MWM 2nd Quarter 2010 Issue

Continued on page 3

VOL. 6 NO. 2 APR-JUN 2010

Serving The Healthcare And Medical Waste Industries

The staff at Charles Cole Memorial Hospital, Coudersport, Penn, tried to implement hospital-wide recycling about 10 years ago, and Director of Environmental Services Trish

Galeotti is pretty blunt about the results of that program.

“It tanked,” she says. “In a very short time.”She says the reason was simple: that

program required everyone to separate their paper from their glass from their plastic from their cans from their cardboard to avoid contamination of each material. But human nature and time constraints being what they are, employees and visitors either became frustrated and threw everything in the trash, or accidentally tossed the wrong materials into the wrong bins.

It’s not an unusual story, and it’s a reason many hospitals and other large public-access businesses haven’t implemented widescale recycling programs to date. But the dawn of truly single-stream recycling is making the prospect more attractive to businesses like the hospital, and encouraging them to give recycling a try.

Charles Cole Memorial Hospital is located in a rural area of Pennsylvania, where residential

curbside recycling isn’t offered; residents have the option to separate out recycling and take it to a central location if they choose, but it isn’t required. The hospital had been recycling shredded paper and cardboard for several years when Galeotti says she started researching a more wide-scale program last summer.

“We wondered what other kinds of recycling we could do,” she says. “We wanted to increase our recycling efforts and step things up a bit.”

She turned to Casella Waste Management, which was already handling trash pickup and disposal for the hospital, and says she was pleasantly, totally surprised by how much recycling was available, and how simple the program would be, both to implement and for employees and visitors to participate in.

“We had just launched recycling in that county,” says Casella Territory Manager Carrie Carpenter. “We got into a conversation with the hospital about our program and they loved the idea--it had never been available before and they were totally on it.”

Carpenter explained the concept of zero-sort recycling to hospital staff and told them it would be simple to implement.

By Kim Fernandez

Single-Stream Makes Hospital Recycling PossiblePennsylvania hospital introduces widescale recycling to huge success

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Medical Waste ManageMent aPR-JUn 2010 3

Continued from page 1

Publisher / EditorRick Downing

Contributing

Editors / WritersKim Fernandez

P. J. HellerRobert J. Rua

Production & LayoutBarb Fontanelle

Christine Pavelka

Advertising SalesRick Downing

Subscription / Circulation

Donna Downing

Editorial, Circulation& Advertising Office6075 Hopkins RoadMentor, OH 44060Ph: 440-257-6453Fax: 440-257-6459

Email: [email protected]

For subscription information,please call 440-257-6453.

M e d i c a l Wa s t e M a n a ge m e n t (ISSN #1557‑6388) is published quarterly by Downing & Associates. Reproductions or transmission of Medical Waste Management, in whole or in part, without written permission of the publisher is prohibited.

Annual subscription rate U.S. is $19.95. Outside of the U.S. add $10.00 ($29.95).contact our main office, or mail-in the subscription form with payment.

©Copyright 2010 by Downing & Associates

PUBLICATION STAFF“It’s really simple,” says Carpenter,

particularly for a corporate application like the hospital. “You mix all of your paper, glass, tin, plastic, cardboard--all of your recycling--together into one bin. It takes a huge amount out of the waste stream.”

TRAining

Galeotti says that while conventional wisdom says hospitals might have a hard

time keeping inappropriate materials out of the recycling bins, a little forethought helped them have no issues to date.

“It’s easy,” she says. “We needed something that was very simple. We don’t get much participation in these programs unless people can just toss things in there, and that’s what they do with this.”

She says Casella sent her flyers listing acceptable items in a very simple, straightforward way. The company also let her use the trash cans the hospital already had in its offices and waiting rooms; Galeotti simply attached the flyers to some of their cans and made those their designated recycling bins.

“We didn’t have to buy anything,” she says. “We took our garbage cans and put the flyers on them and put them out that way.” The program was so effective, she says, that many offices in the hospital have done away with trash cans entirely and now only have recycling for employees and guests.

“A lot of people just have recycling cans for waste,” she says. “And in an office of 20 people we might only have two cans for trash at this point.”

The hospital has a “green team” of employees who volunteer to push environmental issues to their co-workers. Those people were trained in the new program when it launched last June, and then they explained it to their office mates and helped set out the marked bins for collection. They had to be clear that actual medical waste wasn’t eligible for the program, but employees were used to disposing of those sorts of things separately, so it wasn’t a huge learning curve.

Galeotti trained her environmental services staff on collection just before the program started, and says there have been no problems with recyclables going into the trash or with inappropriate items ending up in the recycling.

“They go around and pick up the recycling and put it all into bags,” she says. “They dump it into a container outside and it gets picked up once a week.”

Pickups increased quickly after the program started, she says. “We started out every two weeks, but now we’re weekly,” she says. “They

show up to pick it up and 99 percent of the time, it’s overflowing. We have 35 people in the environmental services department, and they’re very good at their jobs.” Galeotti says they take a careful look at the bins they empty to ensure there’s no contamination with trash, but so far, that’s not been a problem at all.

FlexibiliTy

One thing that’s made a huge difference, she says, is Cassella’s ability to take a huge

variety of materials in the zero-sort program. Everything from office paper to milk cartons to cardboard goes in; this is in contrast to some programs that disallow anything that’s been in contact with food.

Carpenter says it’s a huge asset that’s helped them convince many companies to give the program a try even if other programs haven’t worked out so well.

“Once we collect the recycling, we take it all to our zero-sort facility in New York,” she says. “We load it all up into 100-yard trailers and they’re all sorted by commodity--paper, cardboard, plastic, glass--all sorted by machinery. We have quality-control staff in each facility who also remove any non-recyclables.”

She says the design of a zero-sort system for offices has helped decrease confusion and increase the success of the programs. “People can get a little confused with sorting,” she says. “This way, all the recycling goes into one bin and all the trash goes into another bin. But no trash can go into the recycling bin.”

The hospital invited Cassella to participate in its Earth Day festivities in both 2009 and 2010, giving Carpenter the opportunity to personally visit with employees, talk to them about the program, and answer any questions they had.

“Communication is the most important part,” she says. “We go out and explain to the staff exactly what the program offers. And we’ve had great feedback.”

She also provided her phone number to hospital staff, and says they’re so enthusiastic about recycling what used to be trash that they don’t hesitate to call her with questions.

“If it’s something they’re unsure of, they call me and ask,” she says. “They’ve sent me samples of different things so I can see if we can recycle specific materials. And that’s great. It increases participation.”

She says she was also careful to explain that even though what’s in the recycling bin is all jumbled up, it really will be recycled.

“It’s a popular misconception that if you mix everything together, it doesn’t get 100

Single-Stream Makes Hospital Recycling Possible

Continued on page 6


By P.J. Heller

Got Meds?

William Anderson and Joe Ball would like nothing more than to see that slogan one day rival the ubiquitous

“got milk” advertising campaign catchphrase. Anderson and Ball, president and vice

president of marketing, respectively, for Curbside, Inc., are working toward that goal by offering local and state governments and agencies and businesses a secure and environmentally sound way for the public to dispose of unused, unwanted and outdated household medications.

Those non-controlled pharmaceuticals typically would either be kept stored for months or years in medicine cabinets, tossed in the trash or flushed down the drain. Each of those options is problematic, ranging from in-home personal safety to identity theft to environmental and health issues.

From an environmental standpoint, pharmaceuticals have been increasingly detected at very low levels in U.S. drinking water, the U.S. Environmental Protection Agency has reported.

“Pharmaceuticals and personal care products are contaminating our waterways and sources of drinking water,” contended Jennifer Sass, a senior scientist with the Natural Resources Defense Council in testimony before the U.S. Senate Committee on Environment and Public Works.

A 2008 report by The Associated Press found that “a vast array of pharmaceuticals . . . have been found in the drinking water supplies of at least 41 million Americans.” Earlier studies, notably by the U.S. Geological Survey in 2002, reported similar findings after it sampled 139 streams in 30 states. It found organic wastewater contaminants and pharmaceuticals in 80 percent of the sampled sites.

While the concentrations of pharmaceuticals in the water supply are small and utility companies say their water is safe, there has been growing concern about the unknown long-term effects of those chemicals on human health.

Enter Curbside, Inc., a Placentia, Calif., company with a 15-year history of managing hazardous wastes generated by households and small businesses primarily through a door-to-door collection program. Part of its efforts now include safely collecting and securely disposing of pharmaceuticals from households.

“For more than 15 years, Curbside has created virtually every type of program necessary to collect all but the ordinary household waste

that can legally go to a sanitary landfill,” the company says.

The Curbside collection program about three years ago added sharps, and then evolved to take in non-controlled medicines. The meds are currently collected in California and Colorado with expansion into other states, notably Texas, on the drawing board.

Other collection programs for various household wastes — everything from chemicals to electronics — are operating in California, Pennsylvania, Illinois, Iowa, Oklahoma and Texas. An estimated 70 percent of those items collected are recycled, according to Anderson.

“ We ’ r e t r y i n g to work with in the green environment, to reduce pollutants in the environment,” he says. “Working with pharmacy associations and public agencies, residents now have effective, convenient locations to drop off their old medicines.”

Sharps that are collected are autoclaved; the pharmaceuticals are pulverized and that waste is then shipped to incinerators for final destruction.

In Colorado, Curbside has been working on a pilot program for about half a year to take back household pharmaceuticals. The program is being managed by the Colorado Department of Public Health and Environment with funding and support from more than a dozen governmental agencies, including the U.S. EPA, businesses and organizations.

The Colorado Medication Take-Back Pilot Project involves the placement of 10 collection boxes, eight along the Front Range and two in Summit County, about 70 miles west of Denver. The project has proven so successful — 93 pounds of pharmaceuticals were collected within the

first month and about 2,000 pounds have been collected since the program’s inception — that it has already garnered a 2010 “Sustainability Champion Award” from among nearly 100 entries. The award was one of six presented, three to individuals and three to teams.

Greg Fabisiak, environmental integration manager for the Colorado Department of Public Health and Environment, said the main impetus behind the program was the fact that pharmaceuticals and ingredients in personal care products were being detected in small amounts

in water systems.“We’re finding things

that you would find in pharmaceuticals, over-the-counter drugs and personal care products —the chemicals that we use in our everyday life — are finding their way to the environment,” he explained. “We know pharmaceuticals are one element of that and we believe it was an area we could actually go after to try to prevent it from

entering the environment.” Fabisiak said that keeping the medications

out of the hands of children, teenagers and drug abusers was also important.

“It’s not just an environmental problem,” he said. “If you have medications that are around a home for a long time, they could fall into the wrong hands, maybe a young child could get hold of them and you have an accidental poisoning or teenagers who are prone to experiment with things . . . and may be tempted to take them and maybe cause harm to themselves or harm to their friends. So we really think it’s good to give people an outlet to get rid of them.

“Keeping waste medicines out of the hands of children and drug abusers and out

Continued on next page

Household Medicines Find Way to Curbside

Photos courtesy of Curbside Inc.


Info Request #113

of the environment is an emerging challenge,” he added. “We want to offer the public an alternative to flushing unused drugs, which can end up in our water supplies.

“We think if we give people a convenient and environmentally sound way to dispose of them they’ll take advantage of that and benefit the environment and their family,” Fabisiak said.

Many residents, who may be concerned about the environmental impact of flushing medications down the drain or tossing them into the trash, will often simply just store them somewhere in their homes.

“In surveys in Colorado, we’re finding that many people have been holding on to their medications for years after they have no more use for them because they don’t know what to do with them,” noted Ball of Curbside, Inc. “They’ve gotten mixed signals. In the past, they’ve been told to flush them down the drain. That message has changed.

“Our program is one of the few viable convenient ways they have found where they could actually feel good about getting rid of their materials,” he said.

The Colorado pilot program is expected to last two years and if successful, could be expanded into a sustainable statewide operation.

“We think the need is out there,” Fabisiak said, noting that the program has already received “overwhelming public response.”

“The only negative complaint about the program is that there aren’t enough locations,” he said.

The Colorado program, similar to efforts in California, involves placing secure steel collection boxes at convenient locations — such as pharmacies, libraries, city halls, senior centers and supermarkets — where the public can drop off such things as prescription and over-the-counter medications, vitamins, inhalers, liquid medicines in glass or leakproof containers and even pet medications. Narcotics and other controlled substances which are not permitted are listed on the collection boxes.

The boxes have double locks, requiring both a Curbside employee and a person where the box is located to access the pharmaceuticals. Once removed from the drop box, the material is immediately brought to Curbside’s 18-foot self-contained box truck, where a specially designed machine destroys the pharmaceuticals, including plastic vials and containers. That pulverized material is then shipped to an incinerator for final destruction.

“We didn’t want to be in possession of any of these materials in their original form so we designed equipment that allowed us to grind up the bottles and tubes right on site,” Anderson said.

In addition to the drop boxes, Curbside has provided collections at special events and has done door-to-door pickups in connection with its home hazardous waste collections. The company also is employed by some governmental agencies to collect sharps from homes; those collections typically occur when sharps have

filled a two gallon container. Curbside also has drop boxes in various locations to collect sharps; containers for both sharps and non-controlled pharmaceuticals can often be found side-by-side in pharmacies for customer convenience.

“We started with sharps a few years ago when the California Legislature made it illegal to toss them in the trash,” Anderson recalled. “Governments needed to find a fix and we were there with a solution.”

The Orange County (Calif.) Pharmacists Association has endorsed the take-back program operated by Curbside and has encouraged its members to begin accepting waste pharmaceuticals from the public. At least four pharmacies are participating in the program.

“We know that our customers want to do the right thing with their waste medicines,” said Jack Silberstein of Grove Harbor Medical Center Pharmacy in Garden Grove, one of those participating in both the sharps and medicine take-back programs. “It is important that we provide this service to them.”

Grove Harbor was the first pharmacy in California to be designated as having a model pharmaceutical collection program under guidelines established by the California Integrated Waste Management Board. Only a handful of pharmacies in California have received that designation.

The board’s Web site includes a searchable database of collection locations statewide for disposal of sharps and pharmaceuticals.

Silberstein, a board member and past president of the Orange County Pharmacists Association, funds the sharps and pharmaceutical collection costs out of his own pocket. He has encouraged other pharmacists to get onboard with the program as well.

“I think it has to be done,” he said of protecting waterways from household medications. “It’s a real major problem and it’s only going to get worse.”

Silberstein said he would like to see the collection program expanded to include controlled substances. He also would welcome drug companies taking product stewardship for their products, helping to fund disposal costs of medicines and sharps.

Having carved out their specialty niche, Anderson and Ball said they have no plans to expand offerings to hospitals or doctors’ offices, noting that such facilities are already served by much larger companies. Curbside does collect from a few doctors’ offices who have been referred to the company but it doesn’t actively solicit wastes from medical offices or hospitals.

“That’s not what we want to do and if it [collecting from doctors’ offices] actually got in the way, we wouldn’t do it anymore,” Anderson said. “That’s just not the direction we want to go in. We think we’re going to be much more successful sticking to what we know.

“Our specialty is working with public agencies to solve problems they believe exist with different waste streams,” he explained. “We’re all about home-generated materials. Our whole business is really focused on that.”

Continued from previous page


Info Request #120

percent recycled,” she says. “When you see it all mixed together, it really does look like trash. But we make it very simple to recycle by mixing it that way, and we tell people that we get more recycled materials as a result.”

Selling iT

Galeotti says that while many companies in other areas of the country see rebates

for recycling more, that’s not available in her area of Pennsylvania. But the hospital is saving money on trash pickup.

“There’s a cost difference,” she says. We’ve reduced our amount of regular waste. That regular waste goes into a compactor, and we pay $130 per ton for disposal plus a tipping fee. Recycling it is cheaper. So our costs are down.”

Carpenter says that’s something she explains to every business that’s considering zero-sort recycling. “Recycling saves the company money and lets them do the right thing,” she says. “Initially, it’s hard to gauge how much a company will save. But if the zero-sort recycling program goes well and everybody participates and sorts out their garbage, we do predict that they’ll save money, even though initially they may spend X amount of dollars per month to get the program rolling. You

Single-Stream Makes Hospital Recycling PossibleContinued from page 3

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divert a lot from the waste stream, and that does add up to a savings.”

Thanks to zero-sort, Carpenter says she’s seeing more campus-based businesses willing to give recycling a try.

“We have several hospitals on board,” she says. “We also have several colleges, schools and school districts recycling with us.”

Galeotti says she’s in constant communication with hospital employees, reminding them through emails and flyers what they can and can’t recycle in the bins around the campus.

“We also tell them how many trees we’ve saved and how much water we’ve saved so far,” she says. “And Cassella gives us any information we request. A lot of clinical doctors’ main concern is patient care, not recycling. It has to be extremely simple to work, and this program is.”

Carpenter says that’s key for any large office situation.

“We’ll come in and do a presentation or come in and set up a stand for people to ask questions,” she says. “Communication is big with this. If someone understands they can recycle everything, 10 to one, they’re going to do it. If they’re confused, they’re simply not going to do it.”

Photos showing Casella’s zero sort recycling process. The material flows through several different processes to be sorted by commodity. Visit www.casella.com to view the zero sort recycling online video.


Info Request #106

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TrinovaMed_1-3pg_sq_ad2.indd 1 4/22/10 4:29:42 PMInfo Request #111

Antibiotics Might Team Up to Fight Deadly Staph Infections

Researchers at the University of Illinois at Chicago and Israel’s Weizman Institute of Science have found that

two antibiotics working together might be more effective in fighting pathogenic bacteria than either drug on its own, reports sciencedaily.com.

Lankacidin and lankamycin, two antibiotics produced naturally by the microbe streptomyces, are only minimally effective in warding off pathogens when given individually, says Alexander Mankin, professor and associate director of the UIC Center for Pharmaceutical Biotechnology and lead investigator of the portion of the study conducted at UIC.

Mankin’s team found that when used together, the two antibiotics are much more successful in inhibiting growth of dangerous pathogens such as MRSA, or methicillin-resistant Staphylococcus aureus, and possibly others.

The research results are published in the Jan. 11 online edition of the Proceedings of the National Academy of Sciences of the USA.

Lankacidin and lankamycin act upon the ribosomes, the protein-synthesizing factories of the cell. A newly-made protein exits the ribosome through a tunnel through the ribosome body. Some antibiotics stave off an infection by preventing the ribosome from assembling proteins, while others bind in the tunnel and block the protein’s passage.

Through the use of X-ray crystallography, which determines the arrangement of atoms in biological molecules, the Israeli team, led by Ada Yonath, a 2009 Nobel Prize winner, discovered the exact binding site of lankacidin in the ribosome. Mankin’s group demonstrated that lankacidin prevents the ribosome from assembling new proteins.

However, when researchers realized that streptomyces also manufactures lankamycin, they became curious whether the two drugs might help each other. Biochemical analysis and molecular modeling showed that lankamycin binds in the ribosomal tunnel right next to lankacidin.

“What we found most amazing is that the two antibiotics appeared to help each other in stopping pathogens from making new proteins and in inhibiting bacterial growth,” Mankin said.

Today, many companies are attempting to make individual drugs better, Mankin said. What the research suggests is that in some cases, it is a “much better strategy not to improve individual drugs, but the combinations of drugs that can act together.”

Nyack Hospital Stays Ahead of the Pharmaceutical Waste Compliance Curve

As legislators in New York consider more stringent regulations for pharmaceutical waste disposal, at least one hospital, Rockland County’s Nyack Hospital (NH) – a 375-bed acute care medical and surgical hospital – is getting proactive. NH has gotten ahead of the

compliance curve by enacting a pharmaceutical waste management program, reports nyackhospital.org. Using an extensive sorting process, NH’s pharma waste is characterized, segregated, transported and safely disposed. The program, say NH officials, ensures that everything from packaging to applicators to the drugs themselves are prevented from becoming a threat to the environment or human health. It also helps keep pharmaceuticals from being flushed down toilets and drains where they can eventually find their way into drinking water supplies.

NH’s timing couldn’t be better. The New York Attorney General’s office recently cracked down on five hospitals whose lax pharmaceutical waste disposal practices led to violations of the Clean Water Act. Nationally, the effect of improperly disposed pharma waste has become a hot button topic. According to a report by the Associated Press two years ago, pharmaceuticals have been detected in the drinking water of 41 million Americans.

As part of the compliance program, NH follows the state Department of Environmental Conservation guidelines and provides extensive training for its nursing and pharmacy staff to show patients how to properly dispose of their medications. While many hospitals are just beginning to understand the importance of establishing comprehensive waste disposal programs, NH is a step ahead. “We feel confident that we are making a positive, long-term impact on the environment and responsibly segregating pharmaceutical waste in a cost effective manner,” says one NH representative.

Target your products, equipment & services to more than 5,000 healthcare facilities & medical waste contractors... Advertise in Medical Waste Management! Call today 440-257-6453.


ARCH ENTERPRISES, INC.

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Arch Enterprises is one of the nations leading precious metal refiners. Located in central Missouri, Arch provides recovery for all scrap precious metal including gold, silver, platinum, and palladium. We perform extraction services for the medical, dental, photo, jewelry and catalyst industries. Arch Enterprises specializes in the processing of medical x-rays with the intentions of recov-ering silver and polyester plastics. We are able to process these x-ray films with or without the paper and file jacket material that normally accompanies these types of medical records. Arch Enterprises even goes the extra step and offers free professional purge service of your medical archive film. We know that with the current state of the economy, it is a relief for our hospital clients as they don’t have the extra time and over-time expense that goes into purg-ing file archive rooms themselves. Additional recovery services from the medical field include: 1. EP Catheter tips 2. Antimicrobial dressings 3. Defibrillator pads 4. Silver recovery units Benefits of dealing with Arch: 1. There is no middleman, we own and operate our secure extraction facilities located in the

United States. 2. In compliance with all local, state, and federal environmental regulations. 3. In compliance with all HIPAA regulations. 4. We carry both general and environmental liability insurance policies. 5. Refining terms contingent upon the quantity of material you have. 6. No hidden fees. 7. Up front and honest service for all customers. One Arch Drive, Mexico, MO 65265 • (800) 835-0478 • www.archenterprises.com

Info Request #136

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New Study Examines US Health Care Sector’s Carbon Footprint

University of Chicago researchers recently completed a ground-breaking study of the US health care sector’s carbon footprint, reports sciencedaily.com. According to the research team, the health

care sector currently accounts for 8 percent of the nation’s overall carbon dioxide emissions, the main cause of global warming. The lead author says she hopes the study results will draw more attention to the impact of health care on the environment. “In this country,” she says, “the primary focus is on issues surrounding patient safety, health care quality and cost containment… The health care sector, in general, may be a bit slower than other sectors to put this on their radar screen. But given the focus on health care policy and environmental policy, it might be interesting – if not wise – to start accounting for environmental externalities in health care.”

The research team determined health care’s carbon footprint by examining health care spending using a model of environmental impact called the environmental input-output life cycle assessment (EIOLCA) model, which was developed by the Green Design Institute at Carnegie-Mellon University. The EIOLCA assesses the direct and indirect effects of health care activities on the environment, as well as of the production and distribution of health care commodities. “Carbon intensity,” a measurement of environmental impact, is estimated by each dollar of commodity produced. This complex model of assessment, researchers claim, yields an accurate gauge of overall carbon emissions.

Not surprisingly, hospitals were found to be the largest contributor of carbon emissions in the health care sector due to their high energy demands. The pharmaceutical industry came in second, attributable largely to the high energy demands associated with manufacturing and transportation.

“Obviously, health care… is very highly valued; you’re not going to shut down a hospital because of its environmental impact or not produce a drug that you think is going to save lives because of carbon output,” says the study’s lead author. “But this reminds people in health care that we’re not a trivial part of the issue.” The research team suggests that hospitals improve their energy efficiency by adopting recycling programs and by purchasing supplies from environmentally friendly suppliers. These types of measures can have a huge impact. For example, the University of Chicago Medical Center’s sustainability program diverts more than 500 pounds of waste from landfills every day and has saved roughly $15,000 in energy costs annually.

EPA Proposes Adding Hazardous Pharma Wastes to the Universal Waste Rule

EPA officials recently proposed adding hazardous pharmaceutical wastes to the Universal Waste Rule as part of a larger effort to protect public health and the environment, reports epa.gov. In

addition, the agency has called for a simpler, more streamlined system for disposal that will make it easier for generators to safely collect and dispose of hazardous wastes. The proposed rule would apply to pharmacies, hospitals, physicians and dentists offices, outpatient care centers, ambulatory health care services, veterinary clinics and other facilities that generate hazardous pharma wastes.

The rule would also make it possible for generators to dispose of non-hazardous pharma waste as universal waste, and thus remove unregulated waste from wastewater treatment plants and landfills. The collection of personal medications from the public for proper disposal would be facilitated at various locations across the nation. Currently, the Universal Waste Rule includes such items as batteries, pesticides and a variety of other items found in industrial and household settings.

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Nationwide Campaign Encourages Consumers to Recycle Electronic Devices

AT&T recently partnered with the EPA to raise awareness of the importance of recycling outdated and unwanted wireless devices and accessories during the EPA’s Plug-In to eCycling National Cell

Phone Recycling Week, which ran from April 5 – 11, reports prnewswire.com. AT&T will support Plug-In to eCycling by promoting it in its stores and online, and through the efforts of AT&T Pioneers, a group of environmentally-conscious AT&T volunteers.

AT&T offers a program that allows customers of any carrier to drop off their used cell phones and accessories at any of its more than 2,000 U.S. stores. The company also provides free, downloadable shipping labels for customers to mail in their old phones for recycling. A portion of the proceeds from this program benefit Cell Phones for Soldiers, a charity that sends free phone cards to troops stationed overseas.

Last year, AT&T collected more than 4.2 million cell phones and almost 1.8 million pounds of batteries and accessories for recycling through its own recycling program. The company’s officials estimate that by 2011 AT&T will have collected 14 million wireless devices for recycling – which translates to about 920 tons of primary materials and more than 13 tons of toxic waste diverted from landfills.

The EPA’s Plug-In to eCycling program began in 2003. The program facilitates partnerships with consumer electronics manufacturers and retailers to increase recycling opportunities and to empower consumers with information on how to donate or recycle their unwanted televisions, computers, cell phones and other devices.

Subscribe to Medical Waste Management. Call today 440.257.6453.

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Info Request #133

Researchers to Study the Effects of H1N1 on International Travel

The Public Agency of Canada recently shelled out $176,000 US to a Toronto-based research team to study whether or not warnings against traveling to Mexico during the height of the H1N1 flu

pandemic influenced international air traffic patterns, reports thestar.com. The agency specifically wants to know if the warnings of Canadian and international public health officials had any impact on commercial air travel during the outbreak. Their goal is to determine whether or not travel warnings really do any good. The World Health Organization has grown increasingly hesistant to issue travel warnings because of their detrimental effect on international trade and tourism.

Agency officials say the study could also help the Canadian government decide if it should improve quarantine measures or change the way it screens airplane passengers. Researchers say they expect to find that travel advisories have little effect. Anecdotal evidence suggests economic factors are the driving force behind commercial air travel patterns. Evidence also suggests that warnings issued by public health officials actually made things worse, causing a mass exodus of 2.4 million people from Mexico and thereby exponentially spreading H1N1.

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Bio Care Owner Accused of Fraud

Police recently arrested Paul Montano – owner of Bio Care, a company that receives donated bodies and their internal organs and body parts for biomedical research and medical and pharmaceutical

studies – after finding heads and other body parts at a medical waste facility in Kansas City, Kansas, reports kansascity.com. The body parts had been donated to Bio Care and were supposed to be cremated. Montano is facing three counts of fraud.

According to Montano, after Bio Care harvests organs from donated bodies the bodies are refrigerated. When the harvested organs are returned, the bodies are reassembled, cremated and the ashes are sent to the families. The company pays the cremation costs, which run from $600 to $1,800. Bio Care has a contract with the medical waste disposal company Stericycle to dispose of medical waste, soft tissue and organs, but not heads and torsos.

Reportedly, shipments to New Mexico Learning Center, one of Bio Care’s clients, have been getting increasingly larger over the past three months. Riverside Funeral Home, which also did business with Bio Care, reports that many bodies scheduled to be delivered for cremation have never been received. Investigators say three of the bodies that were found have death certificates that say they’ve already been cremated. Some of the body parts, they add, appear to have been dismembered by a chainsaw or similar instrument.

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Info Request #128

Website Helps Consumers to Safely Dispose of their Pharma Waste

Thanks to a new website – disposemymeds.org – consumers in 40 states are finding it easier than ever to safely dispose of their unused and unwanted medications, reports stormh20.com. The website

allows consumers to search by city, state or zip code for collection sites that participate in “Dispose My Meds,” a program facilitated by the National Community Pharmacists Association (NCPA) and Sharps Compliance Inc. (SCI) to collect and properly dispose of pharma waste. Currently, nearly 800 pharmacies are participating in the program.

An estimated four billion prescriptions are written in the US each year. About 40 percent of the drugs that are not dispensed in hospitals are never taken, creating roughly 200 million pounds of unused pharmaceuticals annually. These unused meds not only find their way into the drinking water of millions of Americans, they are also a leading cause of accidental poisoning.

NCPA is encouraging other community pharmacies to voluntarily sign up for the “Dispose My Meds” program. NCPA President Joseph Harmison says, “Safe and practical disposal programs make a real difference in addressing this growing public health concern. I commend these pharmacies for stepping up for the good of their communities and their patients… hopefully, consumers will gain a greater appreciation of their local community pharmacy. I also appreciate the support our allies and sponsors have shown for this effort.”

Many of the pharmacies participating in the ”Dispose My Meds” program are using the TakeAway Environmental Return System, through NCPA and SCI partnership. “We are proud to work with NCPA and its membership to more efficiently and effectively address the problem pharmacists, patients and communities face with unused patient medication,” says Claude A. Dance, SCI’s Senior Vice President of Sales and Marketing. “It also gives patients and pharmacists’ proactive adherence and counseling opportunities to ensure patients are taking the meds as prescribed by their physician as well as a way to safely discard their unused medications and keep our communities safer.”


Info Request #112

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Englewood Hospital Launches Pharma Waste Disposal Program

New Jersey’s Englewood Hospital and Medical Center (EHMC) recently launched a new pharmaceutical waste disposal in partnership with Stericycle’s Pharmaceutical Waste Compliance

service, reports paramuspost.com. The partnership, say EHMC officials, will help the Center ensure compliance with state and federal regulations and create a positive impact on the environment over the long-term. Safe disposal of pharma waste is becoming increasingly important as least ten US states have passed or are likely to pass more stringent disposal regulations.

In 2008 the Associated Press reported that pharmaceuticals were detected in the drinking water of more than 41 million Americans. EHMC is doing its part to address this problem. “Disposal of medical waste requires careful attention,” says EHMC’s Director of Environmental Services. “Waste must be properly characterized, segregated, transported and documented.”

Mecklenberg County Residents Urge Regulators to Shut Down Incinerator

Residents of North Carolina’s Mecklenberg County are pressuring state regulators to shut down a medical waste incinerator operated by Healthcare Waste Solutions (HWS) in the town of Matthews,

reports charlotteobserver.com. According to one state official, most of the materials being incinerated by HWS – between 90 to 95 percent – could be disposed of using less environmentally harmful methods. HWS representatives have admitted that much of the waste doesn’t need to be burned, but claim no practical alternatives exist for the disposal of body parts, tissues and other pathological wastes.

Contrary to this claim, N.C. regulators actually approved two pathological waste disposal alternatives last December – both involve shredding the waste, then treating it with ozone or chemicals. HWS’s operations manager says these methods are not “commerically viable, demonstrated technology.”

The Matthews incinerator’s air permit is currently up for renewal, and the town’s residents are putting the heat on Mecklenburg County officials to speed up the enactment of tighter restrictions on incineration which are scheduled to take effect in 2014. Residents have been complaining about the incinerator for years. The facility was shut down in 2000 due to complaints, but HWS has since invested $1.5 million to meet air regulation standards.

HWS says the facility must stay open to treat the high volume of medical waste generated in the Charlotte area. Carolinas Medical Center (CMC) in Charlotte, for example, generated 1.6 millions pounds of medical waste in 2009 alone. However, CMC contracts with Stericycle to treat and safely dispose of most of its waste. Novant Health, which operates four hospitals in Charlotte, generated 2.3 million pounds of medical waste last year. Only 16 percent of it was incinerated, the rest was steam treated.

Increased federal regulations have reduced the number of U.S. incinerators from 4,000 in 1990 to just 57 in 2010, but many health care facilities still send their waste to incinerators to save money and avoid liability over improper disposal. But many hospitals spend money on treating waste that doesn’t need to be treated. Blood, bandages, tubing and gloves can all be thrown away; disease-carrying agents can be disposed of after treatment with microwaving or autoclaving. Incineration, however, is almost always less expensive than these methods.

Info Request #114

Info Request #105

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Study Examines Hospital-Acquired Infections

According to researchers with Resources for the Future (RF), a nonprofit research organization that examines public health issues, hospital-acquired infections may cause as many as 48,000 deaths

annually in the US, reports abcnews.com. In an examination of hospital discharge records from 40 states dating from 1998 to 2006, RF found that sepsis and pneumonia were the most common fatal infections. They also estimated that these two kinds of infection alone cost more than $8 billion to treat and lead to more than 2 million days of hospitalization.

The lead author of the study says, “It’s something that deserves a much stronger response from public health authorities than it has (received) so far.” While the problem of hospital-acquired infections has been known for a long time, the overall scope of the problem has been unclear. RF hopes its study will lead to a sea of change in the way health care providers handle the prevention of such infections.

Experts still say the simple act of washing one’s hands remains the single best way to prevent the transmission of hospital-acquired infections. Patients are advised to ask their health care providers what they do to prevent infections, whether or not they will administer antibiotics before a procedure and whether or not they should be screened for an MRSA.

Researchers Study the Effects of Pharma Waste on Fish

In a recent study, researchers with Umea University and the Sahlgrenska Academy of the University of Gothenburg, Sweden discovered traces of pharmaceuticals in the blood of fish that had been exposed to

treated waste water from sewage treatment plants in Stockholm, Umea and Gothenberg, reports sciencedaily.com. The hormone levonorgestrel, found in contraceptive pills, was found in higher concentrations in the fish’s blood than in women who take contraceptive pills. It is estimated that between 80 and 90 million women use contraceptive pills worldwide. Even small amounts of levonorgestrel (less than a billionth of a gram per liter of water) can lead to fish infertility.

Levonogestrel is a synthetic hormone designed to mimic the female sex hormone progesterone. Scientists have known for almost a decade that the synthetic hormones found in contraceptive pills can affect fish living downstream from sewage treatment plants, but until now the line between safe and unsafe concentrations was unclear. Researchers say their findings will help the waste treatment industry better understand which substances need to be removed from waste water.

EPA Awards $2.4 Million to Green Businesses

Sustainablebusiness.com reports that the EPA has awarded nearly $2.4 million to more than 30 small businesses in 16 states that are committed to developing sustainable technologies to protect

human health and the environment through its Small Business Innovation Research (SBIR) program. The SBIR program was established to help ensure that new technologies are developed to solve environmental problems. Among the technologies supported by these grants is the clean up and monitoring of hazardous waste.

To be eligible to participate in SBIR, a small business must have fewer than 500 employees, and at least 51 percent of the business must be owned by US citizens. The EPA will be accepting applications for the development of new environmental technologies until May 11, 2010.

Research Finds Office Staff Still Hanging on to Paper

According to content management association AIIM, office staff loath to give up paper copies, despite the wide availability of scanners and document management systems. AIIM’s recent

survey found that 62% of important paper documents are still archived as paper. Even when documents are sent off for archive scanning, 25% are photocopied beforehand “just in case”. Less than a third of the paper originals are systematically destroyed after scanning. AIIM’s President, John Mancini comments, “We are at last in a situation where electronic archiving of records is efficient, effective and can save huge amounts of space, and yet most office staff seem to be hanging on to paper in the mistaken view that there is some legal reason to do so.”

“Despite the fact that the legal admissibility of scanned paper documents has been established for nearly 20 years, and is nailed down in legislation and standards around the world, there is still this suspicion among users that they may need to produce the original paper copy at some stage,” continued Mancini. “The fact that searching for - and finding - a paper copy is umpteen times more difficult than finding an electronic one seems to have escaped them.” In the survey, 70% of the respondents agreed with the statement, “Users feel that paper records are needed for legal reasons.” Even at the organizational level, in 25% of businesses the legal admissibility of scanned documents is still seen as an issue.

“In many organizations,” says Mancini, “there is a potential win-win situation, but only half of the benefit is being leveraged. Improved searchability of business documents is the biggest user driver for investments in scanning and capture, and yet a more visible benefit – reduced storage costs for records – is unrealized because of this obsession with holding on to the paper.“

Based on over 850 responses, the AIIM research report is entitled “Document Scanning and Capture: local, central, outsource - what’s working best?” Part of the AIIM Industry Watch series, the full report is free to download from the AIIM website at http://www.aiim.org/research/document-scanning-and-capture.aspx.

Medical Gamma-Ray Cameras Could Help Stop Nuclear Waste from Seeping into the Environment

Scientists with the Universities of Manchester and Leeds (UK) say medical gamma-ray cameras used to diagnose patients with heart disease and cancer could help prevent nuclear waste from

seeping into the environment, reports sciencedaily.com. Working with experts in nuclear medicine with the Manchester Royal Infirmary, the team of scientists used gamma-ray cameras to track radioactive isotopes of the element technetium (Tc) in soil samples from a US civil nuclear site in Oak Ridge, Tennessee. Tc is not only produced in abundance by nuclear facilities, it is also used as a medical tracer in human bodies.

Nuclear power plants release tons of Tc into the environment. While the medical isotope of Tc is short-lived, Tc produced by power plants can remain radioactive for thousands of years (though chemically the two isotopes are indistinguishable). Using their gamma-ray cameras, the research team was able to successfully and accurately track the movement of Tc through the soil at the Oak Ridge site. They were also able to confirm that certain microbes, especially those that use ferric iron for energy, can fix Tc in place in soils. The team hopes this method of tracking will lead to better soil remediation techniques that trap radioactive elements and stop them from spreading in the environment.

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Info Request #114

New Agreement Simplifies Pharma Waste Evaluation

The Minnesota Hospital Association (MHA) and the Minnesota Pollution Control Agency (MPCA) recently

reached an agreement to remove controlled substances from the list of criteria health care providers must consider when determining whether or not pharma waste must be handled as hazardous waste, reports mnhospitals.org. The MHA and MPCA are calling the agreement the “alternative method for evaluating pharmaceutical waste.” While this title may not be very catchy, the new evaluation rules will undoubtedly be welcomed with open arms by health care providers operating in Minnesota. Ultimately, the new rules will make the process of properly disposing of pharma waste less complicated, meaning more time and resources can be devoted to patient care.

The MHA plans to begin hosting training programs for the new evaluation method in May. These programs will feature breakout sessions for safety, pharmacy and lab directors as well as clinic and long-term care staff.

New York Health Care Facilities Agree to Clean Up Their Act

Dotmed.com reports that the New York Attorney General Andrew Cuomo has reached a settlement with five

health care facilities to curtail the disposal of pharmaceutical waste into the state’s watershed. Under the settlement the facilities will use the services of waste management companies to treat their pharma waste. The five facilities reportedly flushed unused painkillers, antibiotics, hormones and other waste materials into a watershed area that supplies drinking water for almost half of New York’s residents.

Cuomo says all five facilities were guilty violating federal waste management laws, state regulations and the Clean Water Act. “The 9 million people who get their water from the New York City Watershed enjoy some of the cleanest, safest and best water in the world,” he adds. “We need to make sure it stays that way. These groundbreaking settlements provide a new model to implement immediate and sensible precautions to keep waste drugs out of the drinking water supply.”

HCC Implements Recycling, Conservation Programs

Th e H o s p i t a l o f C e n t r a l Connecticut (HCC) recently announced its newest commitment to air and

water quality standards and diminishing its environmental impact by implementing several waste stream solutions.

In May HCC will launch a program to dispose of pharmaceutical waste, in an effort to keep medications out of the environment. While the hospital says that it has always followed current state and federal regulations on proper disposal of pharmaceuticals deemed potentially hazardous, research is revealing the potential detrimental effects of other pharmaceuticals not covered by regulations.

HCC has also begun using reusable containers for all of its used sharps, such as needles and scalpels, to help keep plastic out of landfills. The hospital expects in one year to prevent 27,553 pounds of carbon emissions by diverting 47,008 pounds of plastic and 2,508 pounds of cardboard from landfills.

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Department of Veterans Affairs Launches Medical Waste Disposal Pilot Program

The US Department of Veterans Affairs (VA) recently launched a pilot program that seeks to ensure the proper disposal of medical waste and unused medications at hospitals and large health

care facilities, reports healthcarefinancenews.com. The program is being executed within the VA Capitol Health Care Network (CHCN), which provides care for eligible veterans in Maryland, Virginia, West Virginia, Pennsylvania and the District of Columbia. The program is made possible through a collaboration with Sharps Compliance Corp (SCC), a Houston-based company that provides medical waste disposal solutions. SCC provides such services as the Sharps Disposal By Mail System and RxTakeAway solutions.

The CHCN consists of four medical centers, a rehabilitation center and fifteen outpatient clinics that serve roughly 780,000 veterans. Each veteran that participates in the program receives a survey designed to help the VA assess the program’s efficacy and ease of use. SCC’s CEO says he hopes that the program may one day be expanded throughout the Veterans Health Administration. Last year, SCC was awarded a five-year federal supply schedule contract by the US General Services Administration and a $40 million contract with the government to provide its Medical Waste Management System service.

John Hopkins University Researchers Advocate for Recycled Medical Equipment

In a recent study released in the journal Academic Medicine, researchers with the John Hopkins University School of Medicine noted that with proper sterilization, recalibration and testing, the recycling of such

single-use equipment as laparoscopic ports is safe, reports sciencedaily.com. Recycling medical equipment, they add, could save hospitals millions of dollars annually and reduce the amount of trash generated by the health care industry, which is currently second only to the food industry in terms of the amount of waste produced annually.

The lead author of the study says, “No one really thinks of good hospitals as massive waste producers, but they are.” Hospitals, he adds, routinely toss away surgical gowns, towels laparoscopic ports and expensive ultrasonic cutting tools after a single use when it’s simply not necessary. Some items are even thrown out without ever having been used, for example, single use devices that have been removed from their packaging. The John Hopkins study urges hospitals to procure items designed specifically to be used more than once (after sterilization, of course).

Reprocessed medical devices have become an increasingly tantalizing option for cash-strapped hospitals as they cost about half as much as new equipment. Banner Health in Phoenix, Arizona, for instance, saved almost $1.5 million last year by using reprocessed compression sleeves, pulse oximeters and other devices. Despite the potential for big savings, the practice of using reprocessed devices is not yet widespread due to safety concerns such as malfunction and transmission of infections.

Under US law, all reprocessed medical devices must be labeled as such and include the name of the company that did the reprocessing – a measure aimed at assuaging patients’ fears. Though the Government Accountability Office (GAO) has declared labeled devices safe for reuse, many remain wary. “The devices are safe, but it’s a public relations challenge,” says one GAO officer. “Some people don’t like the idea that they’re being treated with equipment that has been used before. But these reprocessed devices are as good as new since the testing standards for reuse are impeccable and there have been no patient safety problems in our analysis.”

California Landfill Linked to Birth Defects

EPA officials recently sent a notice of violation to a landfill in Fresno, California operated by Chemical Waste Management (CWM) for the improper disposal of polychlorinated biphenyls

(PCBs), a chemical known to cause cancer, birth defects and reproductive problems, reports the Associated Press. According to the EPA, CWM has failed to follow up on a several violations that were first noted in 2005. Improper treatment and storage of hazardous waste are among the violations. The landfill is the largest in the western US.

CWM has been fined several times for failing to monitor landfill seepage. Its Fresno landfill has been linked to at least eleven birth defects in the past three years. Representatives of the company claim there is no substantial evidence to prove that PCB seepage caused the defects. Until recently the EPA had taken relatively little disciplinary action against CWM.

In 2007, EPA investigators determined that CWM had been using PCB testing equipment that was incorrectly calibrated. They also found that PCB leachate was improperly diluted before being illegally placed in evaporation ponds containing the solvents acetone and toluene, both of which can be detrimental to the environment and human health. Senator Barbara Boxer has accused the EPA of negligence and expressed outrage that no action was taken when the violations were first discovered. In response, the EPA has begun taking air, soil and water samples in the region around the landfill.

Illinois Pharma Round Up Program Aims to Protect Environment, Human Health

The Illinois American Water Company (IAWC), Tazewell County Health Department and the Pekin Police Department recently teamed up to create a pharmaceutical collection and

safe disposal program, reports pekintimes.com. Since last November the program has collected more than 150 pounds of unwanted prescription and non-prescription medications, not including the weight of packaging or containers.

The IAWC has started six similar projects throughout Peoria County and northern Illinois. IAWC spokesperson Karen Cotton says the plan is to eventually take the program statewide. “This is something we have needed for a long time,” she adds. “I think the residents of the county really find this program valuable. We have people call all the time. They have all these medicines and don’t know how to dispose of them. The program is working very well.”

Tazewell County Sheriff Robert Huston says he’d like to take the succesful program to other municipalities. Right now, he adds, people have to drive from around the county to Pekin to drop off their old medications. Huston has contacted other police departments to help bring the program closer to residents in their jurisdictions, but many have expressed concern over liability exposure.

“When a department takes custody of drugs, or any property, they have to be very careful because they are responsible for the control of those drugs and destroying them,” says Huston. “The abuse of prescription drugs is growing at an alarming rate. We want to do whatever we can to make these drugs less available to people who would abuse them or sell them.” Under the protocols of the US Drug Enforcement Agency, controlled medications like vicodin and oxycodone must be only be handled by police officers when being destroyed.


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PAGE 15John Hopkins University Researchers

Advocate for Recycled Medical EquipmentPAGE 18

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