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20 Medical and Infectious Wastes

Nearly all men die of their medicines, not of their diseases.

Moliere (1622–1672)

20.1 INTRODUCTION

Each year approximately 500,000 tons of regulated medical waste is produced in the United States
by about 375,000 generators. For comparison, about 229,000,000 tons of municipal solid waste
(MSW) is generated annually (see Table 1.3). The majority of medical waste is generated during the
administration of healthcare or research by medical institutions and home healthcare activities. The
institutions generating most of the medical waste include hospitals, laboratories, physicians, den-
tists, veterinarians, long-term healthcare facilities, clinics, blood banks, and funeral homes. The
majority (approximately 77%) of regulated medical waste, however, is generated by hospitals. Most
of the remaining classes of generators produce relatively small quantities ( 23 kg or 50 lb per
month) of regulated medical waste (U.S. EPA et al., 1991). The estimated number of generators in
each of these categories and volumes of waste generated are presented in Table 20.1.
Before 1988, the category of waste labeled “medical waste” received little attention by regula-
tors or the general public. In that year, however, syringes, blood vials, laboratory rats, and other
medical-related debris began washing up on the beaches of the Atlantic coast and Great Lakes. In
1990, medical waste began appearing on West Coast beaches as well. Beaches near San Francisco
and San Diego closed because of potentially dangerous public health conditions. While there was
little chance of this medical detritus causing illness, public fears of possible contact with hepatitis
B and HIV viruses led to a corresponding collapse in local tourist industries. It was subsequently
determined that much of the beach washups consisted of garbage and other debris attributed to mal-
functioning solid waste management systems rather than to illegal dumping. A small portion of the
waste consisted of syringes, medical vials, or other wastes of medical origin. This debris was not
linked to hospitals, but more likely the result of home injections (insulin and medications), drug
users, recreational boaters, cruise ships, and U.S. Navy ships (Lipman, 1992).
Federal agencies with the authority to establish medical and infectious waste regulations such
as the EPA and the Centers for Disease Control often developed guidelines or best management
practices rather than promulgate regulations for managing medical wastes. Before federal regula-
tions for medical wastes were established, state and local authorities regulated most medical waste
issues. Regulations varied from one locality to another and up to 1988, several states had no formal
definition of medical waste. A number of states did not regulate medical and infectious wastes,
thereby allowing hospitals and other medical facilities to dispose all wastes collectively as munici-
pal waste (Lipman, 1992).

20.2 THE MEDICAL WASTE TRACKING ACT

Congress passed House Bill 3515, the Medical Waste Tracking Act (MWTA) in November 1988,
which directed the U.S. EPA to develop protocols for dealing with infectious waste disposal.
The EPA was required to publish an interim final rule for a 2-year demonstration medical waste

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