Healing the Harm:
What's Wrong With Incineration Of Medical Wastes 

MARK J. HUFF and PETER deFUR
Virginia Commonwealth University- Center for Environmental Studies
(undated)

Medical waste came into the public spotlight in the late 1980's, when used syringes and other hazardous solid waste turned up on the beaches of New Jersey. Public concern and outcry arose over why this waste found its way into the lives of the public. Both the public and elected officials raised concerns regarding the disposal practices that permitted such waste to turn up anywhere. In quick response, new regulations and requirements were developed for the handling and treatment of the medical waste stream. Although these regulations calmed the public, medical facilities were left with trying to comply with new requirements. These new requirements focused on preventing contact between the public and infectious waste and, as a result, many facilities chose to put much, if not all, their waste into incinerators. This strategy was not only a quick and easy decision for them, it also significantly reduced their waste volume going to landfills, seemingly saving money. Thus, the waste was completely sterilized, the volume reduced, the syringes kept off the beaches, and the public was satisfied.

Unfortunately, incineration is not a clean process. Emissions of heavy metals and organic pollutants from these facilities cause significant environmental harm. The chief environmental contaminants of concern in the emissions are mercury and dioxin. Mercury results from the disposal of metallic material (e.g. small equipment, supplies, etc.) containing mercury, or paints and coatings containing mercury. The dioxin in the emissions is formed from organic material, mostly plastic, reacting at a high temperature with chlorinated material (such as PVC plastic) or chlorine in another form (liquid bleach). Certain conditions in the incineration — high temperature, organic matter, source of chlorine, metals to act as chemical catalysts — make for an ideal environment for dioxin formation.

Medical waste incinerators (MWIs) have been identified as a major contributor of dioxin to the environment. The increasing use of chlorinated plastics, particularly PVC, in medical products may play a role in MWIs' position as a top dioxin emitter. The dioxins present in the emissions of medical waste incinerators have been shown to be threats to both human health and the environment. Among the list of dioxins being released are dioxin-like PCB's, chlorinated dioxins and chlorinated furans, all shown to effect the endocrine systems of humans and animals. These endocrine disrupting chemicals accumulate in the environment, in wildlife and our bodies and reside there resulting in a continued accumulation.

There has been great debate over the total output of dioxins by MWIs. The fact that most of the nation's 2400 medical waste incinerators employ little to no pollution controls, ensures the dioxin produced is going to be deposited into the environment via the smokestack. The sheer number of medical waste incinerators and the increased volume of medical waste being produced demands regulation. Alternative disposal practices are necessary in order to protect the public health and the environment, not to mention meet regulatory requirements.

Considerable time and energy has been spent developing and engineering alternatives to medical waste incineration. The nature of infectious "red bag" waste requires it to be treated as hazardous waste. Many facilities have decided one way to eliminate the hazardous nature of the waste is to burn it. Until recently, this has been the sole solution for infectious waste in hospitals across the country. Unfortunately, many hospitals with MWIs burn not only their infectious waste, but their entire waste stream. Escalating costs along with the human health and environmental damage from MWI emissions and ash provide the incentive and motivation for developing alternatives.

These alternatives have been developed to meet the economic and environmental demands of society. All represent different approaches to addressing the need for safe disposal of medical waste and mane seek to eliminate dioxin, mercury and other toxic emissions which impact our environment. But alternative technology development is just beginning. It needs to be implemented more widely and promoted through regulation and legislation — the traditional means by which agencies and companies deal with waste technologies. Without the proper regulations in place, the need for the new technologies diminishes. Despite the continued release of dioxin from medical waste incinerators, most hospitals continue to rely on them unless alternatives are provided. The technologies exist, and can meet the demands of almost all facilities — and in many cases, in a more cost effective manner. Therefore, without the implementation of new regulations concerning the emission standards of these medical waste incinerators, dioxin and mercury will continue to harm the environment.

Although technology can improve the situation and is often seen as the answer to our problems, we can not forget the importance of the three R's: Reduce, Reuse, and Recycle. There has never been a reason to solve a problem that could be avoided in the first place. While alternative technology is extremely important in helping to solve this waste crisis, we must remember this problem evolved from technology.

The most effective method for dealing with medical waste is to apply the three R's in a toxics use reduction program. First, the materials that come into the hospital must be screened and evaluated for their innate toxicity and disposal requirements. Materials should not have some hidden problem such as an ingredient which is an endocrine disruptor. Whenever possible, reusable products should have priority over disposable ones. Next, if a material is not reusable, staff should investigate whether the product and/or its packaging can be recycled. Materials sent to waste disposal systems need to be true "waste" and not materials that could or should be reused or recycled. Lastly, the waste treatment method should not create toxic compounds or release pollution into the environment.

Medical waste treatment technologies all seek to disinfect or sterilize the waste, and put the remaining waste in a landfill. A variety of methods are used to achieve disinfection. Heat of some sort can be used to sterilize and/or reduce the volume of waste. Chemical sterilization has been used in some systems, but presents the problem of completely treating the waste. These technologies also use toxic chemicals, which present worker safety and environmental hazards. 

Besides heat, other forms of energy such as microwaves have been tried for sterilization, but these are primarily variations on the same idea. Volume reduction is largely accomplished in disposal systems be some form of burning or other chemical treatment (burning is really a chemical process). Shredding the waste reduces the apparent volume, but not the weight of the waste — the total amount of waste remains basically the same. The remaining material, whether ash, sterilized waste from a heat processing system (pressurized steam heat used in an autoclave) or the chemically treated waste, must then be removed to a landfill. There are presently no known alternatives to land-filling the final waste; something must be landfilled. One goal is minimizing the amount (weight and volume) of waste that goes into the landfill.

Various alternative technologies have been developed to sterilize and reduce the volume of medical waste. A list of some of these alternative technologies follows. All of these should be independently evaluated for safety and effectiveness. Any medical waste treatment technology approved by a state or federal agency should be subject to stringent regulations which have been developed With worker safety, public health and environmental considerations in mind. More information is available from specific industrial groups and companies that make or develop alternative technologies. In addition, EPA has several efforts to provide information on alternative technologies.