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Waste Management 24 (2004) 143–151

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Alternatives for treatment and disposal cost reduction of regulated


medical wastes
Byeong-Kyu Leea,*, Michael J. Ellenbeckerb, Rafael Moure-Ersasob
a
Department of Civil and Environmental Engineering, University of Ulsan, Ulsan, South Korea
b
Department of Work Environment, University of Massachusetts, Lowell, MA, USA

Accepted 1 October 2003

Abstract
Many hospitals or health care facilities have faced financial difficulties and thus they have attempted to find cost-effective treat-
ment and disposal methods of their regulated medical wastes (RMWs). This study investigated generation volume and sources,
composition, and treatment and disposal methods for RMWs obtained from three out of the five typical city hospitals in Massa-
chusetts for which we could obtain relevant data on medical waste. Also, this study compared the generation patterns and amounts
of RMWs between the hospital and the medical school. The yearly operational treatment and disposal costs of RMWs based on
different treatment and disposal methods were analyzed for one hospital. The most cost-effective option of four different treatment
and disposal options studied was to combine on-site incineration and microwave technologies. Finally, this study identified mea-
sures for the effective waste characterization methods for the reduction of treatment and disposal costs of RMWs. By careful
exclusion of non-RMW from RMW waste streams, hospitals can reduce the RMW volume that requires special treatment and
reduce disposal costs.
# 2003 Elsevier Ltd. All rights reserved.

1. Introduction potential health hazards, requiring special handling,


treatment, and disposal, usually according to specific
Each year more than 3.5 million tons of medical regulations and guidelines such as Medical Waste
wastes are produced in the United States (MWC, 1994; Tracking Act (MWTA). Special waste can include che-
Hyland, 1993). According to the literature relevant to mical waste, infectious waste, and radioactive waste
the generation rate of medical waste for different coun- (Kerdsuwan, 2000; Hasselriis and Constantine, 1992).
tries (Alvim Ferraz et al., 2000; Kerdsuwan, 2000; Therefore, most of special waste is treated as regulated
Maderira, 1995; Giroletti and Lodola, 1994; MWC, medical waste (RMW) (Davis, 2000; Hall, 1989).
1994), each country has different ranges of medical There are many technologies for the treatment of
waste production depending upon its medical situations medical wastes (Park and Jeong, 2001; Yoon, 2001;
(see Table 1). Medical waste can be classified into two MWC, 1994; CEC, 1993). According to the treatment
types: general waste and special waste. Since general studies of medical wastes, about 59–60% of RMWs are
waste is not regulated or defined as hazardous or treated through incineration, 37–20% by steam ster-
potentially dangerous wastes, it does not require special ilization, and 4–5% by other treatment methods (Park
handling, treatment, and disposal (CEC, 1993; Hassel- and Jeong, 2001; Hyland et al., 1994). Currently, the
riis and Constantine, 1992). Therefore, it is sometimes proportion of off-site treatment and disposal has been
called non-regulated medical waste (NRMW) (Waste- increasing up to 84% due to severe regulations con-
Tech and Konheim and Ketchham, 1991; Marrack, cerning on-site incineration (Park and Jeong, 2001;
1988). Special waste includes materials considered to be Senatore, 1994). Historically, incineration has been used
as an important treatment method for RMW. That is
* Corresponding author. Tel.: +82-52-259-2864; fax: +82-52-259-
because incineration has many advantages including
2629. putrefaction prevention and sterilization of pathological
E-mail address: bklee@mail.ulsan.ac.kr (B.-K. Lee). or anatomic wastes, volume reduction, and waste heat
0956-053X/$ - see front matter # 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/j.wasman.2003.10.008
144 B.-K. Lee et al. / Waste Management 24 (2004) 143–151

Table 1 Recently, many hospitals have faced financial diffi-


A generation rate of medical waste in different countries culties and some of them have tried to merge with other
Country Generation rate, Reference hospitals in order to overcome their financial problems.
kg/(bed day) Therefore, they are trying to find some cost-effective
treatment or disposal means of their wastes. For exam-
Thailand 1 Kerdsuwan (2000)
Portugal 3.8 Alvim Ferraz et al. (2000)
ples, a few hospitals and companies have investigated
2.5–4.5 Giroletti and Lodola (1994) alternative disposal methods through recycling of their
Italy 3–5 Maderira (1995) medical plastic wastes (Lee et al., 2002; Anderson et al.,
USA 5–7 Medical Waste Committee (1994) 1999; Marrack and Meyers, 1994; Batholomew et al.,
1994). The main reasons that recycling programs of
recovery (Hyland, 1993). Many hospitals are employing medical plastic waste should be developed are because
on-site incineration for treatment of their RMWs the plastic content of medical waste is significantly
(MPCA, 1991). However, RMW includes significant higher than that of municipal solid waste (MSW) and
quantities of chlorine containing wastes, such as poly- plastic wastes require significant costs for transportation
vinyl chloride (PVC) or disinfectants, and it might be to disposal facilities (US EPA, 2002; Lee et al., 1995). In
incinerated with status lacking proper controls and addition, the total costs for treatment and disposal of
emission reduction devices. Therefore, incineration of RMW were much more expensive than those of
RMWs might produce dioxins and furans known as NRMW or MSW (Park and Jeong, 2001; Lee et al.,
hazardous pollutants (Alvim Ferraz et al., 2000; Walker 1995). To shed light on the magnitude of this problem
and Cooper, 1992; Glasser et al., 1991; Lee et al., 1991; and opportunities for mitigation, we identified genera-
Powell, 1987). Considerable amounts of heavy metals tion volume and patterns, sources, treatment and dis-
waste can also be emitted as forms of fumes or vapors, posal methods, and disposal costs of RMW in hospitals,
particles and ashes produced from incineration of Massachusetts. Also, we investigated cost-effective
RMW (Fritsky et al., 2001; Yuhas et al., 1994). Hence treatment and disposal methods through a comparison
the public is fearful of potential exposure to these pol- analysis of treatment and disposal costs of RMW and
lutants produced from the incineration of medical waste finally proposed some alternatives to save the total costs
or RMW (Hu and Shy, 2001). Consequently, many new for treatment and disposal of RMW.
techniques without incineration are now being devel-
oped. New technologies being considered by RMW
disposal engineers include microwaving, autoclaving, 2. Methods
radiowaving, and electrotechnologies, which incorpo-
rate electron-beam irradiation, pyrolysis and oxidation, Lee et al.’s previous study focused on analysis of the
steam sterilization, and steam detoxification (Waste recycling potential of medical plastic wastes generated
Prevention Association, 2003; Park and Jeong, 2001; from five typical city hospitals and three typical animal
Salkin and Krisiunas, 1998; O’Connor, 1994; Jordan, hospitals in Massachusetts (Lee et al., 2002). In this
1994; Borowsky and Fleischauer, 1993). Currently, study we focused on cost-effective waste stream analysis
microwaving and autoclaving have been considered as methods, treatment and disposal methods, and waste
positive alternative treatment methods to incineration. characterization methods of RMW.
Microwaving might be economically competitive with We investigated generation volume and sources,
incineration and applicable to continuous—or batch treatment and disposal methods, and cost-effective
operation (CEC, 1993). Wastes are microwaved for 30 waste stream analysis methods of medical wastes
min in a preheated treatment chamber and then held at obtained from five typical city hospitals and three med-
a minimum temperature of 93–95  C to ensure proper ical schools in Massachusetts. As the first step for this
disinfection. However, microwaving is not sufficient for research, we made phone calls to identify relevant per-
sterilization temperature above 120  C. By microwaving sonnel and collect information of hospitals and medical
spores are activated and some spores may survive (Cha schools. More than 200 survey letters were sent to
and Carlisle, 2001; CEC, 1993). In autoclaving (some- managers or responsible personnel of waste generation
times referred as to steam sterilization), steam, dry heat departments such as cafeterias, laboratories, emergency
or radiation is introduced into a tightly sealed chamber rooms and operating rooms, waste collection depart-
and wastes in the chamber are maintained with tem- ments such as environmental services and/or house-
perature between 121 and 163  C for sterilization which keeping departments, facilities and purchasing
destroys spores. This treatment method by autoclaving departments, and administration departments. In the
is widely used for recyclable items such as paper, survey letters information on the following items was
plastics and lab trash. However, microwaving and solicited: number of beds, bed occupancy rate by
autoclaving are generally not applicable for pathologi- patients, waste generation volume and sources, waste
cal, radioactive, laboratory and chemotherapy wastes. treatment and disposal methods and costs, waste
B.-K. Lee et al. / Waste Management 24 (2004) 143–151 145

collection methods, and information of site-visit and general waste. Table 2 shows a summary of waste gen-
personnel to contact. In a few days after sending the eration volume and types, on-site incineration, and off-
survey letters we had made more than four hundred site disposal costs of RMW produced by hospital D.
phone calls to discuss or collect the survey items or set Significant amount of general waste, 80.4 ton per year,
up site-visit schedules. About 30% of the sent survey was considered as infectious waste and it was treated by
letters were returned to us and about 50% of those on-site incineration. The off-site disposal cost, based on
returned contained significant information. unit weight, of radioactive waste and liquid chemical
We then visited more than forty departments in fifteen waste was 24 and 28 times as expensive as compared to
hospitals or health care facilities to collect survey letters that of general solid waste. The waste stream analysis
and discuss this study through interviews with managers method shown in Table 2 can provide a framework that
and personnel of waste generating, collecting and might identify a relationship between waste types and
managing departments that we had sent the survey let- treatment and disposal methods (on-site incineration
ters. Some managers or responsible personnel concern- and off-site disposal), and analyze types or sources of
ing waste management of hospitals gave us significant wastes generated. However, the detailed identification
information from hospital reports or analysis data on of the waste composition of medical waste from this
waste composition, waste generation volume and simple waste classification is relatively difficult.
sources, treatment and disposal methods and costs per- Table 3 shows a comparison of RMW generated by
formed by their hospitals or expert analysis companies. the hospital and the medical school associated with
We could investigate only a limited fraction of RMW hospital D. The hospital produces a large proportion of
produced from a few hospitals under a control of rele- general medical wastes (not requiring a special treat-
vant personnel of hospitals. Thus, most of data con- ment such as incineration) and sharps [loosely defined
cerning RMW were obtained from the reports on waste as anything that can cause a penetrating injury to
analysis performed in the hospitals that we investigated humans or puncture containers (Davis, 2000)]. This is
or other relevant hospital reports (Anderson et al., 1999; because the hospital focuses on patient care and many
UMASS, 1995; Waste-Tech and Konheim and people frequently visit the hospital as visitors or
Ketchham, 1991; Marrack, 1988). This paper focuses on patients. However, the medical school produces a large
generation volume and sources, composition, and proportion of RMW such as pathological and labora-
treatment and disposal methods for RMWs obtained tory wastes. This is because the medical school focuses
from three out of the five city hospitals investigated. In on activities related to medical research. That is, this
this paper, thus we excluded two hospitals that we could difference indicates that the generation patterns of
not get the relevant data to RMW through this study. RMW in a typical city hospital and a medical school
Since each hospital categorizes its RMW with different associated with the hospital were different because of
ways or classification methods, a statistical analysis on different activities. In addition, this result implies that
the obtained data was not performed. However, we the waste generation patterns produced from hospitals
analyzed significant characteristics of waste streams and with a special purpose, such as an eye and ear hos-
disposal and treatment methods of RMW. We also pital, children’s hospital and animal hospital, will be
compared RMW generation patterns between the hos- different from those of a general city hospital.
pital and the medical school where we obtained the
relevant data. We analyzed the yearly operational 3.2. Analysis of treatment or disposal methods and costs
treatment and disposal costs of RMW to identify the of medical wastes
most cost-effective treatment and disposal method
among on-site incineration, on-site incineration Table 4 shows the waste stream and main treatment
including expanding a current incineration capacity, and disposal methods for medical waste generated by
on-site microwaving without on-site incineration, and hospital C. The major disposal method for general solid
on-site incineration combining microwaving depending waste generated from hospitals was landfilling and most
on segregated waste types. Finally, we attempt to sug- of paper and cardboard were mainly recycling like the
gest cost-effective waste segregation methods. MSW. However, most of the RMW is first treated by
incineration, and then it is disposed of. Because of the
potential for the production of dioxins, furans and
3. Results and discussion heavy metals from incineration of RMW, new treatment
techniques such as microwaving and autoclaving have
3.1. Regulated medical waste stream analysis been considered as alternative treatment methods to
incineration. According to one report 90% of intra-
The medical waste stream can be classified into four venous (IV) bag cases studied were not contaminated by
major categories, i.e., three special wastes containing infectious materials during use by patient (Batholomew
infectious, pathological, and radioactive waste, and et al., 1994). This means that hospitals can develop a
146 B.-K. Lee et al. / Waste Management 24 (2004) 143–151

Table 2
Waste stream analysis of regulated medical wastes in hospital D

Generator Type of waste Amounts generated Relative percentage Off-site


(t/year) (%) disposal cost ($/kg)

On-site incineration
Hospital Infectious waste
Sharps 22.7 0.9
Laboratory 35.9 1.4
General medical 80.4 3.2

Sub total 139.0 5.5

Research labs Pathological


Animal carcasses 6.5 0.3

Research labs Radioactive waste


Vials 16.3 0.6
Lab waste 16.3 0.6
Animals 9.1 0.4

Sub total 41.7 1.1


Sub total (on-site incineration) 187.2 7.4

Off-site disposal (shipped out)


Hospital and labs Infectious waste 84.7a 3.4 0.79
Research labs Radioactive waste 1.2 0.05 2.87
Research labs Liquid chemical waste 6.4a 0.3 3.44
Hospital General solid waste 2242.1 88.9 0.12
Sub total (shipped out) 2334.6 92.6

Total waste produced 2521.6 100


a
If the incineration capacity increases, it could be incinerated by on-site incineration.

Table 3
Comparison of regulated medical wastes in hospital D and its associated medical school

Type of waste Hospital Medical school

kg/20 days % kg/20 days %

Regulated medical waste


Pathological 0 0 1607 52.3
Sharps 1713 17.8 87 2.8
Laboratory 1605 16.7 1259 40.9
General medical waste 6288 65.5 124 4.0

Total 9606 100 3077 100


Relative content of each source to total waste produced 75.7% 24.3%

Table 4
Waste stream and treatment and disposal method of medical wastes produced in hospital C

Type of waste Volume Relative Main treatment/


(t/year) percentage (%) disposal method

Solid wastes (plastics) 1115.6 20.0 Landfilling


Solid wastes (others) 2515.1 45.2 Landfilling
White paper recycling 191.4 3.4 Recycling
Cardboard recycling 186.8 3.4 Recycling
Construction wastes 439.0 7.9 Landfilling/recycling
Regulated medical waste 1119.2 20.1 Incineration
Total 5567.1 100
B.-K. Lee et al. / Waste Management 24 (2004) 143–151 147

recycling program even for RMW through effective amount of wastes incinerated and return money from
waste classification or separation. selling recyclable materials, recycling is very important
Table 5 shows the source identification, typical treat- to reduction of treatment or disposal costs of medical
ment and disposal cost and method of medical wastes waste.
generated from hospital B. This table also shows the The medical wastes, which waste generating depart-
relative percentage by volume, weight and treatment or ments or waste characteristics were unidentified, are
disposal cost of medical wastes generated from each mainly treated by incineration. That is, since waste col-
department. The sum of volume of wastes generated lecting or housekeeping staffs do not know whether
from facilities, laboratories, and cafeterias occupied those wastes are infected or non-infected, those medical
about three-fourths of the total medical wastes. The wastes might be considered as infected wastes. For an
relative percentage by weight of cafeteria wastes is example of this, Table 2 represents that more than 60%
almost the same as amounts of those of laboratories. of the infectious waste treated by on-site incineration
However, in a comparison of treatment or disposal consisted of unidentified general medical waste. The
costs of wastes from two departments, the relative costs medical wastes unidentified in their waste generation
for treatment or disposal of cafeteria wastes are much characteristics or types or infection status are mostly
lower than those for treatment or disposal of wastes treated by incineration incurring high treatment costs.
produced in laboratories. This is due to different treat- This implies that clear labeling or description of char-
ment or disposal methods of wastes generated from acteristics of each waste at the waste generating point
different sources. That is, wastes produced from can contribute to the reduction of treatment and
laboratories mainly are treated by incineration, while disposal costs of medical wastes.
cafeteria waste was mainly disposed of by landfilling or
recycling. Also, incineration cost per unit of weight is 3.3. Operational cost reduction for treatment and
much greater than landfilling or recycling cost. disposal of RMW by a combination of treatment and
Cafeterias produce a much higher volume of waste disposal methods
than operating and emergency rooms. In a comparison
of treatment or disposal cost and waste generation Table 6 contains an analysis of the yearly operational
volume, treatment or disposal cost per unit volume of treatment and disposal costs associated with various
wastes produced from cafeterias is much lower than that treatment and disposal methods for the RMW gener-
from operating rooms or emergency rooms. Since ated from hospital D. Treatment and disposal costs
wastes from operating rooms or emergency rooms have given in this table were based on the RMW incineration
high potential to be infected, these wastes are con- study performed in hospital D and the recent informa-
sidered infectious wastes. Infectious wastes are mainly tion relevant to treatment technologies (Waste Preven-
treated by incineration, which requires high disposal tion Association, 2003; Salkin and Krisiunas, 1998;
costs. However, non-infectious wastes like cafeteria UMASS, 1995). The incineration study compared the
wastes are mainly disposed of by landfilling, which treatment and disposal costs for different treatment
requires relatively lower disposal costs. Currently, technologies to equal amounts of RMW currently being
treatment or disposal cost of infectious wastes can be treated by on-site incineration facilities. In this compar-
about 10–20 times more than that of non-infectious ison study it is assumed that there is an existing incin-
wastes (Park and Jeong, 2000). In addition, while some erator that meets new regulations on medical waste
cafeteria wastes are recyclable, waste from operating incineration. In every option, hospital D is assumed to
rooms or emergency rooms have a lower chance for treat as much medical wastes as possible by using its
recycling. Since the recycling of wastes can reduce the own treatment facilities. The remaining RMW is

Table 5
Treatment and disposal characteristics of medical waste produced from different waste generation department in hospital B

Department Waste volume Treatment and Relative percentage by compared unit (%) Typical treatment or
(m3/month) disposal cost ($/year) disposal method
Volume Weight Cost

Cafeteria 88.4 10,000 23.5 20 6.7 Recycling/landfilling/composting


Operating room 7.5 15,000 2.0 10 10.0 Incineration/recycling
Emergency room 14.6 15,000 3.9 5 10.0 Incineration
Laboratories 58.8 20,000 15.7 20 13.3 Incineration
Facilities 132.5 40,000 35.3 30 26.7 Incineration/recycling
Administration 29.6 20,000 7.8 10 13.3 Recycling/landfilling
Other 44.2 31,000 11.8 5 20.0 Recycling/landfilling
Total 375.6 151,000 100 100 100
148 B.-K. Lee et al. / Waste Management 24 (2004) 143–151

41.4%

depends highly upon the type of waste and the same value is assumed for each option. 4. The amount of residual is set at 20% of the RMW volume before treatment, and its unit disposal cost is the same as
Assumptions: 1. The size of the on-site incinerator for option B is greater than that for option A. 2. The sizes of the on-site incinerators for options D and A are the same. 3. Off-site disposal cost per unit weight
disposed of by off-site disposal facilities. Even though

disposal
Microwave Off-site

3479

2524
22,155

28,158
the proportion of the residuals remaining after inciner-
ation and/or microwave treatment is highly dependant




upon waste types and treatment parameters, it is assumed

19.6%
0.16 $/kg
that 20% of the RMW volume remains after treatment

13,324

13,324
by incineration and/or microwave (Waste Prevention






Association, 2003; Wark et al., 1998). Although the unit
incineration

39.1%
and total disposal cost of the residuals is dependent
Option D

1.56 $/kg
On-site

4608
29,437

34,045

68,080
upon the types and the relative proportions of the resi-
duals, the total disposal costs of the residuals are rela-




tively very minor compared to the total costs for

98.0%
treatment and disposal of RMW. Thus this study
disposal

606,720

639,537
5184

3479

1999
Microwave Off-site

22,155

assumes that the residuals are disposed of as general


2.0% solid waste in hospitals, having a unit disposal cost of


0.12 $/kg.
Option C

0.16 $/kg

Option B, having larger capacity of on-site incinera-


13,324

13,324

652,861

tion as compared to option A, was a cheaper disposal






method than option A. In the option A, because of the


15.8%
disposal

limited capacity of the on-site incinerator, considerable


On-site incineration Off-site

3479

2524
22,155

28,158

amounts of infectious waste should be sent to off-site




disposal facilities. Therefore, the total costs for treat-


ment and disposal of medical wastes greatly increased.
In option B, since the incinerator capacity was scaled-
84.2%

up, the hospital could reduce the waste volume to be


Option B

1.21 $/kg

123,687

22,998

150,285

178,443
3600

disposed of off-site. That is, the hospital could increase


the waste proportion to be incinerated on-site. Thus the



Analysis of the yearly operational treatment and disposal costs of regulated medical wastes in hospital D

treatment and disposal cost per unit weight of waste in


46.1%
disposal

the option B became cheaper than that of in the option


On-site incineration Off-site

3479

2524
67,664

22,155

95,822

A. In addition, the hospital could also save significant



contracted disposal costs through increasing on-site


Disposal cost ($/year)

incineration capacity.
Option C using the microwave treatment method
53.9%

instead of incineration on-site was the most expensive


Option A

1.56 $/kg

78,173

29,437

112,218

208,040
4608

option in terms of the total costs for treatment and dis-


posal, even though its treatment cost per unit of weight


is much lower than other methods. This is due to the


Relative cost based on treatment and disposal method within each option

presence of a considerable amount of RMW that is not


Waste stream (kg/year)

suitable for treatment by microwave, but suitable for


treatment by incineration. By operating only the micro-
wave treatment method on-site, those medical wastes
might not be properly treated on-site. Thus a large pro-
portion of RMW under this option must be shipped to
2963

551
244
83,278

18,928

105,964
Residual after incineration or microwave treatment

off-site disposal facilities. Therefore, the hospital would


pay the additional costs for shipping to the off-site as
well as the expensive off-site disposal costs.
general solid waste in hospitals (0.12 $/kg).

The most economical treatment and disposal method


Total cost of treatment/disposal option
Treatment/disposal cost per unit waste

of the four different options considered in this study was


Treatment/disposal method applied
Treatment/disposal method option

option D that employed a combination of incineration


and microwaving. That is, the RMWs to which micro-
waving was applicable were treated by on-site micro-
Chemical (hazardous)

wave, while other RMWs to which microwaving was


Radioactive (high)
Radioactive (low)

not applicable were treated by on-site incinerator. The


Type of waste

other RMWs, to which microwaving or incineration


Pathological
Infectious

was not applicable, were sent to off-site disposal facil-


Sub total
Table 6

ities. In a comparison of the total costs for treatment


and disposal of RMWs, between two cheaper options D
B.-K. Lee et al. / Waste Management 24 (2004) 143–151 149

and B, produced from hospitals or health care facilities The continuously increasing treatment and disposal
having a medical waste production rate of about 100 costs of medical waste are related to the misclassifica-
ton per year, option D was much cheaper up to tion of wastes and the improper disposal of wastes.
$110,000 per year than option B. This cost saving is Every hospital needs to employ a proper classification
large enough to warrant implementation of the neces- system, and utilize different treatment and disposal
sary segregation of medical waste. Thus, an application methods according to the classification or waste type.
of the treatment and disposal method suitable for each For example, the waste segregation and handling pro-
waste type or characteristic of RMW can minimize the cesses should specify which wastes generated at specific
total costs for treatment and disposal. In addition, sources should be collected by which type of collection
treatment on-site, such as on-site incineration and containers, such as red, blue, green or white bags. Reg-
microwaving, should be considered for the cost-effective ularly training for all workers in hospitals is necessary
treatment of RMW. to improve management of their medical wastes.
Finally, the most cost-effective treatment and disposal
3.4. Waste characterization for treatment and disposal methods suitable for each properly-classified waste type
cost reduction can be applied. This will save additional costs due to
avoiding improper treatment or disposal and improper
Hospitals employ different classifications of wastes. classification. In addition, by employing effective treat-
This is due to the absence of a single definition of med- ment and disposal methods based on the characteristics
ical waste. Tables 2 and 4 present different ways of of medical wastes, exposure risks to hazardous air pollu-
characterizing medical waste streams. Table 2 focuses tants, such as dioxins and furans, produced from impro-
on the components and amounts of waste incinerated per treatment of medical wastes could be much reduced.
and shipped-out from a hospital. This table includes
information on waste type, source and volume of
wastes, on-site incineration, and off-site disposal costs 4. Conclusions
of RMW. This characterization method is useful for
comparing various treatment and disposal methods, This study of the treatment and disposal of RMW
such as on-site incineration, off-site incineration, and generated by three city hospitals in Massachusetts has
other off-site disposals, of RMW generated in the hos- found that most of the RMW was incinerated, leading
pital and the research laboratories of the medical to high treatment costs.
school. From a characterization concerning disposal Currently, hospitals are employing many different
of wastes shipped-out, disposal cost per unit of waste stream analysis or treatment and disposal meth-
weight of infectious waste (0.79 $/kg) is much greater ods for their medical wastes. Even though their cafeter-
than that of general solid waste (0.12 $/kg) (see Table 2). ias produce much higher volume of waste than
This indicates that reduced disposal costs through an operating rooms (OR) or emergency rooms (ER), treat-
effective characterization or sorting of RMW can be ment or disposal costs per unit of volume for cafeteria
achieved. However, this table does not present detailed wastes were much lower than those of OR and ER. This
information on waste components and treatment meth- was due to the employment of different waste treatment
ods. Therefore, this characterization method is not or disposal methods according to the activity char-
helpful for identifying methods to reduce treatment acteristics of each waste generation department.
costs of medical waste through the application of dif- In the analysis of the yearly operational treatment
ferent treatment methods according to type of waste. and disposal costs of RMW, treatment by microwaving
Table 4 presents information on the proportion of was the least expensive in terms of the treatment cost
RMW, solid wastes, paper and cardboard that are per unit weight of RMW. However, RMW treatment by
recycled, and treatment or disposal methods of wastes microwaving was found to have limited applicability
generated in a hospital. It helps identify RMW requir- and inadequate sterilization capability. Thus, much
ing special treatment and disposal, and plastics, both RMW had to be sent to off-site disposal facilities which
are about 20% of the total medical wastes. This table require high costs for the waste transportation. There-
also summarizes the relative proportion of current fore, employing only a microwave technology on-site
treatment or disposal methods such as incineration, without incineration was one of the most expensive
landfilling, and recycling for each waste. This classifica- treatment and disposal methods. In contrast, the treat-
tion method can be useful for the identification of ment and disposal method that combined incineration
recyclable products in that hospital. However, it lacks and microwave technologies at on-site was the most
information about metal and glass recycling programs cost-effective method.
and detailed information on solid wastes and RMW. In Finally, this study indicates that hospitals could
addition, this table does not contain information on highly reduce the total costs for treatment and disposal
disposal sites and treatment or disposal costs. of medical wastes by improving their classification
150 B.-K. Lee et al. / Waste Management 24 (2004) 143–151

method for medical wastes and then employing effective Hall, S.K., 1989. Infectious Waste Management: A Multi-faceted
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Hasselriis, F., Constantine, L., 1992. In: Green, A.E.S. (Ed.), Char-
istics of their particular medical wastes. By careful
acterization of Today’s Medical Waste, Medical Waste Incineration
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hospitals can reduce the RMW volume that requires 37–52.
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