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Implementing the medical waste air toxics regulations in New York State: a case study.

Over the past several years, the subject of air toxics has received a great deal of public attention. Starting with the Right-To-Know requirements imposed on industry under Title III of the Superfund Amendments and Reauthorization Act of 1986 and continuing with the Clean Air Act Amendments of 1990, the regulatory atmosphere governing quantification and, ultimately, control of these pollutants has never been more complex. In addition to the significant costs that these regulations have had and will continue to have on industry, public awareness and participation in the industrial community has also increased. This has led to a symbiotic relationship; one, however, that is sometimes strained. Although the public generally agrees with every attempt taken to reduce toxic air pollutant emissions, the NIMBY (Not In My Backyard) syndrome has become so widespread, that it often prevents an environmentally beneficial project from being realized. For example, the creation of regional medical waste incineration facilities, many of which propose state-of-the-art air pollution control equipment, has been met with much opposition from public interest groups. As a result, older, less efficient, facilities continue to operate, exacerbating today's air pollution problems. The implementation of more stringent air pollution regulations, such as Part 219-3, will force these older facilities to evaluate expensive retrofit options or find alternate methods of disposing of their medical waste. For many smaller facilities, where expensive air pollution control equipment would be cost prohibitive, the only alternative is to find another facility that has excess capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollution↗

What happens to expired medications? A survey of community medication disposal.

Improperly disposed-of expired medications pose a significant risk to children. To determine how expired medications are disposed of, 500 callers to our poison information center, 100 community and hospital pharmacies, the state Boards of Pharmacy, and the FDA and EPA were surveyed about medication disposal habits. Of the 500 people polled, 1.4% returned medications to a pharmacy, 54% disposed of medications in the garbage, 35.4% flushed medications down the toilet or sink, 7.2% did not dispose of medications, and 2% related they used all medications before expiration. Of the 100 pharmacies surveyed, all but 3% had specific policies on the disposal of undispensed expired medications, which were usually returned to the producer. Alternative disposal means used for nonreturnable medications were incineration (15%), hazardous waste disposal contracts (17%), and conventional solid waste disposal or down the toilet (68%). Only 5% of the 100 pharmacies had consistent recommendations for their customers on drug disposal; 25% of the pharmacies indicated questions on drug disposal were handled by individual pharmacists only upon consumer request. A variety of drug disposal techniques were encountered in our survey. Pharmacies had specific policies for expired undispensed pharmaceuticals, but lacked uniform guidelines. Little information on the safe disposal of medications was routinely passed on to the public. Uniform guidelines need to be created for the safe disposal of expired medications and should be included in routine consumer education provided by poison information centers and pharmacies.

Data Collection↗

Contact with hospital syringes containing body fluids. Implications for medical waste management regulation.

OBJECTIVE: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes. MATERIAL AND METHODS: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (i.v.) tubes, and d) for intramuscular (i.m.), subcutaneous (s.c.), or intradermic (ID) injections. RESULTS: A total of 7,157 plastic disposable syringes was used; 1,227 (17%) contained blood during use, 346 (4.8%), other body fluids, 5,257 (73%) were used exclusively for drug dilution and application in plastic i.v. lines, and 327 (4.5%) were utilized for i.m., s.c., or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law. CONCLUSIONS: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Body Fluids↗

[The federal communicable disease law and refuse disposal from hospitals and medical practices].

Several laws and guidelines on the disposal of waste from hospitals and practice differentiate between diverse types of waste. The LAGA instruction sheet lists five types: type A = hospital waste, type B = medical waste, type C = infectious waste, type D = chemical waste, and type E = human pathological material. Especially the basis of differentiation between medical and infectious waste is the list of notifiable infectious diseases according to section 3 of the Federal Law on Epidemic diseases. Section 10a confines the list to contagious infectious diseases. However, some tropical epidemics and endemic infectious diseases are not taken into account. On the other hand, the list includes a few harmless childhood and other diseases. There is not scientific evidence that wastes of this kind have led to infections in the community. Therefore, the Federal Law on Epidemic Diseases does not seem to be a suitable basis for the differentiation between medical and regulated medical wastes.

Communicable Disease Control↗

Medical waste autoclaves: not just a lot of hot air.

Over the past ten years, the treatment of medical waste has received much attention. During this time, an entire new industry to develop "alternate medical waste treatment technologies" has emerged. Much of this has been in response to increasingly stringent air quality standards along with public sentiment opposed to incineration, with a resultant decline in the use of on-site medical waste incinerators. However, in between incinerators and alternative treatment systems is a technology that is as much a part of American healthcare as hospitals themselves. Medical waste regulation in all fifty states recognize steam sterilization as an acceptable method of treatment prior to disposal. Within this category of medical waste treatment technology, there is a wide array of systems available, many of which have altered the basic, simple principles of steam treatment to make it more conducive to this application. This Professional Development Series reviews some the basic and newer innovative techniques of steam treatment of medical waste.

Cross Infection↗

PFGE-based epidemiological study of an outbreak of Candida tropicalis candiduria: the importance of medical waste as a reservoir of nosocomial infection.

Between November 2002 and March 2003, an outbreak of candiduria occurred in the surgical intensive care unit (SICU) of a university-affiliated hospital in South Korea. This outbreak affected 34 patients and was caused by Candida tropicalis. To determine the source of the epidemic and the risk factors, surveillance cultures from the SICU, genotyping of Candida isolates by pulsed-field gel electrophoresis (PFGE), and a case-control study were performed. The surveillance cultures revealed that 6 environmental samples related to the urine disposal route were positive for C. tropicalis. The PFGE analysis of genomic DNA demonstrated identical band patterns for all of the C. tropicalis isolates obtained from SICU patients and the 6 environmental samples during the outbreak period, while epidemiologically unrelated strains showed unique PFGE band patterns. Although no risk factors were identified by the case-control study, this epidemiological investigation involving the use of molecular techniques suggests that improper disposal of infectious medical waste led to the cross-transmission of a single clone that was responsible for the outbreak of C. tropicalis candiduria in this SICU. After implementing a better urine disposal system and thorough hand washing procedures, no further clusters of candiduria were detected in the SICU.

Candida tropicalis↗