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Medical waste is generally defined as any solid waste generated during the medical diagnosis or treatment of humans or animals, in related research, or in the production of biologicals used in clinical activities. Concern about medical waste streams has been growing. Syringes washing up on New Jersey beaches in the 1980s following massive illegal dumping of medical wastes into New York harbor threw a spotlight on the issue. Similar beach problems have occurred in Britain and have been suggested to be a cause of hepatitis B among users of recreational waters.

A number of factors make management of medical wastes more difficult than other waste streams. Standard landfill disposal is complicated by the potential for infection of workers and of the general public. On-site incineration of hospital wastes, a common practice that effectively destroys infective organisms, is of increasing concern as a source of dioxins due to the high chlorine content of many of the disposable plastics in common medical use. Local opposition has made it more difficult to site and plan hospital incinerators. Mercury from amalgam fillings discarded in dental offices has been suggested to be a cause of mercury discharge into surface water from publicly owned water-treatment works.

While there are federal guidelines concerning medical wastes, including a 1989 Medical Waste Tracking Act administered by the U.S. Environmental Protection Agency (EPA), the major regulatory control is by state and local authorities. The increased cost of safe disposal of medical waste has led to efforts to reduce the size of the waste stream, including consideration of a return to reusable syringes, endoscopy tubes, and other medical devices. This requires a careful assessment of the tradeoff with simplicity of use, certainty of sterility, and lower costs provided by the disposable items. There is also a tradeoff between increased medical-waste disposal costs and the likelihood of illegal dumping. Clinically useful plastics formulated without chlorine are also being actively sought to decrease the risk of dioxins from incineration.

Not all medical waste comes from obvious point sources such as hospitals, doctors' offices, clinical laboratories, and research facilities. Over a million syringes are used at home by diabetics and others on a daily basis. This has led to community-based approaches to collect and safely dispose of these syringes and needles. Similarly, the trend toward shorter hospital stays means postoperative patients are more frequently discharged to their homes with surgical dressings and other potentially contaminated medical paraphernalia. Chronic infectious diseases are also now more likely to be treated at home than in a hospital. Patients, families, and visiting nurses should be instructed in the proper handling of these wastes. Landfilling of medical wastes is a particular problem in many developing countries, where scavenging of landfills is an organized activity among the poor. In addition to exposure to infectious agents, there have been instances where discarded radioactivity sources, such as cobalt used in the treatment of cancer, have been recycled into the community with devastating effects.

BERNARD D. GOLDSTEIN

(SEE ALSO: Environmental Protection Agency; Municipal Solid Waste; Ocean Dumping; Sewage System)