A Comprehensive Biomedical Waste Survey
Boatright, Daniel T., Edwards, Alicia J., Shaver, Kathleen A., Journal of Environmental Health
The state of Oklahoma, as are all other states, is concerned about the production and management of biomedical waste (BMW). Although the predominant body of scientific literature supports the assertion that the real risk of acquiring an infectious disease through contact with BMW is extremely low, the general population perceives the risk of contracting a disease or illness from these materials to be extremely high (1). State government officials across the nation have responded to public concern by enacting legislation or promulgating regulations to manage the disposal of BMW.
The healthcare delivery system, environmental health practitioners, and the waste management authorities have also become much more sensitive to public concern. From a responsible public and environmental health perspective, it is critical that the response to perceived risk issues be with the same degree of professional concern and attention as any other public health matter. The public has every right to expect that BMW will be managed in an effective, safe, and responsible manner.
This article provides an overview of the development and current regulatory scheme for BMW disposal in Oklahoma and describes the progress toward an improved definition of the BMW stream in terms of sources, quality, quantity, and disposal practices.
The Regulation of Biomedical Waste
Waste disposal management was one of the first environmental health problems faced by man and remains one of the most burdensome. Although legal requirements for the management of solid waste have existed in the United States since before the turn of the century, the federal government has become directly involved only in the last few decades (2). When Congress passed comprehensive waste management legislation in the form of the Resource Conservation and Recovery Act (RCRA) in 1976, the definition of "hazardous waste" encompassed those wastes with infectious characteristics (3). Although a requirement to manage infectious waste was thus established legislatively, such waste was not effectively incorporated into the regulatory system which identified hazardous wastes and established the criteria for disposal practices.
During the 1980s, the public became increasingly alarmed about possible disease transmission due to BMW. Repeated incidents of medical waste washing onto the East and West Coasts and the shores of the Great Lakes, as well as reports of municipal sanitation workers being stuck with needles and then refusing to handle refuse suspected of being generated in the healthcare setting, fueled the escalating fear that HIV (human immunodeficiency virus) could be contracted from exposure to BMW.
Congress responded in 1988 by amending RCRA through the Medical Waste Tracking Act, which instituted a three-year demonstration project designed to support the development of a nationwide model for BMW management (4). The Medical Waste Tracking Act also required that the Agency for Toxic Substances and Disease Registry (ATSDR) study BMW in detail and submit, within two years, a report to Congress on the potential for infection or injury due to managing BMW; the degree to which sharps are implicated annually in the infection or injury of persons involved with BMW; those infected or injured annually by other means of medical waste management; and, for those diseases that may be spread by BMW, an estimate of the fraction of the incidence of those diseases that may be related to BMW.
ATSDR reported some 15 significant conclusions associated with BMW management, and an excellent overview of the ATSDR effort and conclusions is presented by Lichtveld, et al. (1). According to ATSDR, BMW comprises 0.3 % of the solid waste stream. Although the actual risk associated with the management of BMW is recognized to be low, opportunities for the public to interact with these wastes are increasing as in-home and hospice care grows more popular.
Some have charged that the federal government has been slow in acting to improve or enhance the framework for BMW management; however, it must be recognized that, due to the findings of ATSDR and the body of research developed pursuant to identifying the modes of transmission for HIV, BMW represents a low risk area for infectious disease transmission, especially outside the healthcare setting. …