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Medical waste processor, Ecolotec

Small wonder safety should be of paramount importance. Liquid waste from the operating room is comprised of blood and body fluid, which certainly has the potential to be infected with pathogenic organisms. A safe product is tops on the list, but other important factors come into play as well when it comes to managing liquid waste.

It is always safer to transport solids rather than liquids that can splash or dribble. ViraSorb Super Solidifier, from Colby Manufacturing, Tullytown, PA, is available to health- care facilities that may not have access to a hopper or prefer solidifying canister contents. Once gelled, the contents will not crystallize or become slippery and will remain solid throughout the disposal process to guard against spills or leaks. Other companies making solidifiers include: DeRoyal, Powell, TN; DiSorb Systems Inc., Philadelphia, PA; Medline Industries Inc., Mundelein, IL (distributor); Metrex Inc., Orange, CA; Microtek Medical Inc., Columbus, MS; and Safetec of America Inc., Buffalo, NY.

The face of fluid waste disposal is changing. Healthcare facilities are moving away from incinerators to more environmentally friendly methods of managing medical waste. The trend leans strongly toward steam autoclaves. The move to autoclaves is driven by the evolution of tough incinerator air emission rules in state, federal, and advisory-organization guidelines regulating the disposal of medical waste.

Angel Aguiar, vice president, Bondtech Corporation, Somerset, KY, told Healthcare Purchasing News that approximately 80% to 90% of red-bag waste generated in North America is now managed with steam autoclave systems. "We’ve gone through a 20-year learning curve. High-pressure, high-vacuum steam autoclave systems are the best. Nothing in the foreseeable future will change the dominance of the autoclave in managing medical waste."

Another trend is that hospitals are heading in the direction of handling medical waste on-site. The cost of off-site processing continues to rise, and Hurricane Katrina and 9/11 drove home the lesson that hospitals need to be prepared to handle their own waste when disaster strikes.

San-I-Pak Mark II-N sterilizer compactor.	San-I-Pak no-touch loading.

McCoy highlighted the need for hospitals to be self-sufficient: "An in-house program that sterilizes infectious material on-site is the only way to ensure sustainability during a surge event. More hospitals are interested in treating this infectious material on-site as opposed to transporting it through their communities. Hospitals realize that, as a generator of this infectious material, it is their responsibility to manage it properly and to safeguard their communities. The threats our society faces today make sustainability an important factor that influences all operational decisions within healthcare. The consequences of not having a safe and reliable in-house program can be devastating when faced with serious threats."

There are other important advantages to in-house processing. McCoy highlighted a financial benefit for hospitals that process fluid waste on-site. "In addition to safety and sustainability, processing infectious waste on-site yields a significant cost savings compared to commercial off-site contract service providers. In today’s challenged healthcare environment, it is rare to identify one
solution that provides safety, sustainability, and savings."

Eliminating the costs of off-site contract service providers isn’t the only benefit. When hospitals’ medical waste is transported off-site for processing, meeting Department of Transportation (DOT) requirements is vital. The move to on-site treatment with steam autoclaves eliminates this concern, explained Aguiar: "Hospitals that process waste on-site do not have to be concerned with DOT requirements. Once the medical waste is treated on-site, the waste is considered regular solid waste and safe for final disposal."

Bondtech Treatment Technology, model BTT5X12

Noting that canisters of liquid waste can comprise as much as 70% of an operating room’s infectious waste, Aguiar outlined another advantage of steam autoclaves that’s good for both the hospital’s pocketbook and the environment."With solidification eliminated and liquid waste treated on-site, the canisters can be reused." Aguiar pointed out that Dornoch Medical, Riverside, MO; Bemis Manufacturing Company, Sheboygan Falls, WI; and Stryker, Kalamazoo, MI, all have systems that reuse canisters.

Products that are environmentally friendly are steadily garnering increased attention. Environmental friendliness was the attraction that drew Gary Gilliam, executive vice president, Ecolotec, Brentwood, TN, to his company. "I started a medical waste hauling company in 1991. At that time, many facilities were processing their own waste with incinerators. In recent years, this process has been all but abandoned for processes that protect our environment. After 9/11, many of the hospitals I serviced asked me to find a processor small enough to work on-site. The security issues that came to light were the driving force behind these requests.

Steam autoclaves have much in common from one company to another, but they all put their own mark on their products. Many of them process solid waste as well as fluid, which may be a more economical choice. Offerings may include programmable control systems and recorders. The waste is compacted after being destroyed by blades, and, depending on the company and model chosen, the waste may be reduced by volume somewhere between 50% and 80%. Cycle times can vary from 10 minutes to 1 hour. Capacity varies from small loads of 50 pounds to hundreds of pounds.

For safety’s sake, look for a model that ensures minimal handling by employees. Some companies’ systems include bins or carts that can be automatically delivered directly into the autoclave. For example, Aduromed, Bethel, CT, has aluminum nickel alloy carts that go right into the autoclave and are sterilized along with the waste. "The medical-waste red bags are handled by employees only at the point of origin," said Timothy Hertweck, vice president of sales.

Typically, the autoclaves sterilize the waste then destroy it with blades. In the Aduromed MedClean system, the autoclave sterilizes the medical waste using steam, and then the waste is shredded until it’s unrecognizable and can be placed into any municipal waste container. Hertweck describes the end result as "medical confetti." Again, for safety’s sake, it’s a good idea that the medical-waste treatment system is designed so that the waste goes through the sterilization cycle before it’s sent through a shredder. "Then if there’s a problem," Hertweck explained, "the maintenance workers won’t have to go in the shredder and work on contaminated equipment."

McCoy believes that superior sterilization performance must be assured. "Efficacy verification is critical for the solid-waste professionals that may ultimately come into contact with this material."

Aduromed’s autoclave system

Aduromed’s MedClean system installed

Superior performance can pay off in more ways than one. "As a result of San-I-Pak’s longstanding performance," said McCoy, "we have an exclusive alliance with the world’s largest environmental company, Waste Management Inc. Waste Management has launched a new program exclusively for the healthcare community, Waste Management Healthcare Solutions. This comprehensive program allows hospitals to establish an in-house program by providing San-I-Pak equipment with no capital funding necessary.

Gilliam had a few more features and qualities to add to the list of what should be important to purchasers and users of products that manage fluid waste: "The equipment should be user-friendly. You also want to make sure the manufacturer can provide support and parts for the product you purchase."

Here’s an important caveat: "This type of equipment does not need Food and Drug Administration approval," stated Gilliam, "so buyers should review the total testing for the equipment." It would be well advised also to determine whether the equipment meets OSHA and EPA requirements while you’re at it.

Gilliam also urged buyers to look for ease of operation, economy, safety, confidentiality, and peace of mind. "Ecolotec is designed to be easy to operate. It can save the facility thousands of dollars each year versus using a hauling contractor. Because it can handle both liquid and solid waste, it’s more economical. All waste is rendered sterile and unrecognizable, which protects the confidentiality of the waste stream. It contributes to peace of mind, because processing on-site assures that proper procedures are followed and verified. I see the future of processing medical waste turning toward a trend of in-house processing for all these reasons."