Part 1: Are You Throwing Away Money with Your Waste Removal Practices?

Part One of Two
By David Guy

Hospitals produce three primary waste streams: municipal solid waste (MSW); regulated medical waste (RMW); and Resource Conservation and Recovery Act (RCRA) waste, which is hazardous waste. Each of these comes with escalating prices for proper disposal. Prices per pound range from $0.03 to $0.05 for MSW, $0.20 to $0.50 for RMW and $1.70 to $2.00 for RCRA waste, according to Practice GreenHealth. With increasing demand to do more with less, facility managers are evaluating how to control costs and comply with sustainability directives. Since, according to the Healthcare Environment Resource Center, many hospitals routinely throw from 50 to 70 percent of their waste into the RMW stream, the identification of cost-containment solutions is of great importance.

Up until 1995, most hospitals treated their regulated medical waste, whether onsite or offsite, through incineration. However, in the mid-1990s, new Environmental Protection Agency regulations placed air quality restrictions on hospital incinerators because of the harmful emissions released in the air. The cost to upgrade and maintain the incinerators so they would be fully compliant with the new regulations became uneconomical. The Clean Air Act changed the paradigm of how RMW should be handled; incineration was no longer going to be the standard operating procedure for destroying waste.

As incinerators closed, regional hauling services and manufacturing companies began to offer alternative solutions by either opening special permitted landfills or introducing autoclave technology. Today, an estimated 1.6 billion pounds of treated and untreated RMW is dumped into landfills in the United States each year. Most of it has been hauled and autoclaved offsite with only a small percentage ground to an unrecognizable, OSHA-compliant municipal waste state.

Responsible Disposal

Disposing of RMW is much more expensive than disposing of municipal waste. Added to the risk and expense is the cradle-to-grave responsibility hospitals bear for the proper disposal of and regulatory compliance for medical waste.

In recent years several federal agencies, including the Centers for Disease Control and Prevention, the Federal Emergency Management Agency, the Department of Homeland Security, the Joint Commission and Veterans Affairs, have taken a more in-depth view of operational sustainability and environmental stewardship relating to hospital waste, with the Joint Commission requiring healthcare facilities to be self-sufficient for 96 hours.

Pandemics events such as H1N1, terrorist attacks, and severe weather such as Hurricanes Katrina and Sandy or recent historic ice storms have highlighted the need for hospitals to be operationally prepared for unexpected extreme conditions and reductions in available staffing. Hospitals, which rely on service providers to keep pace when the unexpected happens, are becoming more demanding of their vendors to ensure that support will be available when needed. Hospital space is at a premium already, and finding an area to safely store the RMW during disasters until pickups can resume becomes a critical issue. Every hospital needs a pandemic preparedness plan, according to the Healthcare Coalition for Emergency Preparedness.

Onsite Options

During his testimony in a congressional hearing on emergency preparedness, Darrell Henry, executive director of the Healthcare Coalition for Emergency Preparedness, commented, “[V]arious reports by health officials and other experts have recognized that onsite medical waste treatment is the best practice for emergency preparedness and pandemic response … Expenditure for onsite treatment of infectious waste is perhaps the only preparedness tool that would pay for itself from the day of installation, as this equipment often produces a return on investment, a payback between 18 and 36 months.”

There are several options for onsite processing. Our company’s onsite processing, with a system that simultaneously macerates and sterilizes RMW while reducing the volume of waste up to 90 percent, rendering the output safe municipal waste, has captured the interest of healthcare providers around the world. The combination of onsite volume reduction and sterilization in one processing step ensures daily regulatory compliance while also preparing the facility for any pandemic event. Other companies do it in two steps, and many more just autoclave their waste and dump it in the landfill.


Sustainability also relates to environmental impact. With more than a billion pounds of RMW sent to landfills each year, a more innovative and environmentally friendly solution is needed.

Sustainability has moved beyond being a buzzword in board meetings to being implemented through newly created sustainability director positions and programs. As an example, VA hospitals are now required by Executive Order 13514 to reduce their carbon footprint while increasing renewable energy sources. The American Hospital Association (which includes 6,500 hospitals) has created a Sustainability Roadmap to help provide tools to establish a baseline for the carbon footprint of each facility, and has reached out to industry partners to share or develop tools to help facilities perform self-assessments.

The technology to transition hospitals toward self-reliance and becoming good corporate citizens through environmental stewardship is available today. Even in an environment where hospitals have to do more with less staff and smaller budgets, onsite technology is able to provide sustainability and financial benefits.

The onsite processing technology is available and proven, and the benefits for both pandemic and environmental sustainability already are well-known. In part two of this series we will examine the barriers to higher rates of adoption and how to implement these improved practices in healthcare organizations.