Illegal Dumping of Medical Waste in Japan Still Continues - February 2003

Illegal Dumping of Medical Waste in Japan Still Continues - February 2003

In July 1992, against the backdrop of a number of accidents involving nosocomial infections and infections among waste disposal contractors, highly infectious medical waste was designated as "infectious waste," a category of waste subject to special control. The items included bloodstained gauze and needles, scalpels, test tubes, petri dishes, diapers, surgical gloves, dialysis equipment, pathological tissues, and culture media used for testing. Less infectious items such as intravenous infusion bottles, vials, sterilized injection needles and plastic bottles, incinerated ashes, X-ray fixative solution, and development waste are treated as normal medical waste (non-infectious waste), either as industrial waste or as a single waste. At the same time that they were designated as infectious wastes, new license applications and manifests for waste disposers became mandatory. According to a survey by the then Ministry of Health and Welfare, the amount of infectious waste generated by medical institutions amounted to 150,000 tons in FY1998. There were approximately 6,000 companies licensed to collect and transport infectious waste, and 400 companies licensed to incinerate, sterilize, and otherwise treat it.

In principle, hospitals are required to dispose of infectious waste on their own premises. The medical waste guidelines list incineration, melting, sterilization with high-pressure steam sterilization (autoclave) equipment, sterilization with dry heat sterilization equipment, boiling, and disinfection as methods. The most popular of these methods is incineration, which was designated as an infectious waste in 1992, leading to the rapid introduction of incinerators in medical facilities. In recent years, however, the operation of incinerators in hospitals has become increasingly difficult due to opposition to incineration from residents in the surrounding areas. Most medical institutions have now shifted to outsourcing. According to a survey of 9,000 hospitals conducted by the National Institute for Environmental Studies in 2002, it is estimated that less than 10% of infectious waste is disposed of in-house and about 70% is outsourced. For non-infectious waste, 11% was treated in-house, 44% by local governments, and 95% outsourced (multiple responses).

However, improper disposal and illegal dumping of infectious wastes have continued unabated. Even recently, in the summer of 2002, the largest case of illegal dumping in Japan was uncovered on the Aomori/Iwate border. The amount of illegally dumped industrial waste was approximately 820,000 cubic meters, far exceeding the 500,000 cubic meters dumped in the Teshima incident in Kagawa Prefecture. When the waste producers were identified based on the manifests, medical institutions accounted for the largest number of 355 out of 2,600 waste producers. Most of them were businesses in the Tokyo metropolitan area, with national, public, and university hospitals all over the place.

Proper disposal of 1 kg of infectious waste is said to cost at least 100 yen for incineration and 150,200 yen for transportation, including a special sealed container . However, since the designation of infectious waste in 1992, new treatment companies entered the market one after another, intensifying competition and resulting in a dumping war among the companies. Until recently, prices as high as 5,060 yen/kg, slightly higher than the usual industrial waste disposal cost of 20 yen/kg, were prevalent. This is a price that cannot be considered appropriate.

Movement toward proper disposal is gaining momentum.

Until now, the infectious waste treatment market has not developed in a healthy manner due to the lack of proper treatment costs. However, the situation is changing. In 1996, the National Federation of Industrial Waste Management Associations launched the "Proper Treatment Program," under which waste disposers conduct self-checks based on a proper treatment checklist and disclose the results to the public. In addition, in conjunction with the revision of the Waste Disposal and Public Cleansing Law to strengthen the responsibility of waste generators, the Tokyo Medical Association established a "Medical Waste Consultation Desk" and started education and training sessions for those responsible for managing specially controlled industrial waste at medical institutions. In March 2003, the Nichi-Medical Research Institute () will start a "Nichi-Medical Research Institute Certified Training Course for Promoters of Safe Treatment of Infectious Wastes".

As of December 2002, Tensho Electric Industry (Mippel), Idemitsu Plastics (Medipel), and Asahi Pre-Tech (Disposal) have been certified as plastic containers, while Nichi-Medical Research Institute () will start a training course in March 2003 to promote the safe disposal of infectious waste, (Disposal BOX), Gifu Plastic (RISPER), and Kodama Plastics (Medical Box) as plastic containers, and Kusaka Kogyo (Melcon Clean) and Niigata Shiki Kogyo (Ceracapsule) as paper containers. The 20-liter plastic container costs approximately 3,000 yen and has not yet reached the point of full-scale diffusion, but it is an indispensable consumable for proper disposal, and all companies are gradually introducing more and more of these products. The Fuji System Pack Group has launched the "MIPPEL Association" and is holding study sessions to exchange information with 50 related treatment companies nationwide, while the Idemitsu Group has published a medical waste information magazine, "MEDIMARU," and is accelerating its efforts to promote the use of this technology.

New Treatment Technology Replaces Incineration

If the price of treatment settles at a reasonable level, the cost of treatment alone is expected to be around 45 billion yen. This will open up business prospects not only in the intermediate treatment business, but also in treatment equipment, transportation, and collection containers. With the aging of the population, the market is expected to expand further as more and more waste is discharged from general households, such as from geriatric health care facilities, nursing homes, and home medical care.

In the intermediate treatment business, Aso Mine (Fukuoka Prefecture) began trial operations of its medical waste recycling plant "Econovate Hibiki" in Eco-Town, Kitakyushu City, in January 2002. The plant covers an area of 8,500 square meters and is equipped with crushers, high-frequency heat sterilizers, sorters, solid fuel production machines, molding machines, and other equipment, with a processing capacity of 24 tons per day. The plant collects more than 5,000 tons of medical waste annually from contracted medical institutions, crushes and sterilizes it, and sorts it by material. Plastics that can be recycled as materials will be recycled into collection containers at the plant and used by the contracted hospitals. Other materials are turned into solid fuel at the plant and used at the Aso Group's cement plant. Iron and glass content are also used as raw materials for cement.

Meanwhile, the introduction of treatment equipment is expected to gain momentum not only among treatment companies that promote proper treatment, but also again among medical institutions that will see cost advantages from self-treatment as treatment costs approach reasonable prices, or in other words, as prices are raised. In this context, equipment with functions such as carbonization, melting, and sterilization, rather than incineration, which has been the mainstream, is becoming popular in the market, and these new treatment methods are beginning to attract attention as the tightening of dioxin regulations in December 2002 makes it difficult for treatment companies or hospitals to operate existing incineration facilities.

Mayekawa Manufacturing began full-scale sales of the "Kankyo Shin" batch-type carbonizing furnace for infectious waste in the summer of 2002, which carbonizes waste at a high temperature of 700°C, reducing the volume to 1/40th. The lineup includes 500-liter, 1,000-liter, and 1,500-liter carbonization chambers, with the 500-liter type priced at 35 million yen. The 500-liter type is priced at 35 million yen. The system has been introduced at Tomioka General Hospital in Gunma Prefecture and other facilities, appealing to customers for cost reductions by allowing the carbonized waste to be delivered as normal waste or industrial waste, and for its size, which is almost the same as conventional incineration-type equipment.

In terms of melting methods, Koike Oxygen Industries put its DOMIWS melting and solidification system, which uses V-shaped arc plasma, into practical use in 2002 and began full-scale sales. Infectious waste is placed in containers, sterilized in primary, secondary, and tertiary fumigation chambers, and then melted by firing arc plasma into the melting furnace. The furnace reaches a temperature of 1600°C, and all kinds of infectious waste, including needles, cans and other metals, resins, rubber, glass, paper, and cloth, are melted and solidified with the discharge of slag. The system can compress 97% of the volume of the input waste, and the processing cost is 250 yen/kg. The company aims to sell 24 units in fiscal 2003.

Another promising type of processing equipment is the sterilization type. Although it is inferior to incineration in terms of volume reduction, its greatest advantage is that it can suppress the generation of toxic substances due to incineration. In the U.S. in particular, although incineration is technically feasible, opposition from local residents has stimulated the development of alternative technologies, of which sterilization technology is a representative example.

The "Trash Busters" (dry heat sterilization method) from Nippon Kako (Kohoku-ku, Yokohama), which has the largest market share in this type of sterilization technology, is used for syringes, infusion bags, tubes, and absorbent cotton, etc., on trays, which are crushed to 6 to 30 mm square or less by a crusher and simultaneously stirred with catalyst powder in a mixer with a heat circulation double-kettle structure. The mixer then generates heat of 180°C or more and completely sterilizes and dries the material in about 6 minutes. Since its launch in 1992, approximately 40 units have been delivered, and full-scale growth is expected in the future.

Other new sterilizers on the market in 2002 include Hitachi Medi-Eco Systems (Ushiori City, Ibaraki Prefecture), a subsidiary of Hitachi Medical Corporation, and Eibag (Fukushima City), a medical equipment manufacturer.

Each of these companies is compliant with dioxin regulations, and their features include volume reduction rate, compactness, and price, but their greatest strength is their ability to perform intermediate treatment so that infectious waste can be discharged as normal waste or industrial waste. In the past few years, outsourcing has become the norm for medical institutions, but as the cost of treatment has approached a reasonable level, there is a growing awareness that in-house treatment is safer in the long run because it is less expensive (reduced transportation costs through volume reduction and conversion to normal waste) and because responsibility of the waste producer is being strengthened. The awareness that it is safer to dispose of waste in-house is spreading as the responsibility of the discharger is being strengthened.