Wisconsin hospitals manage medical waste in accord with Wisconsin Department of Natural Resources regulations.

Voluntary organizations, like Hospitals for a Healthy Environment, educate healthcare facilities about pollution prevention in hospitals.

Listen to Marge McFarlane describe ways that Sacred Heart Hospital has reduced waste generation.

Listen to Barb Derflinger talk about how the DNR oversees medical waste reduction.

E-mail Andrew Haak with questions or comments on this story.

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Hospital waste separated, shipped to treatment centers

Certain producers of waste, like healthcare facilities, cannot safely throw everything in common trash cans.  Sacred Heart Hospital, 900 W. Clairemont Ave., generates four types of waste, including infectious waste, hazardous chemicals, confidential documents and common trash.  Each type is separated from the others and treated differently.

Both hazardous chemicals and infectious waste are separated from other garbage and shipped to specialized treatment centers in Eau Claire and St. Paul, Minn.  There, hazardous chemicals are treated and infectious waste is heated to the point of disinfection.

“Everyone benefits from segregating hazards, reducing the hazards as much as possible, and then handling them in a safe and efficient manner,” said Marge McFarlane, the safety coordinator at Sacred Heart Hospital.

In turn, local communities have cleaner ground water, blood-borne pathogens are contained and hospitals are safer for employees and patients.  While the management of medical waste has improved, the Wisconsin Department of Natural Resources is still looking to decrease the amount of medical waste and better the separation of different waste types.

What kinds of medical waste are there?

Some waste, like hazardous and infectious waste, will endanger nearby communities’ water and health if it ends up on land, in drains or in a landfill.  The healthcare industry generates these wastes.

Sacred Heart Hospital creates four classes of waste.  Outside organizations treat the hazardous chemicals and infectious waste, while the hospital manages regular trash, recycling and confidential documents.

Hazardous chemicals are used in medical processes, such as chemotherapy, McFarlane said.  But after use, they are not poured down common drains because sewage plants do not treat them.  If they go down the drain, they pass through sewage plants and contaminate the clean water supply, McFarlane said.  Keeping hazardous chemicals out of drains keeps carcinogenic chemicals, like formaldehyde, and alcohol away from drinking water.

The hazardous chemicals, which are picked up every other month and treated at WRR Environmental Services Co. Inc. in Eau Claire, are kept in 55-gallon drums and a secure storage area.

Infectious waste, on the other hand, is picked up three times a week and endures a lengthier journey to its fate in St. Paul, Minn.

Infectious waste is blood and body fluids, items saturated with blood and body fluids, or sharp items with blood and body fluids on them.  This waste is carefully handled because it can carry hepatitis B and HIV, McFarlane said.

“The moment you make the [infectious] waste, you need to put it directly into the red containers,” McFarlane said.  The red containers are marked with hazardous labels and scattered throughout the hospital so they can easily be accessed.

Rich Wise, assistant team leader of housekeeping at Sacred Heart Hospital, said employees go through an orientation program to familiarize them with the hospital waste.

“The biggest thing we learn is how to not grab sharps,” Wise said.  “That’s a big one because you can get a lot of needle pricks.  The other one is how to handle blood.  You don’t try and handle it twice.”

All employees go through an orientation session so they know what to do with the different hazardous wastes and how to avoid harm, Wise said.

“Training is the biggest thing,” he said.

Separating infectious waste from other types is part of the hospital employees’ job, but fully disposing it is left to other people.

“There are only certain ways you can handle [infectious waste],” McFarlane said.  Sacred Heart Hospital does not have the technology to disinfect the waste, so it is collected and trucked to Stericycle Inc. in St. Paul, Minn.

How are hazardous and infectious wastes treated?

Hazardous waste from Sacred Heart Hospital is transported to WRR Environmental Services in accord with DNR and Department of Transportation regulations.  The chemicals are tracked as they are transferred from their generator to the treatment facility, said Vice President of Operations Support Steve Stokke.

The chemicals are tested upon arrival to see if they can be processed.  Alcohol, which is one of the hospital’s regularly used chemicals, is treated in a distillation column.  But after treatment, residue remains.

The residue can be re-used when it is combined with other substances that will not spark a dangerous reaction.  The right combination creates a supplemental fuel, which can replace virgin fossil fuel, Stokke said.

“We treat everything,” Stokke said.  “Nothing is wasted.”

Infectious waste does not have as promising a future.

Sacred Heart Hospital generated 107,621 pounds of infectious waste in 2003, according to its annual infectious waste report.  This waste is consistently transported to Stericycle in St. Paul, Minn.

Infectious waste travels in lined, leak-resistant containers to comply with DOT regulations, said Kay Sargent, area manager of environmental safety and health at Stericycle.  The containers are sealed so that, in the case of an accident or a container tipping over, nothing would spill.

While chemotherapy waste and pathological waste, which is human or animal tissue, are transferred to Kansas City, Mo., to be incinerated, Stericycle treats items contaminated with blood.  These items could carry hepatitis B or HIV, Sargent said.

Once the infectious waste arrives it is autoclaved, or “literally cooked at over 300 degrees,” Sargent said.  The waste is heated, but not destroyed, for 30 minutes under high pressure, which kills the pathogens in it.  From there, it is compacted and hauled to a segregated, medical landfill.

“We handle and dispose of regulated medical waste in the safest, most compliant manner possible,” Sargent said.

In the case of hazardous and infectious waste, its transport is documented when the waste changes hands and is moved.  While the waste is the generator’s responsibility until it is destroyed, the documentation is proof that a shipment of waste was disposed.

“It’s like a chain of custody,” Stokke said.

What is being done to control medical waste?

In the past, numerous hospitals had on-site incinerators to burn waste and cut transportation costs, said Barb Derflinger, the medical waste coordinator at the DNR.

In the early 1990s the federal government and the state started discussing stricter air pollution rules, which led hundreds of incinerators to close, Derflinger said.  The few that remained were upgraded to better pollution control equipment.

This brought about alternative technologies, like autoclaving, and hiring specialized organizations to get rid of and process waste.

“There’s much less medical waste now than there used to be because people are not mixing other stuff in with it,” Derflinger said.  “And it’s being treated by non-incineration technologies.”

The DNR has also implemented a statewide regulation to reduce the amount of medical waste.

“In Wisconsin there are two ways where we try to keep infectious waste under control,” Derflinger said.  “One is to make sure everyone understands what is and is not infectious waste, so our rules are very clear about that.  The second thing is we require them to reduce it to the minimum.”

Organizations devise a medical waste reduction plan for separating, reducing and managing their waste, evaluating replacements for disposable items and maintaining waste reduction efforts, according to the rule.  They are then required to submit a yearly report to assess the results.

To reduce medical waste, one “should look upstream in the process,” McFarlane said.  “Do you need to use or generate [the waste] in the first place?  That’s how you eliminate waste downstream.  You eliminate waste upstream.”

Sacred Heart Hospital also has technology to purify used chemicals, which gets multiple uses out of what used to be thrown away.

“Now we can re-use it, re-use it and re-use it by reprocessing it here ourselves,” McFarlane said.  “That’s one way we have drastically reduced the amount of chemicals that we use.”

While progress has been made, management of medical waste is not perfect.

“There’s a whole realm of environmental improvements where we’ve used medical waste as a doorway to get into these facilities and start looking at them,” Derflinger said.  “There’s always more to go.”