Medical waste.

In the past few years, public concern over the disposal of medical waste has markedly increased. The rising concerns over medical waste disposal were stimulated by reports of such waste washing up on the beaches along the east coast from Maine to Florida, the west coast, the Great Lakes, and the Gulf coast. This resulted in a number of beach closings and a loss in revenues to the tourist industries in these areas. While there also have been rare and isolated instances of public exposure, such as the report in 1987 of children in Indianapolis, Indiana, who were found playing with needles and vials discarded by a doctor’s office, the literature shows no instances of public illness caused by such exposures. While the problem of medical waste washing up on beaches is a serious one, the problem is less sensational than the media, general public, and legislative reaction would imply. For example, the quantity and volume of medical waste washing up on beaches is relatively small. This is one of the conclusions of four largely unnoticed reports of the beach washups that found that the vast majority of waste on beaches was debris (about 99%) such as plastic, glass, and paper, not medical waste. l4 Despite extensive investigations, the washed-up medical waste found could not be traced to illegal dumping or a specific source such as hospitals, but was more directly related to improper control of New York City’s solid waste stream (e.g., malfunctioning sewage treatment systems) and changes in prevailing winds and currents.’ Additionally, Environmental Protection Agency (EPA) documents acknowledge that much of the medical waste that washed ashore in the summer of 1988 was syringe-related (65%) and came from home healthcare and illegal intravenous drug use.2,5 Chemical analysis of a few syringes collected during the EPA Harbor Studies Program have identified insulin and/or cocaine in 60% (3/5).6 In spite of the failure of investigative efforts to uncover illegal dumping of medical waste and the absence of any evidence that medical waste has ever caused an infection in any person outside of a healthcare facility, the Medical Waste Tracking Act (MWTA) was signed into law on November 1, 1988.5 Fueling the fears of the public about medical waste are such concerns as the hypothetical risk of medical waste for transmitting the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other agents associated with bloodborne diseases. The public also is concerned about the emissions from incinerators that burn medical waste and whether these emissions may contain microorganisms or toxic substances. Thus, a lack of understanding of the modes of transmission of agents associated with bloodborne diseases, the fear of a fatal disease such as the acquired immunodeficiency syndrome (AIDS), and a distrust of healthcare facilities accentuated by intense and often misleading media coverage has led to intense public pressure on federal, state, and local politicians to regulate medical waste. Responses by state governments have ranged from no regulation of medical waste to imposition of extensive regulations including refrigeration of medical waste while stored and awaiting transport to a waste disposal facility, inclusion of any article stained with blood or body fluids in the definitions of regulated medical waste, and elaborate procedures and