This article was published in Health
Facilities Management Magazine
Posted August 2004
By Beth Burmahl
Selecting A Winning Waste Disposal
Environmental services directors and other health facility professionals
who have decided to switch to on-site waste disposal but are still
up in the air about which technology will best suit their needs
might consider taking a road trip.
That's how Sonny Wyatt, CHESP, director of environmental services
for Anderson (S.C.) Area Medical Center, and other staff members
settled on the Tempico Rotoclave system when scouting out waste
management technology for their 587-bed facility in 1998.
"At the time, there were three main technologies out there being
used by health care," says Wyatt. "We took site visits and looked
at the microwave system, the autoclave system and the Rotoclave
system. We chose the Rotoclave because we felt it had a better steam
An on-site visit was also a selling point for Ed Barr, support services
manager, Thomas Jefferson University Hospital, Philadelphia, who
eventually settled on Tracy, Calif.-based San-I-Pak's autoclave
system after his team saw the technology in action.
"I took some employees out to the site to a new San-I-Pak and said,
'Tell me what you think,' and they gave me feedback," says Barr.
"For example, we could have bought an automatic tipper, but the
staff came back and said it would be faster to do it manually."
Getting a first-hand look at the equipment will help narrow your
choices, but be prepared to wade deeper into the waste management
waters if you want to avoid making a costly mistake.
In an industry estimated to be worth $1 billion a year in the United
States alone, Barr cautions that there are companies out there who
will come up with "new ways to sell you the wheel," which is why
you need to do your homework.
One excellent educational opportunity will be offered next month
at the American Society for Healthcare Environmental Services (ASHES)
annual conference in Orlando, Fla., when a panel discussion will
be held on three main types of waste management technologies. Barr
will speak on autoclaves, Wyatt on the Rotoclave, and Nord Sorensen,
COO of Sanitec Industries, Washington, D.C., will discuss the microwaving
Additionally, though it doesn't endorse a particular technology,
the nonprofit environmental group Health Care Without Harm (HCWH)
compared 50 different medical waste treatment technologies in a
report issued in August 2001, which is available at www.noharm.org/library/docs/Non-Incineration_Medical_Waste_Treatment_Te_2.pdf.
The report classifies the technology in four categories: heat, chemical,
biological systems and radiation.
The bottom line? The technologies that use heat--autoclaves, advanced
autoclaves and microwaving--still have the best track record, according
to HCWH's Jorge Emmanuel.
Chemical processes such as chlorine and nonchlorine-based systems,
biological and radiation systems are still emerging, he says. "But
no matter what technology you choose, there has to be a whole system
of segregation and minimization in place to be truly effective,"
says Emmanuel (see sidebar).
Indeed, many experts stress, waste reduction should be your top
waste management priority. For instance, HCWH recommends doing a
medical waste audit to pinpoint the sources of waste, waste content
and rates of generation, which will help determine the type and
size of on-site system that is most suitable. The group says the
audit may also give information on minimizing waste, handling practices,
segregation, regulatory compliance and costs.
Hospitals should also be aware that there are no federal regulations
governing medical waste, which is regulated at the state level.
Although all states accept autoclave systems for medical waste treatment,
some states require some advanced autoclaves to be approved separately.
Hospitals should also check with regulators to find out if certain
waste streams (such as chemotherapy or animal or body parts) cannot
be treated by nonincineration technologies.
Differences in autoclaves
Autoclaving is an old technology--experts say it predates World
War II--and it is still the primary waste management technology
used by hospitals today. But not all autoclaves are created equally,
"Some companies sell inexpensive autoclaves," says Barr. "And, sure,
it's cheap, but a lot of labor goes into running them."
Barr's facility is a second generation buyer of the Sani-I-Pak autoclave
system, having upgraded after the facility--which generates 10 tons
of waste a day--outgrew the first system. He says the system is
"expensive but labor-friendly," and that his 650-bed facility has
saved an average of six figures a year since making the switch from
On average, San-I-Pak customers pay 7 to 9 cents a pound to ship
regulated medical waste, says Arthur McCoy, senior vice president
of the company. He says the equipment--which can range anywhere
from $60,000 to $1 million--generally pays for itself in less than
two years. The company can also custom-design equipment to suit
the hospital, saving construction costs.
Apart from becoming fully automated, McCoy says the biggest advancement
to the system in recent years has been the electronic management
capabilities it now offers. The PC-based system does its own waste
auditing and tracking and creates a waste generation report detailing
how much waste comes from which department, among other details.
"What previously took environmental services managers 20 hours a
month to compile, the machine is doing automatically," says McCoy.
But every technology has advantages and disadvantages. While HCWH
concluded that autoclaves utilize a proven technology with a successful
track record and are approved or accepted as an alternative technology
in all states, the group added that many autoclaves do not render
waste unrecognizable and do not reduce the volume of treated waste
unless a shredder or grinder is added.
And if an autoclave doesn't include a way of drying the waste, it
will come out heavier (and more costly to ship) because of the condensed
A better mousetrap?
Autoclaves that do have an internal shredding system, called "advanced
autoclaves" (the Tempico Rotoclave is one example), may have a rotating
drum that tosses and turns waste after spikes tear it from the bags.
The process offers uniform sterility because the steam is exposed
to all of the waste equally.
"The autoclave offers steam sterilization, but everything is left
in the bag and there is no rotation ... it just goes into a sterilizer,"
says Wyatt. "That's why we chose the Rotoclave."
The waste goes onto a conveyer belt leading to a grinder, which
renders the waste unrecognizable, says Craig Boots, director of
engineering for Tempico, Hammond, La. "When it comes out of the
Rotoclave, it is considered standard waste, which means it can go
into a dumpster and be taken to a regular landfill," says Boots.
"That's an advantage because most landfills will not let you dispose
of sharps and items of that nature unless they are ground up," says
On average, Rotoclave customers pay 6 to 12 cents a pound to ship
the waste, says Boots, who says the technology ranges from $400,000
to $1 million.
Wyatt's facility processes 1.9 million pounds of waste per year,
which includes waste from 34 off-site satellite facilities. The
Rotoclave, which cost the facility about $600,000, saves 6 cents
a pound on treated waste, says Wyatt, who says increasingly strict
air quality standards forced the facility to shut down its incinerator.
"The capital expense and the space to house the equipment were factors,
but we feel the investment is paying off," says Wyatt. "We built
a temporary facility here in the main campus to house it."
In recent years, advanced autoclaves have been developed to offer
a number of combinations that allow a facility to custom-fit the
technology, so to speak, to suit its needs. Some of the combinations
include: steam treatment-mixing-fragmenting/drying/shredding; shredding-steam
treatment-mixing/drying; and preshredding/steam treatment mixing.
A drier alternative
Indianapolis-based WR2 and its parent company, Sterile Technology,
offer a regulated medical waste processing unit that emits decontaminated
waste that is shredded, unrecognizable, dry and ready for the landfill,
says Marty Wetzel, vice president, WR2.
"Our process is a continuous feed auger that is steam-heated through
a jacket, but it's not a pressure vessel," says Wetzel. "The main
advantage is that it treats the waste in such a way that it comes
out dry with no odor."
The system preshreds the waste--including sharps, needles, IV bags,
etc.--which creates a finer mulch, Wetzel says. "It comes out as
confetti-type mulch that can go out as municipal waste."
HCWH cautions that preshredding should not be done before disinfection
to protect workers from exposure to pathogens released in the air
by the mechanical process (except when shredding or grinding is
part of a closed system designed in such a way that the air stream
from the process is disinfected before being released).
The technology ranges in size from 300 to 600 pounds per hour and
in cost from $320,000 to $1 million installed, Wetzel says.
Microwave gaining ground
Microwave technology--a heat/thermal induction-based process--is
still not widely used in the health care industry, but is gaining
ground. Sanitec, which has been operating in the United States since
1990, has installed 48 systems in the United States, and a total
of more than 80 units worldwide--most of them at hospitals.
With microwaving technology, the waste is shredded, dry, unrecognizable
and ready for the landfill. It can treat the same types of waste
as autoclaves (excluding toxic waste) and some that it can't. In
most states, microwave technology is permitted to treat biological,
trace chemo and pathological waste, which are not treated by autoclaves.
And if waste streams are properly segregated to prevent hazardous
chemicals from being fed into the treatment chamber, the emissions
from microwave units are minimal, according to HCWH.
Sorensen, of Sanitec, says, "Microwaves give a very thorough kill
of the bacteria. And it's a very clean technology. There are no
air emissions, no liquid emissions. And employees never come into
contact with the waste."
He says the technology has taken longer to take hold in health care
because autoclaves are entrenched in the market and microwaving
is relatively new. HCWH also cites its cost as a drawback, but Sorensen
says it's hard to give a ballpark figure because microwaving is
done as a cooperative venture with hospitals who pay a waste management
fee to use the technology, plus a rate per pound.
"The actual cost of disposal depends on the size of the hospital
and the volume of waste they are treating," Sorensen says.
But the technology can save facilities money in other ways. Sorensen
says the technology can reduce medical waste volume up to 80 percent,
which reduces final waste disposal hauling costs, and the Sanitec
units can be used by facilities to process Health Insurance Portability
and Accountability Act-sensitive medical records. He says a facility
can be expected to save 15 to 25 percent in overall costs.
Other waste disposal options include high-heat thermal technology
in which pyrolosis is usually the dominant process. It operates
at or above the temperature of an incinerator and can handle the
full spectrum of medical waste except for radiological waste and
But HCWH's Emmanuel says he has told a number of hospitals who have
asked him about the process in recent years that he considers the
process "problematic" because it creates some of the same pollutants
"It has the incineration advantage--you could just burn everything--but
then you raise the issue of what are the pollutants you are releasing?
Studies have shown that many are the same type of pollutants created
by incineration," Emmanuel says.
The system also has a high capital cost related to its throughput
capacity, and may especially not be cost-effective for small hospitals.
A very small percentage of the market is taken up by biological
processes that use enzymes to decompose organic waste, and the radiation
process where electron-beam technology bombards medical waste with
radiation, damaging the cells of the microorganisms.
Chlorine or sodium hydroxide chemical systems have a longer track
record, but Emmanuel says the method has raised concerns about contaminants
being released in the wastewater.
One chemical system that he says does occupy a favorable niche in
the market is the alkaline digestion process that is used to convert
animal and microbial tissue into a decontaminated solution. The
system, the Path-Clav, developed by WR2, uses alkaline hydrolosis
at elevated temperatures. "The alkaline digests the organic material
so that what is left is a neutral solution that goes into the wastewater,"
The Path-Clav does not handle the full range of waste streams, but
is designed specifically for tissue waste including organs, placentas,
body fluids and animal carcasses.
With varying regulations and changing technology, hospitals don't
have many constants they can rely on when selecting a nonincineration
But if they consider the most critical factors--type of waste, throughput
capacity, regulatory compliance, environmental emissions, reduction
of waste volume, reliability and cost among them--facilities will
be able to determine which waste management technology best suits