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What this means is that it's often much more costly to dispose of an item than to buy a new one. "The sad part of this industry and some of the scary stories that are involved in it is that some of the waste costs ten times more to get rid of than when the customer — the customer being like a doctor or a dentist — bought it off the shelf," said Gastellum. "They paid $25 or $40 bucks for a gallon of it, then it costs them $90 to get rid of it. So it's staggering — the diference in prices. ... Some of the stuff costs so much to treat it — that's what drives the disposal price."
Pharmaceuticals are one of the medical waste industry's biggest concerns — not only because of the environmental pollution related to their incineration, but also because many people still dispose of their unused drugs improperly by throwing them in the garbage or flushing them down the toilet, which pollutes our environment and our water supply. Alameda County had been paying for drug disposal sites, but most recently passed a landmark ordinance requiring pharmaceutical companies to shoulder the burden — the first of its kind in the nation. But at this point, it's unclear whether the county can enforce the ordinance, or whether the pharmaceutical industry will sue to stop it.
In light of the huge costs associated with disposing of medical waste, the industry has begun looking at ways to reduce, reuse, and recycle in recent years. Most of this has occurred in the front-end of hospital operations, since hospitals are also huge users of resources. "Hospitals are ... the fourth-largest user of energy, and one of the largest users of water in the community," said Practice Greenhealth's Eckl.
For many hospitals, energy and water consumption are sort of the low-hanging fruit when it comes to waste reduction. Locally, Washington Hospital in Fremont, a member of Practice Greenhealth, has decreased its solid waste from 65 percent of its total waste to 62 percent in the past two years, according to spokeswoman Gisela Hernandez. It's also increased its reduce-reuse-recycle rates from 27 to 31 percent in the same time period. The hospital composts its food waste, recycles alumnium cans, accepts unused medication from the community, and has decreased its energy and water consumption.
Recycling on the patient-care side of hospital operations may be more challenging, but even the slightest reduction in waste can add up to huge savings. For example, Eckl said that Kimberly-Clark Corporation just launched a program to recycle its blue wrap — the plastic that covers all sterilized surgical instruments and is pulled off before a patient even enters the room. According to the CalRecycle Hospital Waste Reduction and Recycling Team, the health care industry estimates that nearly 20 percent of the waste stream is from surgical services, a large percentage of which is clean blue wrap.
Another example of recent improvement: Fluid-suction containers have traditionally made up 40 percent of the waste in the ER, said Eckl. Typically, they're treated with chemicals and then thrown away. "Now we have resuable cannisters," she said. Similarly, containers that hold used sharps have traditionally been thrown away. But now there are reusable sharps containers, said Gastellum.
Hospitals and medical suppliers are increasingly taking initiatives to reduce the amount of plastic they use. But anecdotal evidence suggests these efforts are not yet nearly as widespread as they should be. Erin Ford, who has been a nurse for fifteen years and is currently an RN in the post-anesthesia care unit at California Pacific Medical Center in San Francisco, said the majority of the equipment and supplies — except for hazardous waste and sharps, which must be specially disposed of according to law — goes into the trash can. "Most everything goes into regular trash," she said, citing empty IV bags, IV tubing, oxygen face masks, EKG leads, soiled bandages and tissues, plus Bair Paws — huge plastic gowns that patients wear pre-operatively — as examples.
And yet, "anything plastic could probably be put into a [recycling] bin," she said, "everything from nasal cannulas to open saline bottles to humidified oxygen bottles — even the IV bags that are empty — we throw them in the trash. There's nothing on them." What's more, anything that's expired — even if it's unused — must also be thrown away, she said. "We go through all the supply rooms and if anything is outdated we throw it away," she said. Other nurses who work or have worked in other Bay Area hospitals and private doctor's offices interviewed for this story also said recycling didn't exist where they worked and that everything is thrown away.
For hospital staff, throwing everything away isn't mandatory, but it appears to be the easier option. Take scalpels, for example, which used to be predominantly stainless steel and sterilized before each use but are now disposable — they've got plastic handles and a tiny stainless steel blade at the end. Anna, a nurse who works at a private surgery clinic in San Francisco and only wanted to go by her first name, said she believes disposable scalpels are more popular because they're cheaper, but also because of the lessened risk associated with simply being able to throw the item away after using it. "It's easier to buy cheaper disposable scalpels — cleaning and sterilizing is more of a risk," she said. "That's a risk for someone to get poked."