It was an extraordinary summer, and not only for the ferocity with which it wrung sweat from our hides.
Summer, 1988, was notable also for its assaults on the psyche of the beachgoer. First tans became unfashionable, then the country`s Eastern beaches seemed to have transmogrified: from sunny sandboxes into minefields of medical detritus, once-placid landscapes suddenly sprinkled with syringes, blood samples, even colostomy bags.
Uproar over the uninvited medical waste-which closed beaches from Massachusetts to North Carolina, on Lake Erie in Cleveland and just last weekend on Lake Michigan near Pentwater, Mich., across the lake from Sheboygan-came fast and loud. As quickly as you could say, ”Back to the car, kids,” new laws regarding the disposal of such waste were in the works, laws that are percolating in Congress now.
The summer of the beachgoing syringes served to spotlight a small and specialized pile amid the huge mound that is the nation`s growing waste-disposal dilemma. This pile-infectious medical waste-is regulated by an inconsistent but increasing assortment of state laws, and what seems likely to come out of the summer, some experts say, is some sort of national regulation of medical waste disposal.
Still, the evidence is strong that the fuss is fueled by a perception of danger that is far greater than any real danger, especially to the public at large. That perception is best expressed in the four-letter acronym AIDS.
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”It`s an issue of FRAIDS, fear of AIDS,” says David Lane, marketing director for Precision Energy Systems. Precision, a young company
headquartered in an industrial park in west suburban Lombard, watched the summer`s furor with more than passing interest. All of a sudden, its trade, once practically unknown to the general public, was on and in the news almost daily.
Its name notwithstanding, the major business of Precision is medical waste. For a fee, the company picks up the potentially infectious trash of hospitals, physicians` offices and health clinics, among others, seals it in the back of a truck and ships it to, in most cases, an incinerator in South Carolina.
Illinois began regulating hospital wastes in 1981, says Precision`s president, Ed Juracek. Though he has since come to be a national expert in the field, at the time of the new laws, he was working as a mechanical and civil engineer for another company. When nobody in general waste-hauling seemed eager to form a business or adapt an existing one that would help hospitals meet the requirements of the new Illinois law, he did a quick market survey and found a business hole big enough to drive a truck through-literally what he did.
With the AIDS epidemic prompting hospitals to take even more precautions with infectious waste, and with the flurry of public interest in medical waste, business has boomed. In its seven years, the company has grown to four offices-the others are in St. Louis; Valparaiso, Ind.; and Columbus, Ohio-and, with more than 350 clients in the Chicago area, it claims to have in the neighborhood of 90 percent of the area market. It removes more than 1 million pounds of such waste monthly.
Precision finds itself in the right place at the right time and in a market that executives feel is still growing. With Congress and the public now paying serious attention, with no catch-all federal law regulating medical-waste disposal and with no clear definition, even, of what should be treated as infectious waste, many hospitals are expanding their definitions of infectious waste and thus producing more of it than ever before, says Sharon Muraoka, an administrator with the Metropolitan Chicago Health Care Council, which represents about 100 hospitals and health-care groups in the area.
Furthermore, many smaller producers of infectious waste-unregulated under most states` laws-are beginning to adhere voluntarily to the same standards hospitals do, Juracek says.
Another factor apparently affecting the rise in the waste stream is the federal Centers for Disease Control`s ”universal precautions,” issued in August of last year, which suggested in response to AIDS that hospitals should treat all patients as potential carriers. Though not required to do so, some hospitals now are basing their definition of infectious waste on the universal precautions, according to Ray Fligg, facilities vice president at Holy Family Hospital in Des Plaines. Under the broadest interpretation, every patient`s food tray thus might be classified ”infectious.”
From last year to this, for instance, Oak Park`s West Suburban Medical Center has seen its infectious waste rise beyond the capacity of its incinerator. About 6,000 pounds is disposed of at the hospital, and another 3,000 pounds is sent out monthly, according to Rich Long, the center`s engineering manager. Last year the hospital generated about 4,000 pounds monthly, almost all of which could be incinerated.
This year Holy Family will spend more than twice that in 1986 to remove infectious waste, and it expects to spend more than three times the 1986 amount next year, Fligg says. Part of this increase can be attributed to rising incineration fees, along with increased use of disposable items, but the bulk of it, he says, is due to an increase in volume brought about by the hospital`s application of universal precautions to their waste.
”What would happen to a hospital if a regulatory agency came in, said you haven`t done this, this and this,” Fligg asks. ”Instead of face the embarrassment, what does a hospital do, especially in light of no specific legislation? In the end, you grab everything that you believe is possibly dangerous, and there go your costs.”
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It should be remembered that infectious waste is not necessarily infectious, only potentially so. What generally fits the definition includes body parts, scalpels and syringes, blood samples and disease cultures, surgical byproducts and pretty much everything from isolation wards. As the definition broadens, it can also encompass surgical gowns, disposable mattresses, even leftover food from a patient`s plate. A handout Precision gives health-care institutions to help identify potential sources of such waste lists items from virtually every hospital department, though the company counsels a common-sense approach to waste classification.
Most states-and more and more are regulating such waste, even before the incidents this summer-rely on some combination of guidelines put forth by the Environmental Protection Agency, the Centers for Disease Control and the National Institutes of Health. According to one expert, the centers`
guidelines might result in 5 percent of a hospital`s waste being labeled potentially infectious, the EPA`s in 10 percent. And using the universal precautions to define infectious waste might bring the figure up to 80 percent.
Lane cites a bloodstained bandage from the finger of a patient. Although the danger from it is almost surely remote, in some hospitals this is considered infectious waste and automatically goes into a special container. In others, it may go out with the regular trash.
On average, Lane says, a hospital produces about 13 pounds of waste per day per bed, as much as 5 pounds of it infectious. With careful segregation of wastes and good training of workers, that number can be brought down to about 1 1/2 pounds, he says.
On a national level, the EPA estimates that 10 percent to 15 percent of the 3.2 million tons of hospital medical waste generated yearly is infectious. However it is classified, though, hospital medical waste is just a tiny portion-about 2 percent-of the nation`s total trash, currently running at about 160 million tons a year.
”If everybody agrees on nothing else-including the legislators, regulators, haulers and landfill folks-it`s that the lack of clear definition has caused the greatest amount of problems and confusion in this area,” says Jim McLarney, director of the division of health facilities management for the American Hospital Association.
As if further proof of the intense interest in this issue is needed, an Indiana company, makers of a machine that renders infectious waste innocuous, now sends out a press release accompanied by a small plastic bag stuffed with what looks like chunky clothes-drier lint. The release explains that what is inside is medical waste. ”Fear not,” it says. ”Medical SafeTEC has thoroughly decontaminated this waste, and it is safe.”
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There is considerable question as to how profound the dangers are yet almost no debate that the primary danger is at the hospital-worker level, where a blood-borne disease is far more likely to retain its virulence than once it is out in public.
In response to this, in recent months the Occupational Safety and Health Administration has stepped up its monitoring of infectious-disease control in the health-care industry, using adherence to the universal precautions as its standard. ”Anytime we go into a health-care facility, we will include an inspection of their blood-borne-disease program,” says Gary J. Anderson, area director of OSHA. This would include even an inspection of precautions taken at a first-aid station in a factory.
When blood in one of the vials found washed up on a New York beach was found to contain evidence of the AIDS virus, the state health commissioner said the chances of a beachgoer being infected were ”remote,” even if he were to step on the vial and cut a foot, because of the virus` fragility outside the body.
An August, 1987, issue of the Centers for Disease Control`s Morbidity and Mortality Weekly Report says, according to Muraoka, ”there is no epidemiologic evidence to suggest that most hospital waste is any more infective than residential waste” and none that ”it has caused disease as a result of improper disposal.”
Says Muraoka, ”There are a lot of people who feel that the only infectious waste hospitals need to be concerned about is sharps”: needles, scalpels and such.
Several studies, according to an ”environmental backgrounder” released last month by the EPA, have shown that hospital wastes are generally less virulent than even domestic waste, the stuff you keep in your garage for weeks before taking it to the dump.
At the heart of the issue, though, is FRAIDS. People read about the horrors of AIDS and see it on TV, and they know that the disease can be transmitted through hypodermic needles. It is not a great leap in logic to assume that an encounter with a spent syringe lying on a beach could very well be fatal.
”This thing is so emotional,” says McLarney of the American Hospital Association. ”The AIDS disease is so hideous that it distorts the way that most of us think about the hazards of exposure. And even those of us who have been closer to this issue and have a basic understanding of how difficult it is to acquire the disease-we all still react from the gut.
”It`s not only a natural reaction; we should expect it. There are no second chances with AIDS, and so people are just not willing to have someone look him in the eye and say, `Trust me on this one. It`s all right. We can put this bloody bandage in a landfill, and it`s not a hazard.` ”
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Where there is public outcry, there is congressional activity. In late July seven pieces of legislation regarding the issue were before Congress, Lane says.
Whatever the true dangers of infectious waste are, ”federal regulations are inevitable,” says Lane, likely as a part of the federal Resource Conservation and Recovery Act, the congressional authorization of which expires this year.
”The regulations will include cradle-to-grave liability, more than likely,” he says, a system that requires a paper trail of such waste, from creation to the point where it`s rendered innocuous and disposed of or burned. The Senate has passed a bill that would set up a pilot program of this sort for New York, New Jersey and Connecticut, and a companion measure is pending in the House. Illinois mandates such a system already.
Perhaps the strongest bill, sponsored by Rep. Thomas Lukens (D., Ohio), was approved Friday in his Subcommittee on Tourism, Transportation and Hazardous Material. It would create a new subtitle to the aforementioned Resource Act, calling on the EPA to promulgate national regulations for the handling of infectious waste, including a pilot tracking program, and for the agency to provide a clear definition of the term.
Another bill, says Nelson Slavik, chairman of the American Hospital Association`s environmental safety committee and president of a South Bend consulting firm, would place infectious waste under the solid-waste subtitle of the resource act, labeling it a ”nonhazardous waste, specially
regulated.”
Other legislation, Slavik says, scheduled to testify before a Senate environmental committee on the issue next Monday, calls for stricter penalties for those illegally dumping infectious waste in the ocean.
The key bills, though, are those that would establish national regulation, Slavik says. ”As a result of the different bills, the two companions may be merged, scrapped, who knows. There should be one piece of legislation that is emerging as a result of all this.”
He feels this likely will happen before Congress adjourns in October.
Another key issue, Lane says, is who will be covered by new legislation. Illinois, like many states, regulates only hospital infectious wastes, but many smaller generators of infectious waste, such as individual doctors, laboratories and medical clinics, have begun to follow hospital rules, Juracek says.
”What has occurred because of, for instance, what happened in Indiana last year, where some kids got involved with syringes that were thrown out at a clinic, is, a lot of clinics have taken a stand that `We will do it anyway,` ” Juracek says. ”It`s an ethical issue, as well as a liability issue.”
And many landfill operators, as dumping space in Illinois and across the country grows ever more scarce and fear of infectious disease remains high, are rejecting even infectious waste that has been ”autoclaved,” or rendered sterile in an in-hospital device similar to a pressure-cooker, according to Juracek, who teaches the National Safety Council`s courses on infectious and hazardous hospital waste.
The Du Page County Forest Preserve District, which owns two dumps, has drawn legislation that would more strictly regulate what small-scale producers of such waste and hospitals can dispose of in its landfills, says Dick Utt, the district`s superintendent of government services.
”What we would like to do is get everybody`s awareness that these sharps and blood wastes don`t belong in a landfill,” where workers may be endangered, Utt says. The rules ”will have provisions for penalties and exclusion from the site. If the generator can`t be identified, the trucker will be excluded-so he`s going to notify those people” producing it, he says. The Illinois Pollution Control Board, which writes environmental legislation in the state, according to Harish Rao, a board environmental scientist, is conducting a survey to find out what type of waste hospitals produce and where it goes, so that it will have accurate information in case it decides further regulation is needed. Nothing is in the works now, though, he says.
Nationwide, a Council of State Governments survey, the results of which were released in May, reported that 10 states have amended their infectious-waste regulations since 1985 and that a change is in process in another 25. It found that ”88 percent of the states, compared to 57 percent of the states in 1986, are or will soon be regulating infectious wastes.”
No matter how tight the regulations eventually do get, and no matter whom they include, says Robin Woods, a spokeswoman for the EPA, one problem likely will remain:
”You can set up the most elaborate and comprehensive system in the world,” she says, ”but that won`t necessarily preclude illegal dumping.”
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To its clients, Precision sells special, thick-walled cardboard containers for storing the wastes, the plastic containers into which used sharps are deposited, as well as the red trash bags that are a standard symbol denoting such waste.
Even the seeming simplicity of a color-coded bag has proved troublesome when it comes to infectious waste, however. Around Christmastime last year, Neiman-Marcus, the perennially precious department store, made available to its clientele, at $6.25 for 20, bright red trash bags bearing the store`s logo.
Shoppers bought and dutifully filled the bags with torn wrapping paper, boxes, bows, bangles-whatever the holiday mood inspired them to jettison-and, it can be assumed, placed them in the trash.
This ostentatious dumpster display caused no end of consternation among waste haulers and dump operators. Now there were conflicting symbols: Instead of, say, a bandage that had covered the open sore of an unhealthy human, a red bag might contain the hand-printed paper that had recently wrapped a hand-carved pony. Some just would not accept the bags.
Neiman`s, when the situation was brought to its corporate attention in January, went out of its way to yank the red bags from the market and donate them to those who could put them to the time-honored use, such as hospital associations. And the company changed its bag hue to surgical-gown green, a soothing color to trash hauler and landfiller alike.
