Medical Waste: Illegal Dumping Persists - February 2003

Medical Waste: Illegal Dumping Persists - February 2003

Against the backdrop of frequent incidents such as nosocomial infections and infections among waste disposal workers, in July 1992, medical waste with particularly high infectivity was designated as "infectious waste," a category of specially managed waste. Items subject to this designation include gauze and syringes contaminated with blood, scalpels, test tubes, petri dishes, diapers, surgical gloves, dialysis equipment, pathological tissue, and culture media used for testing. Items with low infectivity—such as IV bottles, vials, disinfected syringes, plastic bottles, incinerated ash, X-ray fixing solutions, and waste developing solutions—are treated as general medical waste (non-infectious waste) under industrial waste or general waste regulations. Additionally, concurrent with the designation of infectious waste, requirements were established for new licensing applications by waste disposal operators and the mandatory use of manifests. According to a survey by the
Ministry of Health and Welfare (at the time), the volume of infectious waste generated by medical institutions reached 150,000 tons in fiscal year 1998. There were reportedly approximately 6,000 licensed infectious waste collection and transport companies, and 400 treatment companies specializing in incineration, sterilization, and other processes.

In principle, infectious waste is to be processed on-site at medical institutions. The Medical Waste Guidelines list methods such as incineration, melting, sterilization using high-pressure steam (autoclave) equipment, sterilization using dry heat equipment, boiling, and disinfection. Among these, incineration is the most common method. Following the designation of infectious waste in 1992, medical institutions rapidly introduced incinerators. However, in recent years, opposition from local residents to incineration has made it increasingly difficult to operate on-site incinerators. Currently, most medical institutions have shifted to outsourcing. According to a 2002 survey conducted by the National Institute for Environmental Studies targeting 9,000 hospitals, on-site processing of infectious waste is estimated to account for less than 10%, while outsourcing accounts for approximately 70%. Furthermore, regarding non-infectious waste, on-site processing accounts for 11%, muni
cipal processing for 44%, and outsourcing for 95% (multiple responses allowed). However, improper disposal and illegal dumping of infectious waste have been persistent problems. As recently as the summer of 2002, Japan's largest illegal dumping case was uncovered on the border between Aomori and Iwate prefectures. The volume of illegally dumped industrial waste—approximately 820,000 cubic meters—far exceeded that of the Toshima incident in Kagawa Prefecture (500,000 cubic meters). When waste generators were identified based on manifests, medical institutions accounted for the largest share at 355 out of 2,600 generators. Most of these were businesses in the Tokyo metropolitan area, with national, public, and university hospitals all appearing on the list.

It is said that the proper disposal of 1 kg of infectious waste via incineration costs at least 100 yen for incineration fees, plus 150 to 200 yen for transportation costs, including the use of specialized sealed containers. However, since infectious waste was designated as such in 1992, a wave of new entrants into the disposal industry has intensified competition, leading to a price-dumping war among operators. Until recently, prices of 50 to 60 yen per kilogram—slightly higher than the standard industrial waste disposal cost of 20 yen per kilogram—were rampant. These prices are simply too low to ensure proper disposal.

Movement Toward Proper Disposal Gains Momentum Due to this situation where proper disposal costs were not being borne, the market for infectious waste disposal had not developed in a healthy manner. However, the situation is changing. In 1996, the National Federation of Industrial Waste Associations launched the "Proper Disposal Program," under which disposal operators conduct self-checks based on a proper disposal checklist and publish the results. Furthermore, in line with the strengthening of producer responsibility under the revised Waste Management and Public Cleansing Act, the Tokyo Medical Association established a "Medical Waste Consultation Desk" and launched educational and training sessions for Specially Managed Industrial Waste Management Officers at medical institutions. Additionally, the Japan Medical Association Research Institute (http://www.jmari.med.or.jp/) began offering the "JMA Research Institute Certified Training Course for Promoters of Safe I
nfectious Waste Disposal" in March 2003.

Furthermore, the Japan Industrial Waste Management Promotion Center has operated a certification system since 1996 to certify that collection and transport containers used for infectious waste are suitable for proper disposal. As of December 2002, the following containers are registered: plastic containers from Tensho Electric Industry (Mipear), Idemitsu Plastics (Medipear), Asahi Pritec (Disposal BOX), Gifu Plastics (Respear), and Kodama Resin Industry (Medical Box); and paper containers from Kusaka Industry (Melcon Clean) and Niigata Paper Container Industry (Cera Capsule). Although the 20-liter plastic containers are somewhat expensive at around 3,000 yen, they are essential consumables for proper disposal, and adoption is gradually increasing across companies. The Fuji System Pack Group has launched the "Mipell Association" and is holding study sessions centered on 50 related treatment companies nationwide to facilitate information exchange. Additionally, the Idemitsu
Group is accelerating efforts to promote adoption by publishing the medical waste information magazine "Medimaru." New Treatment Technologies to Replace Incineration If appropriate treatment prices are established, treatment costs alone are expected to reach approximately 45 billion yen. Consequently, business prospects are opening up not only in the intermediate treatment sector but also in treatment equipment, transport, and collection containers. As the population ages, waste generation from elderly healthcare facilities, nursing homes, and home healthcare services is increasing, and the market is expected to expand further. In the intermediate treatment sector, Aso Mining (Fukuoka Prefecture) began trial operations in January 2002 at the Kitakyushu Eco-Town with its medical waste recycling plant, "Econovate Hibiki." Spanning an 8,500-square-meter site, the facility is equipped with a shredder, high-frequency heating sterilization equipment, a sorting machine, a
solid fuel production machine, and a molding machine, with a processing capacity of 24 tons per day. It collects over 5,000 tons of medical waste annually from contracted medical institutions, which is then shredded, sterilized, and sorted by material type. Plastics suitable for material recycling are recycled into containers within the plant and used by contracted hospitals. Other materials are converted into solid fuel at the plant and used at the Aso Group's cement plants. Iron and glass components are also utilized as cement raw materials. Meanwhile, interest in reintroducing processing equipment is expected to rise not only among waste management companies seeking to ensure proper disposal but also among medical institutions where self-processing becomes cost-effective as disposal fees approach fair market prices—in other words, when fees increase. Against this backdrop, the market launch of equipment featuring functions such as carbonization, melting, and steriliza
tion—rather than the incineration that has been the mainstream method—is gaining momentum. With the tightening of dioxin regulations in December 2002 making it difficult for treatment contractors or hospitals to operate existing incineration facilities, these new treatment methods are beginning to attract attention. Maekawa Manufacturing has been selling its batch-type carbonization furnace, the "Kankyo-jin," designed for infectious waste, on a full-scale basis since the summer of 2002. The system carbonizes waste at a high temperature of 700°C, reducing its volume to one-fortieth of the original. The lineup includes models with carbonization chamber volumes of 500 liters, 1,000 liters, and 1,500 liters, depending on the required processing capacity, with the 500-liter model priced at 35 million yen. The system has been adopted by facilities such as Tomioka General Hospital in Gunma Prefecture, thanks to its appeal of cost savings—as the carbonized material can be
disposed of as general or industrial waste—and its size, which is nearly equivalent to that of conventional incineration equipment. In the melting method, Koike Oxygen Industries commercialized the "DOMIWS" melting and solidification system, which uses a V-shaped arc plasma, in 2002 and has begun full-scale sales. Infectious waste is fed into the system in its containers; after sterilization in primary, secondary, and tertiary fumigation chambers, an arc plasma is discharged into the melting furnace to melt the waste. The furnace reaches 1,600°C, melting all types of infectious waste—including metal items such as syringes and cans, plastics, rubber, glass, and paper and cloth—which solidify along with the discharge of slag. The system can reduce the volume of input waste by 97%, with a processing cost of 250 yen per kilogram. Although the equipment price is somewhat high—approximately 60 million yen for a unit with a daily processing capacity of 250 kg—it has bee
n well-received for its high volume reduction rate and the ability to make the equipment more compact compared to other methods. The company reports having already received over 70 inquiries from medical institutions and aims to sell 24 units in fiscal year 2003.

Another type of treatment equipment viewed as promising is the sterilization type. Although its volume reduction rate is lower than that of incineration, its greatest advantage is that it suppresses the generation of harmful substances caused by incineration. In the United States in particular, while incineration is technically feasible, the development of alternative technologies is accelerating due to opposition from local residents, and sterilization technology is a prime example of this. Nippon Kako (Yokohama City, Kohoku Ward), which holds the top market share in this category, offers "Trash Busters" (dry heat sterilization method) is the market leader in this category. Syringes, IV bags, tubes, and cotton swabs are placed on trays and fed into the machine, where a shredder reduces them to pieces no larger than 6–30 mm. Simultaneously, a mixer with a double-walled heat-circulating vessel stirs the waste with a catalyst powder, generating heat exceeding 180°C to achiev
e complete sterilization and drying in approximately six minutes. In addition to reducing the final volume to one-fifth or less, the waste is classified as general or industrial waste rather than infectious waste, leading to significant reductions in disposal costs. Since its launch in 1992, approximately 40 units have been delivered, and substantial growth is expected in the future.

In addition to this sterilization equipment, Hitachi Medical's subsidiary, Hitachi Medical Systems (Itako City, Ibaraki Prefecture), and medical device manufacturer I-Bag (Fukushima City) have also launched new equipment on the market since 2002.

While each model complies with dioxin regulations, their key features include high volume reduction rates, compact designs, and competitive pricing; however, their greatest selling point is the ability to perform intermediate treatment that allows infectious waste to be disposed of as general or industrial waste. While outsourcing has become common practice at medical institutions in recent years, as processing costs approach appropriate market rates, there is a growing recognition that on-site processing is more cost-effective in the long term (due to the conversion of waste into general waste and reduced transportation costs from volume reduction) and safer, especially as producer responsibility regulations are being strengthened.