MARCH 1992, VOL 55, NO 3 -
AORN JOURNAL
Legislation Medical waste: Science vs politics
M
edical waste is an issue of growing concern. The entire topic has spurred debates, with the public, lawmakers, and scientists taking different sides. The public is concerned about dangers to public health, lawmakers respond by introducing demanding legislation, and scientists insist that the waste is not a health risk.
The Medical Waste Tracking Act hen medical debris washed ashore along the East Coast in 1987 and 1988, the public was outraged. Congress responded. It passed the Medical Waste Tracking Act (MWTA) of 1988 as an amendment to the Resource Conservation and Recovery Act (RCRA) of 1976. The law required the Environmental Protection Agency (EPA) to develop a two-year program that involved “cradle to grave” tracking of “medical waste.” The MWTA definition of medical waste includes cultures and stocks of infectious agents and associated biologicals, pathological waste, human blood and blood products, used sharps, whether contaminated or not, contaminated animal carcasses, surgery and autopsy waste, laboratory waste, dialysis waste, discarded medical equipment, and isolation waste. All facilities in participating states (ie, New
York, New Jersey, Connecticut, Rhode Island), as well as Puerto Rico, that produced 50 lb or more of medical waste per month were subject to the provisions of the act. The only exceptions were facilities that treated (ie, “substantially” reduced or eliminated the potential for causing disease) and destroyed (ie, rendered the waste unrecognizable as medical waste) their medical waste on site. The demonstration project was in effect for two years-from June 22, 1989 to June 22, 1991.
Is Tracking Necessary, EfSective ?
T
here has been great debate over the effectiveness and usefulness of the MWTA. First, most hospitals have comprehensive waste management policies, formal training for employees who handle medical waste, and protocols for managing medical waste in compliance with Centers for Disease Control (CDC), Atlanta, guidelines.’ The problem is that increasing amounts of medical waste are coming from nonregulated sources, including inhome health care, illicit IV drug users, and diabetic patients who use needles for insulin injections. Second, for the MWTA, the EPA’s definition of medical waste includes much more waste than CDC and regular EPA guidelines. For example, neither the CDC nor the EPA designates uncontaminated sharps as infectious waste. The CDC also does not include isolation wastes or animal carcasses in its designation of infectious waste. This means that more waste is 855
AORN JOURNAL
being specially treated and tracked than really is necessary. For example, to comply with the law and MWTA’s expanded definition of medical waste, Yale-New Haven (Conn) Hospital had to place 800 additional tons of medical waste in the red bags that identify infectious waste. This additional waste has not been found to be a risk to public health, however.* The “risk” of hepatitis and human immunodeficiency virus (HIV) infection from medical waste is a risk only to people in certain occupations, including nursing, emergency medical service, janitorial, laundry services, and refuse disposal. Third, costs of the program have been astronomical. When it developed requirements for the demonstration project, the EPA estimated that each hospital would have to spend about $3,800 to comply. Yale-New Haven Hospital’s expenditures have far surpassed that e ~ t i m a t e . ~ By 1990, the hospital was spending about $50,000 per month, up from the $9,000 to $12,000 it was spending before the program began. In addition, it spent an additional $108,000 that year for five new full-time employees to handle the waste. In its first interim reports to Congress in May and December 1990, the EPA said the program has helped set standards for medical waste management and increased awareness of different treatment technologies. Indeed, 45 states have regulations that define medical waste, and several use a “chain of custody” for managing it. In addition, since the passage of the MWTA, the definition of medical waste has become more uniform, according to Kristina Meson of the EPA’s Office of Solid Waste. The EPA’s final report was due in September 1991 but is not expected to be released until the fall of 1992.
Legislators Respond
I
n the meantime, several pieces of legislation have been introduced on the federal level regarding medical waste. Rep Jim Saxton (RNJ) introduced HR 1816, which would extend the medical waste tracking program through June 1993. At press time, this bill had 45 856
MARCH 1992, VOL 55, NO 3
cosponsors. It had been referred to the Energy and Commerce Committee, but no hearings had been scheduled. The program was to end June 22, 1991, but because of the proposed legislation, it will continue as is until Congress decides whether it should be extended. This bill may be designed to allow Congress more time to determine how to incorporate the program’s findings into the RCRA reauthorization, which is expected next year. Other major legislation was introduced by Sen Max Baucus (D-Mont). His bill (S 976) includes several amendments to the RCRA of 1976. The amendments include references to definitions, transportation, volume, and toxicity of medical waste. The bill, which has two cosponsors, has been referred to the Senate Committee on Environment and Public Works and the Environmental Protection Subcommittee. Several committee and public hearings have been held, but it had not come out of committee as of the end of January. According to Daniel J. O’Neal, RN, MA, CNAA, assistant director, congressional and agency relations for the American Nurses Association, the bill probably will be rewritten, combined with a new bill, or replaced by a new bill. That new bill may be S 2108, which was introduced by Sen Dave Durenberger (R-Minn) in November 1991. The Medical Waste Management Act of 1991 is intended to ensure “the safe management of wastes generated by hospitals, clinics, laboratories, and other medical facilities,” according to Sen Durenberger. It would replace the MWTA and establish a national policy to encourage the proper collection, handling, treatment, and disposal of medical waste. Sen Durenberger introduced the bill as an amendment to the RCRA because it is “appropriate for the special characteristics of medical waste.” The bill includes a broad definition of medical waste, including infectious agents; pathological waste; biological waste; chemotherapy wastes including IV bags and needles, tubing, vials, gowns, gloves, and masks; blood and items saturated or caked with blood; and used and unused sharps. The bill also includes a
AORN JOURNAL
MARCH 1992, VOL 55,NO 3
Proposed Legislation Regarding Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: status:
Bill: Purpose: Status:
Bill:
858
HR 12 Beaches Environmental Assessment, Closure, and Health Act of 1991 To amend the Federal Water Pollution Control Act and the Coastal Zone Management Act of 1972 to improve the quality of coastal recreation waters In House Subcommittee on Fisheries and Wildlife Conservation and Environment HR 173 Solid Waste Transportation Act To amend the Solid Waste Disposal Act to place certain restrictions on the interstate disposal of solid waste In House Committee on Energy and Commerce HR 215 Research on the Management of Infectious Wastes, Requirement To require the EPA to conduct research on the management of infectious medical waste Referred to House Committee on Energy and Commerce and House Committee on Science, Space, and Technology HR 607 Solid Waste Disposal Act, Amendment To amend the Solid Waste Disposal Act to grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to House Committee on Energy and Commerce HR 724 Hazardous and Solid Waste Management Act of 1991 To amend the Solid Waste Disposal Act to grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to House Committee on Energy and Commerce HR 1816 Medical Waste Tracking Program, Extension To extend the medical waste tracking program through June 1993 In House Committee on Energy and Commerce HR 2398 Hazardous and Additional Waste Export and Import Act of 1991 To prohibit hazardous and additional waste from being exported from and imported into the United States except in compliance with requirements of the act In House Committee on Energy and Commerce and House Committee on Foreign Affairs HR 2861 Protection of Postal Employees and the US Mail from Exposure to Medical Waste, Provision To direct the US postal service to promulgate regulations to protect postal employees and the US mail from exposure to medical waste Referred to House Committee on Post Office and Civil Service HR 2951 Federal Safe Syringe and Needle Promotion Act of 1991
MARCH 1992, VOL 5 5 , NO 3
-
AORN JOURNAL
Federal Medical Waste Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
To prohibit the use of federal funds for syringes and needles that are “not nonreusable” In House Committee on Energy and Commerce HR 3253 Pollution Prevention, Community Recycling, and Incinerator Control Act To establish certain requirements with respect to solid waste and hazardous waste incinerators In House Committee on Energy and Commerce HR 3386 State Solid Waste Management Act To authorize states to regulate the treatment, disposal, and other disposition of solid waste In House Committee on Energy and Commerce HR 3521 Medical Waste Mail Control Act of 1991 To prohibit the mailing of medical waste except in limited circumstances Referred to House Committee on Post Office and Civil Service
S 592 Hazardous and Solid Waste Management Act of 1991 To grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to Senate Committee on Environment and Public Works S 774 State Regulation and Management of Solid Waste Act of 1991 To provide state management of solid waste and to reduce and regulate the interstate transportation of solid waste. Referred to Senate Committee on Environment and Public Works S 976 Resource Conservation and Recovery Amendments of 1991 To amend the RCRA In Senate Committee on Environment and Public Works and Environmental Protection Subcommittee
S 1082 Hazardous and Additional Waste Export and Import Act of 1991 To prohibit hazardous and additional wastes from being exported from and imported into the United States except in compliance with requirements of the act Hearings adjourned by Environmental Protection Subcommittee S 2108 Medical Waste Management Act of 1991 To establish a national policy to encourage the proper collection, handling, treatment, and disposal of medical waste materials In Senate Committee on Environment and Public Works
cr 859
AORN JOURNAL
MARCH 1992, VOL 5 5 , NO 3
detailed management system that includes the following provisions. Medical waste must be segregated and stored in specially designed containers. Any person who transports medical waste off site must register with the EPA and obtain a permit for treatment facilities. Vehicles used to transport medical waste must be identified as such and decontaminated if spillage or leakage occurs. Vehicles must be registered to the transporter, insured for cleanup costs or damages, and inspected by the Department of Transportation. This bill is being considered in the Committee on Environment and Public Works. Many other bills related to medical waste have been introduced in the House and Senate. (See “Proposed Federal Legislation Regarding Medical Waste.”)
Options
A
nother major aspect of medical waste does not involve defining or tracking the waste, but where it should go. In the 1970s, some 20,000 municipal landfills were available for household and other types of waste.4 Nearly 70% of those have been closed, and those that remain are quickly filling up. Instead of contributing to the landfills, most hospitals incinerate 64% to 93% of their medical waste.s Incineration technology handles the infectious and aesthetic concerns of medical waste. Many regulations are placed on incinerators, however, to comply with the Clean Air Act and other environmental concerns. Recent legislation requires the EPA to develop specific regulations for small incinerators used by health care facilities. To meet the regulations, many incinerators will have to be totally renovated or replaced. As yet another option, many hospitals are turning to regional incineration programs. Experts say that one well-run, state-of-the-art incinerator equipped to control air pollution is better than many small incinerators in terms of air quality and cost containment.‘j Others dis862
agree, claiming that sending waste to regional centers increases disposal costs.’ Options seem to be running out. Some solutions to the growing problem of medical waste include reducing the amount of waste by recycling and reusing medical materials and developing new technologies for treating the waste to render it noninfectious. Some believe that hauling waste to rural areas in other states is the best way to handle it. This, however, has resulted in a “not-in-my-backyard” attitude and has prompted states to call for limited interstate waste transportation. Some researchers believe in the scientific method. According to William A. Rutala, PhD, and David J. Weber, MD, If regulatory control were based on epidemiologic and microbiologic data, only two types of medical waste would require special handling and treatment-sharps and microbiologic waste.8 There are many facets to the medical waste issue. Medical waste is a problem, if not because it is a danger to public health, then because disposal options are limited. The problem must be addressed, and a solution must be reached, whether by lawmakers, scientists, or a combination. LAURIE D. CRUZ SENIOR ASSOCIATE EDITOR Notes 1. W A Rutala, R L Odette, G P Samsa, “Management of infectious waste by US hospitals,” Journal of the American Medical Association 262 (Sept 22/29, 1989) 1635-1640. 2. US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry, “The public health implications of medical waste: A report to Congress,” September 1990. 3. K Pallarito, “Will waste tracking become law of the land? Hospitals decry cost, duplication of federal demonstration project,” Modern Healthcare 2 1 (June 17, 1991) 52. 4. D 0 Weber, “Friends of the Earth,” Healthcare Forum Journal 34 (MarcWApril 1991) 22. 5. W A Rutala, D J Weber, “Infectious waste: Mismatch between science and policy,” The New England Journal of Medicine 325 (Aug 22, 1991) 579. 6. R Hard, “Is regional incineration the answer for
AORN JOURNAL
MARCH 1992, VOL 55, NO 3 -
waste?’ Hospitals 65 (Aug 20, 1991) 60. 7. Rutala, Weber, “Infectious waste: Mismatch between science and policy,” 580. 8. W A Rutala, D J Weber, “Environmental issues and nosocomial infections,” in Infection Control in Intensive Care vol 12 of Clinics in Critical Care Medicine ed B F Farber (New York City: Churchill Livingstone, 1987) 131-171. Suggested reading
Organizations, Plant, Technology & Safety Management Series: Medical Waste Managernent: Recycling and New Technologies. Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations, 1991. Karpiak, J; Pugliese, G. “Medical waste: Declining options in the 90s.” American Journal of Infection Control 19 (February 1991) 8-15. Kriz, M E. “The big stink.” National Journal 23 (Oct 19, 1991) 2540-2542.
Fay, M F, et al. “Medical waste: The growing issues of management and disposal.” AORN Journal 51 (June 1990) 1493-1508. Joint Commission on Accreditation of Healthcare
“Lawmakers consider extending waste act for two more years.” American Hospital Association News 27 (June 17, 1991) 1,5.
Education Session Added at 1992 Congress
Baccalaureate Enrollments Increase Sharply
Another education session, “OSHA: The Final Rule,” has been added to the 1992 Congress program. This session was not listed in the PreCongress Journal. The session will be offered Tuesday, March 17, 1992, from 9 to 10:45 AM at the Dallas Convention Center. The session was added to provide up-to-date information on recent developments regarding the bloodborne pathogens standard. The Occupational Health and Safety Administration (OSHA) published the final rule on the bloodborne pathogens standard in the Dec 6, 1991, Federal Register. Many health care professionals are unaware that the rule is final, or they lack information on how to implement the standard in their institution. This comprehensive education session will examine and interpret the specific language of the rule. Enforcement procedures also will be explained. The session is designed to help nurses understand the full scope of the rule, develop hazard abatement strategies, and construct a hospital exposure control plan. The speaker will be Lois M. Bruning, RN, BSPA, CNOR, manager of professional education, Kimberly Clark Corp, Roswell, Ga.
Nursing school enrollments numbered 237,758 in 1991, an increase of 7.5% from 1990, according to a Jan 14, 1992, news release from the National League for Nursing (NLN). Baccalaureate program enrollments showed the largest gain with a 10.8%increase. The NLN data also show that two applicants were turned away for every person enrolled in 1991. The number of nursing students enrolled in diploma courses in 1991 was 22,980 (up 4.6% from 1990). The nearly 124,000 students enrolled in associate degree programs in 1991 reflected an increase of 5.4% from the year before. Nearly 91,000 students enrolled in baccalaureate programs in 1991. Claire M. Fagin, RN, PhD, FAAN, NLN president, cautioned that the increases do not mean an end to the nursing shortage and that increased enrollment alone will not solve the shortage. These new nurses must be used effectively in the delivery of care, according to the news release. The NLN report also notes a 10%increase in graduations from all types of nursing programs. Total diploma graduates increased 22.5%, associate degree graduates increased 12.3%, and baccalaureate degree graduates increased 3.3%. The total number of graduations in 1991 was 72,027. Peak years for graduations were in the early 1980s, when graduations numbered more than 82,000. 863
AORN JOURNAL
Legislation Medical waste: Science vs politics
M
edical waste is an issue of growing concern. The entire topic has spurred debates, with the public, lawmakers, and scientists taking different sides. The public is concerned about dangers to public health, lawmakers respond by introducing demanding legislation, and scientists insist that the waste is not a health risk.
The Medical Waste Tracking Act hen medical debris washed ashore along the East Coast in 1987 and 1988, the public was outraged. Congress responded. It passed the Medical Waste Tracking Act (MWTA) of 1988 as an amendment to the Resource Conservation and Recovery Act (RCRA) of 1976. The law required the Environmental Protection Agency (EPA) to develop a two-year program that involved “cradle to grave” tracking of “medical waste.” The MWTA definition of medical waste includes cultures and stocks of infectious agents and associated biologicals, pathological waste, human blood and blood products, used sharps, whether contaminated or not, contaminated animal carcasses, surgery and autopsy waste, laboratory waste, dialysis waste, discarded medical equipment, and isolation waste. All facilities in participating states (ie, New
York, New Jersey, Connecticut, Rhode Island), as well as Puerto Rico, that produced 50 lb or more of medical waste per month were subject to the provisions of the act. The only exceptions were facilities that treated (ie, “substantially” reduced or eliminated the potential for causing disease) and destroyed (ie, rendered the waste unrecognizable as medical waste) their medical waste on site. The demonstration project was in effect for two years-from June 22, 1989 to June 22, 1991.
Is Tracking Necessary, EfSective ?
T
here has been great debate over the effectiveness and usefulness of the MWTA. First, most hospitals have comprehensive waste management policies, formal training for employees who handle medical waste, and protocols for managing medical waste in compliance with Centers for Disease Control (CDC), Atlanta, guidelines.’ The problem is that increasing amounts of medical waste are coming from nonregulated sources, including inhome health care, illicit IV drug users, and diabetic patients who use needles for insulin injections. Second, for the MWTA, the EPA’s definition of medical waste includes much more waste than CDC and regular EPA guidelines. For example, neither the CDC nor the EPA designates uncontaminated sharps as infectious waste. The CDC also does not include isolation wastes or animal carcasses in its designation of infectious waste. This means that more waste is 855
AORN JOURNAL
being specially treated and tracked than really is necessary. For example, to comply with the law and MWTA’s expanded definition of medical waste, Yale-New Haven (Conn) Hospital had to place 800 additional tons of medical waste in the red bags that identify infectious waste. This additional waste has not been found to be a risk to public health, however.* The “risk” of hepatitis and human immunodeficiency virus (HIV) infection from medical waste is a risk only to people in certain occupations, including nursing, emergency medical service, janitorial, laundry services, and refuse disposal. Third, costs of the program have been astronomical. When it developed requirements for the demonstration project, the EPA estimated that each hospital would have to spend about $3,800 to comply. Yale-New Haven Hospital’s expenditures have far surpassed that e ~ t i m a t e . ~ By 1990, the hospital was spending about $50,000 per month, up from the $9,000 to $12,000 it was spending before the program began. In addition, it spent an additional $108,000 that year for five new full-time employees to handle the waste. In its first interim reports to Congress in May and December 1990, the EPA said the program has helped set standards for medical waste management and increased awareness of different treatment technologies. Indeed, 45 states have regulations that define medical waste, and several use a “chain of custody” for managing it. In addition, since the passage of the MWTA, the definition of medical waste has become more uniform, according to Kristina Meson of the EPA’s Office of Solid Waste. The EPA’s final report was due in September 1991 but is not expected to be released until the fall of 1992.
Legislators Respond
I
n the meantime, several pieces of legislation have been introduced on the federal level regarding medical waste. Rep Jim Saxton (RNJ) introduced HR 1816, which would extend the medical waste tracking program through June 1993. At press time, this bill had 45 856
MARCH 1992, VOL 55, NO 3
cosponsors. It had been referred to the Energy and Commerce Committee, but no hearings had been scheduled. The program was to end June 22, 1991, but because of the proposed legislation, it will continue as is until Congress decides whether it should be extended. This bill may be designed to allow Congress more time to determine how to incorporate the program’s findings into the RCRA reauthorization, which is expected next year. Other major legislation was introduced by Sen Max Baucus (D-Mont). His bill (S 976) includes several amendments to the RCRA of 1976. The amendments include references to definitions, transportation, volume, and toxicity of medical waste. The bill, which has two cosponsors, has been referred to the Senate Committee on Environment and Public Works and the Environmental Protection Subcommittee. Several committee and public hearings have been held, but it had not come out of committee as of the end of January. According to Daniel J. O’Neal, RN, MA, CNAA, assistant director, congressional and agency relations for the American Nurses Association, the bill probably will be rewritten, combined with a new bill, or replaced by a new bill. That new bill may be S 2108, which was introduced by Sen Dave Durenberger (R-Minn) in November 1991. The Medical Waste Management Act of 1991 is intended to ensure “the safe management of wastes generated by hospitals, clinics, laboratories, and other medical facilities,” according to Sen Durenberger. It would replace the MWTA and establish a national policy to encourage the proper collection, handling, treatment, and disposal of medical waste. Sen Durenberger introduced the bill as an amendment to the RCRA because it is “appropriate for the special characteristics of medical waste.” The bill includes a broad definition of medical waste, including infectious agents; pathological waste; biological waste; chemotherapy wastes including IV bags and needles, tubing, vials, gowns, gloves, and masks; blood and items saturated or caked with blood; and used and unused sharps. The bill also includes a
AORN JOURNAL
MARCH 1992, VOL 55,NO 3
Proposed Legislation Regarding Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: status:
Bill: Purpose: Status:
Bill:
858
HR 12 Beaches Environmental Assessment, Closure, and Health Act of 1991 To amend the Federal Water Pollution Control Act and the Coastal Zone Management Act of 1972 to improve the quality of coastal recreation waters In House Subcommittee on Fisheries and Wildlife Conservation and Environment HR 173 Solid Waste Transportation Act To amend the Solid Waste Disposal Act to place certain restrictions on the interstate disposal of solid waste In House Committee on Energy and Commerce HR 215 Research on the Management of Infectious Wastes, Requirement To require the EPA to conduct research on the management of infectious medical waste Referred to House Committee on Energy and Commerce and House Committee on Science, Space, and Technology HR 607 Solid Waste Disposal Act, Amendment To amend the Solid Waste Disposal Act to grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to House Committee on Energy and Commerce HR 724 Hazardous and Solid Waste Management Act of 1991 To amend the Solid Waste Disposal Act to grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to House Committee on Energy and Commerce HR 1816 Medical Waste Tracking Program, Extension To extend the medical waste tracking program through June 1993 In House Committee on Energy and Commerce HR 2398 Hazardous and Additional Waste Export and Import Act of 1991 To prohibit hazardous and additional waste from being exported from and imported into the United States except in compliance with requirements of the act In House Committee on Energy and Commerce and House Committee on Foreign Affairs HR 2861 Protection of Postal Employees and the US Mail from Exposure to Medical Waste, Provision To direct the US postal service to promulgate regulations to protect postal employees and the US mail from exposure to medical waste Referred to House Committee on Post Office and Civil Service HR 2951 Federal Safe Syringe and Needle Promotion Act of 1991
MARCH 1992, VOL 5 5 , NO 3
-
AORN JOURNAL
Federal Medical Waste Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
Bill: Purpose: Status:
To prohibit the use of federal funds for syringes and needles that are “not nonreusable” In House Committee on Energy and Commerce HR 3253 Pollution Prevention, Community Recycling, and Incinerator Control Act To establish certain requirements with respect to solid waste and hazardous waste incinerators In House Committee on Energy and Commerce HR 3386 State Solid Waste Management Act To authorize states to regulate the treatment, disposal, and other disposition of solid waste In House Committee on Energy and Commerce HR 3521 Medical Waste Mail Control Act of 1991 To prohibit the mailing of medical waste except in limited circumstances Referred to House Committee on Post Office and Civil Service
S 592 Hazardous and Solid Waste Management Act of 1991 To grant states the authority to regulate the interstate disposal of hazardous waste and solid waste Referred to Senate Committee on Environment and Public Works S 774 State Regulation and Management of Solid Waste Act of 1991 To provide state management of solid waste and to reduce and regulate the interstate transportation of solid waste. Referred to Senate Committee on Environment and Public Works S 976 Resource Conservation and Recovery Amendments of 1991 To amend the RCRA In Senate Committee on Environment and Public Works and Environmental Protection Subcommittee
S 1082 Hazardous and Additional Waste Export and Import Act of 1991 To prohibit hazardous and additional wastes from being exported from and imported into the United States except in compliance with requirements of the act Hearings adjourned by Environmental Protection Subcommittee S 2108 Medical Waste Management Act of 1991 To establish a national policy to encourage the proper collection, handling, treatment, and disposal of medical waste materials In Senate Committee on Environment and Public Works
cr 859
AORN JOURNAL
MARCH 1992, VOL 5 5 , NO 3
detailed management system that includes the following provisions. Medical waste must be segregated and stored in specially designed containers. Any person who transports medical waste off site must register with the EPA and obtain a permit for treatment facilities. Vehicles used to transport medical waste must be identified as such and decontaminated if spillage or leakage occurs. Vehicles must be registered to the transporter, insured for cleanup costs or damages, and inspected by the Department of Transportation. This bill is being considered in the Committee on Environment and Public Works. Many other bills related to medical waste have been introduced in the House and Senate. (See “Proposed Federal Legislation Regarding Medical Waste.”)
Options
A
nother major aspect of medical waste does not involve defining or tracking the waste, but where it should go. In the 1970s, some 20,000 municipal landfills were available for household and other types of waste.4 Nearly 70% of those have been closed, and those that remain are quickly filling up. Instead of contributing to the landfills, most hospitals incinerate 64% to 93% of their medical waste.s Incineration technology handles the infectious and aesthetic concerns of medical waste. Many regulations are placed on incinerators, however, to comply with the Clean Air Act and other environmental concerns. Recent legislation requires the EPA to develop specific regulations for small incinerators used by health care facilities. To meet the regulations, many incinerators will have to be totally renovated or replaced. As yet another option, many hospitals are turning to regional incineration programs. Experts say that one well-run, state-of-the-art incinerator equipped to control air pollution is better than many small incinerators in terms of air quality and cost containment.‘j Others dis862
agree, claiming that sending waste to regional centers increases disposal costs.’ Options seem to be running out. Some solutions to the growing problem of medical waste include reducing the amount of waste by recycling and reusing medical materials and developing new technologies for treating the waste to render it noninfectious. Some believe that hauling waste to rural areas in other states is the best way to handle it. This, however, has resulted in a “not-in-my-backyard” attitude and has prompted states to call for limited interstate waste transportation. Some researchers believe in the scientific method. According to William A. Rutala, PhD, and David J. Weber, MD, If regulatory control were based on epidemiologic and microbiologic data, only two types of medical waste would require special handling and treatment-sharps and microbiologic waste.8 There are many facets to the medical waste issue. Medical waste is a problem, if not because it is a danger to public health, then because disposal options are limited. The problem must be addressed, and a solution must be reached, whether by lawmakers, scientists, or a combination. LAURIE D. CRUZ SENIOR ASSOCIATE EDITOR Notes 1. W A Rutala, R L Odette, G P Samsa, “Management of infectious waste by US hospitals,” Journal of the American Medical Association 262 (Sept 22/29, 1989) 1635-1640. 2. US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry, “The public health implications of medical waste: A report to Congress,” September 1990. 3. K Pallarito, “Will waste tracking become law of the land? Hospitals decry cost, duplication of federal demonstration project,” Modern Healthcare 2 1 (June 17, 1991) 52. 4. D 0 Weber, “Friends of the Earth,” Healthcare Forum Journal 34 (MarcWApril 1991) 22. 5. W A Rutala, D J Weber, “Infectious waste: Mismatch between science and policy,” The New England Journal of Medicine 325 (Aug 22, 1991) 579. 6. R Hard, “Is regional incineration the answer for
AORN JOURNAL
MARCH 1992, VOL 55, NO 3 -
waste?’ Hospitals 65 (Aug 20, 1991) 60. 7. Rutala, Weber, “Infectious waste: Mismatch between science and policy,” 580. 8. W A Rutala, D J Weber, “Environmental issues and nosocomial infections,” in Infection Control in Intensive Care vol 12 of Clinics in Critical Care Medicine ed B F Farber (New York City: Churchill Livingstone, 1987) 131-171. Suggested reading
Organizations, Plant, Technology & Safety Management Series: Medical Waste Managernent: Recycling and New Technologies. Oakbrook Terrace, Ill: Joint Commission on Accreditation of Healthcare Organizations, 1991. Karpiak, J; Pugliese, G. “Medical waste: Declining options in the 90s.” American Journal of Infection Control 19 (February 1991) 8-15. Kriz, M E. “The big stink.” National Journal 23 (Oct 19, 1991) 2540-2542.
Fay, M F, et al. “Medical waste: The growing issues of management and disposal.” AORN Journal 51 (June 1990) 1493-1508. Joint Commission on Accreditation of Healthcare
“Lawmakers consider extending waste act for two more years.” American Hospital Association News 27 (June 17, 1991) 1,5.
Education Session Added at 1992 Congress
Baccalaureate Enrollments Increase Sharply
Another education session, “OSHA: The Final Rule,” has been added to the 1992 Congress program. This session was not listed in the PreCongress Journal. The session will be offered Tuesday, March 17, 1992, from 9 to 10:45 AM at the Dallas Convention Center. The session was added to provide up-to-date information on recent developments regarding the bloodborne pathogens standard. The Occupational Health and Safety Administration (OSHA) published the final rule on the bloodborne pathogens standard in the Dec 6, 1991, Federal Register. Many health care professionals are unaware that the rule is final, or they lack information on how to implement the standard in their institution. This comprehensive education session will examine and interpret the specific language of the rule. Enforcement procedures also will be explained. The session is designed to help nurses understand the full scope of the rule, develop hazard abatement strategies, and construct a hospital exposure control plan. The speaker will be Lois M. Bruning, RN, BSPA, CNOR, manager of professional education, Kimberly Clark Corp, Roswell, Ga.
Nursing school enrollments numbered 237,758 in 1991, an increase of 7.5% from 1990, according to a Jan 14, 1992, news release from the National League for Nursing (NLN). Baccalaureate program enrollments showed the largest gain with a 10.8%increase. The NLN data also show that two applicants were turned away for every person enrolled in 1991. The number of nursing students enrolled in diploma courses in 1991 was 22,980 (up 4.6% from 1990). The nearly 124,000 students enrolled in associate degree programs in 1991 reflected an increase of 5.4% from the year before. Nearly 91,000 students enrolled in baccalaureate programs in 1991. Claire M. Fagin, RN, PhD, FAAN, NLN president, cautioned that the increases do not mean an end to the nursing shortage and that increased enrollment alone will not solve the shortage. These new nurses must be used effectively in the delivery of care, according to the news release. The NLN report also notes a 10%increase in graduations from all types of nursing programs. Total diploma graduates increased 22.5%, associate degree graduates increased 12.3%, and baccalaureate degree graduates increased 3.3%. The total number of graduations in 1991 was 72,027. Peak years for graduations were in the early 1980s, when graduations numbered more than 82,000. 863
