by MAURA KELLER
Like many industries, the ongoing pandemic has had a significant impact on the medical waste industry – requiring waste and recycling companies to alter their processes and procedures, while keeping their frontline employees safe.
Jim Anderson, vice president of product management and innovation at Stericycle, said that as we enter a new phase of the pandemic with the Delta variant, the medical waste industry will continue to face strong demand for services, all while continuing to manage through pandemic headwinds such as labor shortages, supply chain challenges, and higher costs for fuel and other commodity prices.
“In Q2, we saw an increase in the average weight per container, which we believe is due to increased elective surgery waste,” Anderson said. “At the same time, demand for medical waste services is expected to continue from the ongoing testing and treatment of COVID-19. Medical waste management companies are also gearing up for more sharps waste as the flu season approaches and potentially coincides with COVID-19 vaccine boosters and the availability of vaccines for children under the age of 12.”
Embracing Challenges
Erika Kimball, RN, MBA, founder and principal consultant at Kimball Sustainable Healthcare, sees additional challenges currently affecting the medical waste industry. As in other sectors, COVID has exposed longstanding challenges in the medical waste industry: process challenges and product challenges.
“From the waste management perspective, variations in material definitions and handling instructions among different entities along the waste management process can create safety and quality gaps,” Kimball said. “Given the conservative approach to medical waste management, these gaps have increased the generation and overtreatment of waste during the pandemic. From the materials management perspective, COVID has shown some of the inherent limitations of single-use disposable plastic medical supplies.”
Inside healthcare facilities, there are critical supply shortages due to high demand coupled with supply chain disruption.
“In the community, we have seen the emergence of single-use disposable masks and gloves as litter in public spaces and as contaminants in recycling facilities,” Kimball said.
A key challenge with waste generated from COVID-19 – as opposed to other medical waste – is how decentralized it is. As Anderson explained, consumers aren’t just going to their hospital or primary care physician to be tested for COVID or to receive the vaccine. They are going to retail pharmacies, school gyms, large stadiums and even parking lots, in addition to standard healthcare settings, to receive care related to COVID-19.
“Another difference between COVID waste and other medical waste is the short timeframe in which the waste was generated,” Anderson said. Typically, waste is generated over a wider time period (e.g., flu season or waste surrounding ongoing medical procedures), which allows waste management companies to anticipate volume and adjust processes over time. Also, the unpredictable nature of the COVID-19 virus has made it more difficult to anticipate volume.
“The unpredictable nature of the virus, the short time frame in which the waste is generated, and how decentralized it is have made the net for procedures wider and more complicated than standard medical waste,” Anderson said. This has required medical waste companies to be flexible and creative in coming up with solutions to service their customers where they are literally and figuratively.
Anderson said another important factor in successfully managing COVID-19 waste is being able to scale capacity to manage the fluctuating demand. While vaccination and testing had been on the decline, they are ramping back up again rapidly due to the Delta variant. This has required medical waste companies to build infrastructures that are specifically designed to accommodate these rapid shifts in demand.
Stericycle has been successful in navigating the unique nature of COVID-19 waste because the company’s waste management network is designed to scale capacity to meet fluctuating demand. Stericycle also modernized its fulfillment center and added extra shifts to scale up production of sharps mail back kits by 400 percent.
“Additionally, we increased our available inventory of reusable sharps containers,” Anderson said. “When considering all the services we offer to dispose of sharps, including mail back, we are poised to handle well over 700 million needles in North America on a monthly basis with our existing capacity.”
Industry Impact
Waste and recycling tasks may involve a high level of interaction with waste items, may be performed in environments prone to airborne particles such as dust, and may necessitate close contact with other people. Kimball stressed that this reinforces the need to closely follow existing safety protocols and standard workplace COVID safety measures.
“Above standard precautionary measures, the best way to ensure safe waste management and recycling, especially among medical waste generators, is through open communication,” Kimball said. “Waste management is a team sport, from the point of generation to final processing. Sharing materials management best practices, definitions, and safety protocols among upstream customers and downstream processors can help to clarify and align processes, improving quality and trust.”
It is also necessary for waste and recycling companies to be flexible and meet their customers where they are. Anderson suggested that during the pandemic, that can mean non-traditional settings, such as a “pop up” location in a parking lot versus a doctor’s office or hospital. Of course, safety procedures must be considered and developed for these new settings to ensure precautions are taken to protect everyone.
“Safeguarding medical waste professionals from needle stick injuries and potentially harmful and contagious COVID-19 waste is equally as important as protecting the healthcare professionals administering care as well as the public,” Anderson said. “At Stericycle, we follow all safety procedures set by regulatory agencies, our company, and our customers, including COVID-19-related protocols and PPE guidance.”
A Focus on Employee Safety
For five years, Dean Calhoun worked at Waste Management as an environmental, health and safety coordinator with responsibilities for protecting worker safety at landfills and recycling centers. Today Calhoun is currently president and chief executive officer of Affygility Solutions, an EHS consulting firm serving the life science industry. He also serves on the American Board of Industrial Hygiene.
Calhoun said that like most industries that require a combination of a physical demanding job and strict adherence to regulatory requirements, finding qualified workers is always challenging. In addition, in the medical waste transportation side of the business, drivers are required to have a commercial driver’s license (CDL).
“Drivers with a CDL are in high demand across all industries and employee turnover is high,” Calhoun said. “Furthermore, due to social distancing requirements, most loading dock areas have policies in place for reduced capacity, thus causing supply chain disruptions.”
Calhoun said that existing safety requirements and training will be adequate as long as employees adhere to those requirements (vaccinations, medical surveillance, wearing of personal protective equipment).
“This also requires cooperation from the medical waste generating facilities, such as hospital and clinics,” he said. “They should be reminded through written alert or other correspondence that proper packaging of the medical waste prior to pick-up is required. Medical waste collection personnel should be reminded not to accept improperly packaged medical waste. “
Currently the OSHA requirements to protect workers from COVID-19 exposures are evolving. Management personnel should routinely review the most current recommendations and guidance issued by OSHA.
Looking Beyond the Pandemic
Kimball said the future of the medical waste industry involves leveraging lessons learned from the COVID crisis to improve holistic materials management. Waste management companies and recyclers play a key part.
“We can extract value from the medical waste stream throughout the industry by establishing shared best practices for disposal, collection and end-processing of materials. With better processes in place, medical suppliers must use better materials and minimize single-use disposable plastics,” Kimball said. The measures needed to ensure safety during COVID, strong partnerships and communication among medical waste stakeholders, also happen to be the first steps toward better waste management solutions and innovation.
Because of the expensive and non-sustainable nature of off-site transportation and processing of regulated medical waste, Calhoun predicted that there will be an increased emphasis on on-site treatment technologies. “This will not only reduce the volume of regulated medical waste, but indirectly reduce the carbon-footprint due to the transportation of medical waste,” Calhoun said.
“As artificial intelligence and image recognition improves, companies will see a significant increase in the use of robotic sorting devices. This will not only improve efficiency, but also will greatly reduce any safety related issues.”
Of course, with increasing demand for safe, responsible, and sustainable waste management methods and technologies, the COVID -19 pandemic has brought a renewed global focus on the medial waste management industry.
“We believe the industry will play a significant role in shaping a healthier and safer world for everyone, everywhere, every day,” Anderson said. “This starts by reimagining waste management facilities to reduce annual energy consumption, implementing technologies to convert waste-to-energy, and identifying ways to reduce greenhouse gas emissions.” Anderson said the industry will also be challenged to modernize its fleet of vehicles to be more environmentally friendly. Additionally, automation will continue to gain traction as a way to improve productivity while increasing worker safety.
“It’s an exciting time to be working in medical waste management,” Anderson said. “Going forward, it’s important that we continue to work closely with regulators and healthcare providers to deliver innovative solutions in a safe, responsible and sustainable way.”
Published in the October 2021 Edition