Apart from hospitals, our medical and related waste comes from a weird array of organizations.
Dentists, veterinary clinics, juvenile correctional centres, police cells, jails, local health centres, hospital linen cleaning businesses, plastic surgeons, brothels, funeral parlours, home health carers, tattooists, nursing homes, universities, needle exchange programs, pathologists, acupuncturists all produce this waste.
The definition of medical and related waste is a bit technical. Nevertheless here it is: any waste generated by pathological or microbiological procedures on humans or animals, whether for medical, research or cosmetic reasons.
It ranges from the obvious to the peculiar. There are limbs, operating sheets, swabs, bloodied bandages, syringes and used medicines; as well as amalgam and dental fillings; radioactive urine, linen, paper cups and plastic spoons.
The administrative problems swirling around medical waste are complex and bewildering for the many organisations all over the world faced with the task of getting rid of it. Australia's Sydney Water organisation is fairly typical.
Consider for instance hospitals which provide radioiodine treatment for thyroid cancer. The waste problem caused by this is well...rather unexpected.
Radioiodine is a nuclear medicine taken orally with a half-life of just over eight days. Therefore during treatment friends and staff must have limited contact with patients who are...slightly radioactive .
As is happens however thyroid patients, like everyone else in the world, need to go to the toilet. But unfortunately their waste is radioactive. This therefore raises the problem of what to do with their faeces and urine….
This is an engineering problem. Apart from being distanced from other people, thyroid patients must also have their personal waste separated from everybody else’s urine and faeces.
In Sydney, this toilet waste is flushed down into a special storage container where it sits until its radioactive half-life falls to an acceptable level. At that stage it is let out into the Sydney Water sewer system.
Medical and related waste is a confusing business. The simplest part of its story is where it ends up. Most of it is either incinerated or land filled
It’s the “getting there” that’s complicated. In Sydney all of the waste is colour coded into different bags and bins. There’s red, yellow, white and purple waste.
Red waste is radioactive. It goes into a red bag and then into a steel container. It’s then placed into storage where it waits until its radioactivity reduces to a level where it can be landfilled. If its radioactive half-life is too high, it is categorized as low level or medium level waste.
Since Australia has no near surface radio active waste dumps, this low level and medium level waste is kept often at a Defense site or other government run site. There are about such 100 sites in Australia.
Yellow bags and bins are for clinical and infectious waste. This is the biggest stream. It includes most needles, blades and other sharps. These are placed into containers and then incinerated. Clinical waste also includes human and animal body parts (recognizable and unrecognizable), blood, fluids, used condoms, incontinence pads, contaminated tubes, plastics, gloves, laboratory cultures and disposables. Basically anything which might be infectious.
Solid recognizable body parts are placed in yellow bags and bins and normally taken straight to incinerators or crematoriums. But this does not always happen. Sometimes patients or families ask to keep a limb or organ so that a body is “whole” when it is buried or cremated. Researchers and medical schools are also quite interested in gaining body parts.
The rest of the clinical waste is also placed into yellow bags, two thirds full, with the air gently squeezed out and then into yellow bins. These bins are then collected and if need be refrigerated until ready for collection by contractors and taken for incineration.
Unrecognisable body parts, bandages, operating theatre gowns and the like are then normally sterililized. Although they can be macerated or ground into pieces. They are then incinerated. Less usually they are dumped in landfill. (This is because although landfill dumping is about a quarter of the price of incineration, it is somewhat frowned upon as it involves trucks and earthmovers dumping, digging and bulldozing things. Not to mention flocks of ibises scavenging about the place.)
In Sydney, liquid clinical waste such as blood, urine and other body fluids is sometimes poured straight into the sewerage where Sydney Water must once again deal with problem. This happens if there is not much liquid waste, money is a problem or nobody seems to care.
But this cannot happen with cytotoxic waste. All cytotoxic waste, whether liquid or solid, must always be incinerated. It must first go into purple bags and then into purple bins. Cytotoxic waste contains toxins. The most common cytotoxic wastes are chemotherapy drugs, containers, gowns, sharps and materials.
Pharmaceutical waste must also be incinerated. If it is a controllable drug such as morphine or an illicit drug it must be incinerated in the presence of police. Drugs can never be flushed down sewers. The bags are logged and recorded.
During incineration, whether for clinical, cytotoxic or pharmaceutical, about 90 percent of waste is transformed into a mixture of carbon dioxide and moisture. The remaining ten per cent is ash which is sent to landfill.
The white bag is for the standard general waste. This waste should not contain any medical waste.
One other small but potent waste types are the amalgams, commonly used in dental fillings. These may contain mercury, gold, silver, copper and palladium. Incineration of mercury amalgams causes toxic emissions, something which often happens during funeral cremations. Amalgams are therefore sent to precious metals recyclers.
Finally there’s that part of the industry which is completely unmonitored and it’s growing… rapidly. It’s the home health care industry.
Currently in NSW, Australia home health care is guided by a code which “urges” “enables” “recommends” and “encourages” home carers to properly dispose of waste.
Carers are given guidance by hospitals on how to develop a safe waste management plan. But in reality, how a carer gets rid of needles, tubing, pads, and drugs is completely unmonitored. Instead it is all left to the overwrought, tired conscience of the home carer.
Consequently this home medical and hazardous waste is often tossed into the general household bin; just like band-aids, used condoms, nappies, sanitary pads and even pills (which are supposed to be taken to chemists for disposal)
Sometimes a concerned carer will try to minimise needle stick injuries by pushing needles into a plastic bottle. Unfortunately these bottles are crushed and broken apart by the compacting trucks which pick up household rubbish. This means waste workers run the risk of being jabbed by filthy, contaminated syringes.
http://www.wmaa.asn.au/uploads/documents/ClinicalWasteCodeofPractice%285thEdition%29.pdf