The syringe tide environmental disaster The
syringe tide environmental disaster of 1987–1988 raised awareness about medical waste as medical syringes washed ashore in Connecticut, New Jersey, and New York. The syringes endangered marine species and posed a threat to humans who visited the beach. The crises spurred scientists and lawmakers to create mechanisms, policies, and laws so that health care providers would process their bio-waste in an environmentally friendly way.
Effects of medical waste on the environment Improper management of health care waste can have both direct and indirect health consequences for health personnel, community members and on the environment. Indirect consequences in the form of toxic emissions from inadequate burning of medical waste, or the production of millions of used syringes in a period of three to four weeks from an insufficiently well planned mass immunization campaign. Biomedical waste is not limited to medical instruments; it includes medicine, waste stored in red biohazard bags, and materials used for patient care, such as cotton and bandaids. The most serious effect that biomedical waste has on our seas is the discharge of poisons into the waters that could then be consumed by ocean life creatures. Toxins would interject into the food chain and eventually reach humans who consume sea creatures. Human exposure to such toxins can stunt human growth development and cause birth defects. The high volume of plastic use in the medical field also poses a dangerous threat to the environment. According to North and Halden, 85% of disposable plastic materials make up all medical equipment. Our current reliance on plastic materials is rooted in their unique capabilities to be lightweight, cost-effective, and durable while preserving the sterility of medical equipment. In addition to the serious health implications of releasing harmful toxins in the environment from medical waste deposits, introducing this volume of single-use plastics can catalyze the compounding health detriments caused by macro and
microplastics.
Incineration of biomedical waste Advances in waste treatment technologies, including non-burn systems and high-efficiency incineration, are improving the safe disposal of pharmaceutical waste while reducing environmental impact. According to the World Health Organization, non-burn treatment methods can reduce harmful emissions by up to 95%, while advanced incineration systems can achieve pathogen destruction efficiencies of 99.99%.
Methods of biomedical waste incineration The three type of medical waste incinerators are controlled air, excess air, and
rotary kiln. Controlled air is also known as starved-air incineration, two-stage incineration, or modular combustion. This is the process of which waste is fed to a combustion chamber and combustion air begins to dry and facilitates volatilization of the waste. As a result,
carbon dioxide and other excess gases are released into the atmosphere. The second type of incineration is the excess air process. This is similar to the controlled air process, such as the waste being dried, ignited, and combusted by heat provided by the primary chamber burner. However, the main difference is that moisture and volatile components in the waste are vaporized. In a rotary kiln, the process is similar to the two mention above, however, it is more versatile in terms of being able to mix wet and dry waste components and viewed by many waste engineers as being the most environmentally friendly.
Impact on the environment Post incineration process, toxic
ash residue is produced and is often disposed at
landfills. These landfills are not protected by any barrier and the residue has the potential of reaching
underground water that is often exposed to human use. The combustion of
plastic material releases toxic gases that escapes and joins breathable air. Human and animal
exposure to such gases can cause long term breathing and health issues. The rotation of toxic air does not only impact human well-being, but also of animals and plants.
Air pollution caused by the incinerators depletes the
ozone layer, causes crop and forest damage, and increases the effects of
climate change. Constant exposure to such toxins and chemicals in the air could be deemed detrimental to trees and plants and could eventually lead to extinction of certain plants in specific areas. Pollution and chemical leaks also affect the fruits of trees and would cause them to be poisonous and therefore inedible.
Environmental waste in California Medical waste management program California created the
Medical Waste Management Program, which regulates the generation, handling, storage, treatment, and disposal of medical waste by providing oversight for the implementation of the Medical Waste Management Act. Precautions have been taken in California which permits and inspects all medical waste offsite treatment facilities and medical waste transfer stations. In order to dispose waste, the department recommends the following process to make
controlled substance waste non-retrievable. Pills containing a controlled substance are crushed before placing the residue into a pharmaceutical waste container. Controlled substance that is remaining in a syringe is wasted into a pharmaceutical waste container before disposing of the syringe in a
sharps container. Expired medications should be returned through a reverse distributor.
Environmentally friendly alternatives Reusable RMW or sharps containers reduce the amount of plastic sent to landfills and emissions. Non-incineration treatment includes four basic processes: thermal, chemical, irradiative, and biological. The main purpose of the treatment technology is to
decontaminate waste by destroying
pathogens. Modern technology invented mechanics that would allow medical professionals and hospitals to dispose medical waste in an environmentally friendly way, such as
autoclaving,
plasma pyrolysis,
gasification, chemical methods, and
microwave irradiation. These alternatives are also highly versatile and can be used for all different types of waste. An autoclave, similar to a pressure cooker, uses high-temperature steam to penetrate waste material and kill micro-organisms. Autoclave treatment has been recommended for microbiology and biotechnology waste, waste sharps, soiled and solid wastes. Microwave irradiation is based on the principle of generation of high-frequency waves. These waves cause the particles within the waste material to vibrate, generating heat and killing the pathogens from within. A simple yet effective method is
chemical disinfection: 1%
hypochlorite can kill thriving bacteria. Plasma pyrolysis is an environment-friendly mechanism, which converts organic waste into commercially useful byproducts. The intense heat generated by the plasma enables it to dispose all types of waste including
municipal solid waste, biomedical waste and
hazardous waste in a safe and reliable manner. Gasification can offer
carbon sequestration and energy generation, reducing the carbon footprint of biomedical waste treatment. Additionally, to further minimize the carbon footprint of medical waste, especially in ORs, one-time use instruments can be replaced with reusable ones like ports, graspers, forceps, suction and irrigation tools, basic open instruments, and more.
Other possible solutions Significant strides may be made relatively quickly if the focus shifts towards surgical subspecialties and their involvement in generated medical waste. Surgical specialties in particular have focused on infection control and thus have implemented single-use operative tools in their practices. One example of this can be seen within the practice of gastroenterology, where each endoscopy alone in the U.S. generates approximately 2.1 kg of disposable waste, of which 64% of the waste ended up in landfills. Thankfully, it appears that surgeons across the U.S. have agreed that their practice generates a high amount of waste and that a change needs to be implemented. A multi-center survey of 219 U.S. surgeons showed that 90% of them agreed strongly that waste of sterile surgical items is an issue and moreover, 95% of them agreed to a willingness to change their operating room workflow to reduce waste. Another focus that proves to be effective is reform around the policies that surround "red bag waste." Separation of medical waste is typically done via these bags and a narrative review out of U.S. operating rooms found that 90% of red bag waste, or the items found in the red waste bags, did not actually meet the criteria for pathologic or infectious waste. Initiative from corporations and hospitals is essential to creating a healthier environment, however, there are various methods in which involves action from the general population and would contribute to a clean air environment. By creating surveillance groups within hospitals, everyone would be held accountable for misconduct and improper disposal of waste. Consequences could be implemented where individuals would be required to pay a fine, or face unpaid suspension from work. Companies and governmental organization should also initiate non-routine checkups and searches, this would place pressure on hospitals to ensure that waste is properly disposed all year round. Voluntary clean-ups would involve hospital staff in assuring that medical waste is not littered around the hospital or thrown into regular garbage bins. Because hospitals, specifically ORs, generate the most medical waste in the healthcare industry, it is crucial for ORs to work towards developing sustainable initiatives. Items used in the operating room that cannot be reused in subsequent surgeries can be repurposed through donations to the community. For example, plastic trays and surgical gowns can be given to art classes, towels to cleaning initiatives, and foam packing to moving companies. Repurposing was taken to the next level by a warehouse called Donations In Kind, run by the Rotary Club, as it takes in repurposed medical supplies from ORs to provide support for hospitals and communities in developing nations. This warehouse is just one of 24 taking on this initiative. ==See also==