn an entire community, to infection. Medical waste materials also can include toxic chemicals, pharmaceuticals, or radioactive materials that can cause health risks to people and pollute the environment.
The Environmental Protection Agency began to define and control the tracking and disposal of medical waste in 1989 after Congress passed the Medical Waste Tracking Act of 1988. The act came about mostly because medical waste washed up on several East Coast beaches. Congress directed the EPA to gather data on the sources, associated health hazards, and current procedures and regulations for management and disposal of the waste. The EPA also was to evaluate the health hazards associated with transporting, incinerating, and burying medical waste materials in a landfill, and disposing of them in a sanitary sewer system. Under the act, the EPA gathered a lot of data, and most states subsequently controlled medical waste under local regulations.
Careless handling of hazardous medical waste can have several detrimental effects on public health. Medical waste containing blood and other body fluids or body parts can spread diseases. Waste with needles and other sharp objects presents physical hazards, and toxic or radioactive waste can harm individuals or the environment.
Medical waste use and disposal is not regulated everywhere in the world, and little research on public health effects from medical waste has been conducted in developing countries. What is more, there can be hazards associated with small, scattered sources of medical waste. It also can be impossible to enforce all medical waste management in spite of best efforts. As recently as September 2012, Volusia County, Florida, authorities reported medical waste washing ashore at Ormond Beach. The waste included hypodermic needles and medicine bottles that spread over a mile. The source of the waste was unknown.
An EPA study reported that approximately 3.2 million tons of medical waste are produced in the United States each year. Not surprisingly, hospitals, long-term health care facilities, and physicians' offices are the major producers of medical wastes, which account for about 0.3% by weight of all municipal solid waste. However, facilities that produce less than 50 lb (23 kg) of medical waste per month are exempt from most requirements. More people are being treated at home, and many people with diabetes treat themselves with daily injections. In short, it is difficult to adequately measure all of the medical waste in the United States or elsewhere in the world.
In addition to ongoing concerns about the potential for medical waste to spread HIV/AIDs and hepatitis, other disease outbreaks can be caused or intensified by medical waste. In 2009, World Health Organization (WHO) officially recognized the 2009 H1N1 virus as the cause of influenza and noted that a flu pandemic was underway. This announcement caused increased attention to the role medical waste can play in spreading the virus through contaminated tissues, gloves, masks, and other waste.
There are potential health, pollution, and esthetic effects of unregulated medical waste. It is expensive for medical facilities to control biohazardous waste and ensure infectious and toxic materials do not enter the general waste stream or pollute communities' air and water. Healthcare facilities can spend five to 10 times as much to dispose of regulated medical waste as they do their general solid waste.
If not managed properly, medical waste can spread disease from hospital and other clinical settings to the general public. Occupational safety also is a concern because healthcare workers can become infected with diseases their patients have if they do not follow infection control procedures. Infections such as HIV and hepatitis can spread from patients to workers. In addition, some medical waste is toxic to humans and animals and can cause or add to pollution of water if not controlled properly.
Certain types of medical waste can cause disease or injuries. For example, sharps, which include needles, scalpels, and other sharp medical instruments, can be coated with blood or fluids that spread disease but also can injure by cutting someone who comes in contact with them. Genotoxic waste includes highly toxic drugs and materials, such as chemotherapy medications used in treating cancer. Even waste from patients undergoing certain treatments can be highly toxic. These toxins can potentially contaminate municipal wastewater systems. Heavy metals, such as mercury, also can make their way to the environment. Mercury is used in thermometers. Its toxic effects vary, but mercury can cause poisoning and death. Its toxins can be released into the air during incineration, adding to air pollution. Finally, radioactive materials are used in medical imaging and to treat cancer. Ionizing radiation causes cancers. Exposure to high levels of radiation has been linked to birth defects, and direct exposure can cause serious radiation burns. The biggest problem with radioactive waste is the long half-life of the materials. Special management and disposal strategies are required to ensure the radiation is contained.
The Medical Waste Tracking Act of 1988 was perhaps the most formal large response to managing medical waste and potential spread of disease resulting from medical waste. As a result of the participation of four states (New York, New Jersey, Connecticut, and Rhode Island), along with Puerto Rico, in the voluntary program, the EPA gathered data on the disease-causing potential of medical waste. The data helped the agency determine that the highest potential danger from medical waste existed at the occupational level. The Occupational Safety and Health Administration oversees a number of activities aimed at protecting healthcare workers from needlestick injuries and spread of blood-borne pathogens. Infection control practices are developed and monitored at health care facilities, by accrediting organizations, and by states. Some states assess penalties for placing infectious waste materials into regular solid waste systems. These policies and regulations protect workers, patients, and communities.
WHO created the first comprehensive global publication to address the hazards and control of medical waste in 1999 and has since updated the information. The document addresses how countries can create regulations, improve planning, and minimize waste. It also suggests strategies for handling medical waste, such as how best to store, transport, and dispose of materials.
Developing and adhering to proper controls of medical waste can help prevent threats to public health and safety. These threats might come in the form of infections that spread through blood-borne pathogens or because of health risks introduced by environmental exposure to medical waste products and toxins. Prevention includes proper management practices and knowing how to respond should an unexpected exposure occur. Proper management means that healthcare workers follow infection control policies and procedures promoted by their facilities and all regulations regarding infection control and medical waste management that are enforced by their states.
WHO asserts that awareness and training are the first steps toward creating change in many countries. The organization offers countries and facilities publications to help guide them in safe medical waste management on a daily basis or in emergencies.
See also Disease outbreaks ; Flu pandemic ; Hazardous waste ; HIV/AIDS ; Occupational Safety and Health Administration .
Centers for Disease Control and Prevention. “Biologic and Infectious Waste.” http://www.cdc.gov/nceh/ehs/etp/biological.htm (accessed September 24, 2012).
Greenpeace International. “Alternatives to Incineration.” http://www.greenpeace.org/international/en/campaigns/toxics/incineration/alternatives-to-incineration/ (accessed September 25, 2012).
HealthCare Waste Management. “The 10 Categories of HCRW.” http://www.healthcarewaste.org/basics/categories/ (accessed September 25, 2012).
Miami Herald. “Medical Waste Washes Ashore in Ormond Beach.” http://www.miamiherald.com/2012/09/15/3004081/medical-waste-washes-ashore-in.html (accessed September 25, 2012).
Teresa G. Odle