Hospitals generate lots of trash. Everything from food containers to half-used mini-shampoos to small scraps of paper that describe what the patient ate can be found in a patient’s room. That doesn’t include the medical waste, or red bag waste, such as plastic ventilator tubing, IVs, scalpels and syringes, used tape and dressings, and human tissues.

Countless items make up the more than two million tons of waste hospitals produce every year. The Canadian Medical Association Journal estimates that a North American hospital generates 19.8 pounds of waste per patient every day. Around 20% is potentially hazardous medical waste, which is costly and difficult to deal with.

The EPA defines medical waste as any solid waste that is generated in the diagnosis, treatment, or immunization of human beings or animals. This definition includes what comes into contact with a body in an examining or operating room, radioactive material from testing and treatment, and cultures and pharmaceuticals. Medical waste can spread disease. It can also be toxic if left untreated when it enters the general waste stream. The syringe that was used on a hepatitis B patient, for example, can spread the illness to uninfected persons.

Hospitals dispose of medical waste by decontaminating it and disposing of it in a landfill. Or they can incinerate it. Many hospitals decontaminate at least part of their hazardous waste with an autoclave, which uses high-pressure steam. Though some hospitals have their own system, or contract with mobile treatment companies, others send their waste to the large autoclave in the Houston region located in Conroe and owned by Stericycle.

After treatment, local medical waste is often sent to landfills. According to Bruce Arnett, an environmental investigator for the Texas Commission on Environmental Quality, after treatment medical waste can be disposed of in a permanent landfill. “Some hospitals ship it off site and they [the waste management companies] are responsible for taking it to a treater and disposal site,” he says. Incineration is common for many kinds of trash, but medical waste cannot currently be mixed with municipal waste in incinerators run by the city. There are two permitted incinerators in the Houston region that burn medical waste: one at UTMB Galveston and one in Chambers County.

Both disinfection and incineration have problems. Many hospitals have tried to reduce the amount of incinerated waste they produce because incinerators are notorious for polluting the air with dioxin and heavy metals. But landfills have been found to be an environmental hazard as well, often leaking and contaminating water or emitting hazardous gasses.

Scientists even disagree about which method is less hazardous. While some have called for a ban on incineration, David Marrack, MD, who has consulted on medical waste issues in Houston and around the world, says that good incineration technology exists and could be used to reduce the environmental costs of getting rid of medical waste. He states, “The problem is, the EPA and the state administrations and the environmental quality organizations dropped the technology. It isn’t the cost, either. And the cost of the landfill ­ buying it and replacing it -- is so high that the incinerator becomes cheap.”

Because there isn’t a way to give medical care without creating pollution , the challenge is in dealing with waste responsibly. The management of medical waste is under the jurisdiction of government agencies that issue permits for incinerators and autoclaves, and publish guidelines for tracking waste receptacles, registering medical waste transporters, and monitoring emissions from incinerators. Although these guidelines spell out penalties for violators, they do not address the larger problem ­ reducing the amount of waste produced and treating it with less environmental damage.

One of the first impediments to managing waste effectively is the habits of hospital employees. According to Arnett, it’s important to make sure all waste goes to its proper place. He says, “Basically all the medical waste consists of either the sharps and needles, which go into their own special hard plastic container, or it’s the non-sharp material, which can be sample bottles or clothing or any of that sort of stuff. That’s all supposed to go into a red plastic bag.” But when other waste is mixed in with the red bag waste, the disposal process becomes inefficient and potentially hazardous. Arnett says , “A lot of times, whoever is on the staff just throws anything they want to into it. So it’s not necessarily medical waste that’s really going into these bags. And nobody wants to open that red bag after it’s been sealed off. So nobody checks to find out if it’s all medical waste or if some of it’s not medical waste.”

Even more serious is the lack of real incentives for hospitals and waste management teams to try new technology. While organizations such as Health Care Without Harm and Hospitals for a Healthy Environment offer support and recognition to hospitals that deal with waste in more environmentally friendly ways, the ultimate decision-making is left to hospital administrators. And there are pressures against change. Doctor Marrack says, “There’s a tremendous economic pressure from the transporters and the medical waste disposal people who want everything to go into their high-priced medical waste transporter or incinerator system. There’s a huge vested interest in not changing the system.”

Moreover, there is no real incentive or reward for changing the system by reducing red bag waste. He says, “You need to start at the big manufacturer’s end. They need to devise systems and promotions for recycling. You need to put in economic incentives, or disincentives for not recycling. There ought to be a real tax on not recycling.”

Doctor Marrack also argues that the fear of malpractice suits prevents hospitals from trying to reuse items that have a low risk of spreading infection.

But the biggest problem is that the waste keeps coming. In the time it took to read this article, as much as 15,000 pounds of waste has accumulated in Houston hospitals. That’s enough to fill four 2-ton trucks.