Trying to Prevent Beach Nightmares of 1988 : EPA Program Will Keep Tabs on Medical Wastes

After paying big bucks to rent a house on Long Beach Island last summer, Kathleen McKeand wasn’t about to stay away from the beach simply because of the scare about medical waste washing up on shore.

But the Bayonne Hospital executive remembers how anxious she felt watching her year-old niece play in the sand.

“We went to the beach, but still you were extremely careful,” she said. “You look upon digging in the sand as almost a birthright for a child, and yet you would very carefully examine where the baby was digging. I found myself being almost paranoid about it.”

She wasn’t alone.

The specter of medical wastes on the beaches cast a long shadow over the summer of 1988. Favorite bathing beaches on the Jersey shore and New York’s Long Island were closed, and vacationers at other beaches worried about pollution.

With a new season fast approaching, government officials are hoping to prevent a repeat of the nightmares of 1988 with new rules on how hospitals dispose of their used needles, blood bags and other potentially infectious wastes.

The U.S. Environmental Protection Agency is working to put in place by the first day of summer a pilot program for tracking medical wastes for New Jersey, Connecticut, New York and seven other states that border the Great Lakes. Even so, the EPA cautions that the new rules “may not significantly reduce the amount of medical waste deposited on beaches.”

Federal officials doubt that the medical trash that made the headlines--including more than 100 bloody vials found on the shoreline behind Bayonne High School here last July--came from hospitals or other medical facilities that will be covered by the tracking system.

“Let’s not delude ourselves into thinking that this program is going to instantaneously capture all medical waste,” said Dr. John Moore, deputy EPA administrator and chairman of an agency task force on medical waste.

The federal tracking program will cover hospitals and other facilities that each month dispose of 50 pounds or more of medical trash. Doctors, dentists and clinics that have less trash will have to weigh and log medical wastes, but not fill out the tracking forms.

None of this tracking or log-keeping will capture any of the syringes that diabetics put in household trash, or the needles used by drug addicts and tossed down sewer grates.

“If you think of a couple of million people a day, in the privacy of their home, using a needle or syringe for medical purposes, that’s a lot of needles,” Moore said. “Let’s not delude ourselves into assuming that none of this stuff is going to find its way on some beach, somewhere, sometime.”

Experts say medical waste is part of a broader problem of floating garbage that sullies all American shores.

“We treat medical waste no better or no worse than we treat any other kind of solid waste,” said Tom Super, a special assistant to Moore.

Awareness of AIDS has heightened public concern about sanitary disposal of blood, needles and the tons of other potentially hazardous trash that is produced in abundance at medical care facilities.

The EPA says hospital medical trash accounts for 3.2 million tons of the 160 million tons of solid waste generated each year in the nation, but no more than 15% of that medical waste is potentially infectious. Into that category fall human blood and blood products, used needles and surgical instruments, pathological wastes from surgery and autopsies, cultures and stocks of infectious agents and contaminated animal carcasses from research labs.

Most hospitals have in-house incinerators and burn such waste to render it harmless. The EPA estimates that 70% of hospital waste is incinerated in-house, 15% is sterilized in autoclaves and 15% is hauled away for incineration or burial.

Although the sight of needles or bloody vials on a beach is revolting, the EPA said several studies have found medical wastes generally to be less virulent than typical household trash.

“Public health officials, including the Centers for Disease Control, believe the risk of contracting such diseases as AIDS from exposure to these wastes is very low,” the agency said. Those most at risk are the medical personnel and sanitation workers who handle such materials on the job.

Dr. James H. Sammons, executive vice president of the American Medical Assn., in a recent letter cautioned the EPA against defining medical waste too broadly. He wrote that discarded diapers posed more of a hazard than than most of the trash hospitals and doctors produce.

Dirty diapers are full of bacteria, the EPA’s Moore said, but “there’s no evidence that suggests you need a special tracking system for disposable diapers.”

Moore said the EPA tried to define medical waste narrowly enough “to capture the stuff that’s worthy of capture because of infectious potential or the potential for physical harm, but not capture the disposable pillowcase that just happens to be on a hospital bed used by a heart attack patient.”

Some lawmakers have accused the EPA of casting too small a net. In a letter to the head of the EPA, 19 members of Congress charged that the agency had exempted too much medical waste from the tracking system.

“There is a real threat that the same offensive and potentially dangerous medical trash will once again wash up on our beaches because EPA has issued this sweeping exemption,” said the group led by Rep. James Florio, (D-N.J.).

Florio said that under the EPA plan, bedpans, sponges, bandages and sutures will not be subject to tracking unless they are soaked with blood.

The EPA estimates that it will cost facilities in the 10 demonstration states $55 million a year to comply with the tracking and reporting requirements. Average costs will range from $3,757 per year for a hospital to $71 for a dental office.

Bayonne Hospital and other hospitals in New Jersey have been operating under a state waste-tracking system since last fall. Even before that, concern about AIDS and other blood-borne diseases had prompted changes in the handling of human blood and used needles.

Use Precautions

“We use precautions now for all patients,” Thomas Pontoriero, the hospital’s director of environmental services, said.

Immediately after needles are used, nurses deposit them in lockers installed on the wall of each patient room. The sealed containers are picked up and dropped into a special cage, and later emptied into the incinerator.

Likewise, there are now special white baskets with red liners in each room for other medical waste bound for the incinerator. Even the linen baskets in the hallways now have vinyl liners to keep blood from seeping through.

Bayonne, a prosperous, 299-bed community hospital that celebrated its centennial last year, is also hiring an extra sanitation worker to deal exclusively with the medical waste, to weigh and log it before incineration.

“In retrospect,” Pontoriero said, “we have always followed precaution procedures. Most hospitals have handled it properly, but it’s good to have a formal protocol to follow in handling this stuff. It’s better to be safe than sorry.”

Waste Carted Off

The hospital’s incinerator broke down last July and was out of operation almost four months. Pontoriero spent $24,000 having a waste hauler cart off the medical trash twice a week for eventual incineration in South Carolina.

The disposal company, Eastern Chemical Waste Systems, “had a foolproof manifest system,” Pontoriero said. “We had their documentation, signed by them, about the number of boxes that went out and the total weight (and) 15 days after they picked it up, we received a copy back signed by the outfit in South Carolina that was burning this stuff for us.”

The federal pilot program will rely on similar logs that both the medical facilities and the haulers will fill out. If a hospital fails to get a signed receipt from the waste’s destination point in 45 days, it must notify both the EPA and the state. Violators can be fined up to $50,000 a day and jailed for up to five years.

Teens Found Vials

It was just after the hospital incinerator broke down that some teen-agers walking on the shore behind Bayonne High School found the first blood vials.

It was just a coincidence, but it caused a few anxious moments for Pontoriero and McKeand, who is the hospital’s director of marketing and public relations.

“We knew what Eastern Chemical’s credentials were,” McKeand said, “but once it’s out of our hands, it’s not like we ride shotgun on their trucks to make sure it is going to South Carolina.”

The medical trash on Bayonne’s shoreline was never traced to the source.

The EPA’s Super said that the evidence points to individuals, not facilities, as being responsible for most of the medical waste that washed up on beaches from Maryland to Massachusetts last year.

“One of the great myths of this past summer was that the facilities were somehow midnight-dumping their waste,” he said.