Medical waste: Who gets it, and what happens to it?

This article was originally published on April 9, 2018, in the El Paso Inc. Medical Section. The article was edited for length and slight stylistic reasons; the original version can be found below.

The Mediwaste autoclave, closed. Photo by Jorge Salgado.

Every day, box trucks pull up to a nondescript warehouse on the far-east side of El Paso to unload a fairly grotesque cargo. The trucks are carrying used catheters, bandages, diapers, syringes, and soiled gowns collected from around the city. The trucks belong to Mediwaste Disposal, a locally-owned company that handles the medical waste of more than five hundred clients in El Paso and New Mexico. If you’ve ever wondered what happens to the contents of those ominous red buckets in your doctor’s office, the Mediwaste fleet is the group to follow.

Companies that produce “regulated medical waste,” such as funeral homes, tattoo parlors, veterinarians, dialysis centers, and dentists, are required by law to dispose of it properly. While the waste eventually ends up in El Paso’s Clint Landfill, the process is not as simple as chucking it there. Texas law requires that a company fully licensed and vetted to treat medical waste pick it up and treat it.

“This is stuff you don’t want any Tom, Dick, and Harry handling,” said Mike Perez, one of the company’s co-founders. (There are other medical waste transporters in the city, but they take their loads elsewhere to be treated.)

To begin, Mediwaste supplies each business with containers that fit their needs. The containers are picked up as often as needed and loaded into the back of a box truck, which is legally required to have extra leak-proof capabilities. Labels are affixed denoting the containers’ provenance and are transported back to the warehouse. Each truck does approximately 35-40 pickups per day, Perez estimates.

The surprisingly innocuous Mediwaste facility is spare and clean-swept, with a few indistinct apparatuses in one corner and the smell of disinfectant lingering in the air. The day’s haul is taken off of the truck and dumped wholesale into what look like metal minecars.

A Mediwaste cart filled with…medical waste! Photo by Jorge Salgado.

Up to four of these carts are wheeled into a giant autoclave to begin the sterilization process. Superheated water from the adjacent boiler bathes the carts and their contents in steam for almost an hour. A sensor on the autoclave records the entire process to make sure that necessary temperatures are met, and these records are kept on file for five years. (If for some reason the autoclave goes down, the waste is stored in a refrigerated truck until it’s back online.)

Following their steam bath, the carts slide back out of the autoclave and their contents are dumped into a trash compactor, which crushes the assorted waste together in preparation for transport to the landfill. Though the prospect of dumping medical waste into a standard landfill seems questionable, Perez said that the autoclave process ensures that pathogens and other malicious contaminants are killed. In fact, he said, “our waste is probably the cleanest waste in the landfill.” Not only that, but it is an arguably cleaner way of dealing with the waste than earlier methods, such as incineration, which could release hazardous chemicals into the air.

The autoclave can hold up to four medical waste-bearing mine carts. Photo by Jorge Salgado.

Every aspect of the process is governed by stringent health and safety guidelines dictated by the Texas Commission on Environmental Quality, which Perez said are some of the strictest in the country. On top of the regulations governing transport and treatment, the facility is required to have security cameras and a fence running the length of its perimeter. At the end of each day, employees are required to patrol an area stretching two miles in any direction from the facility to make sure that no telltale red bags have dropped from any of the trucks.

When Perez began the arduous process of applying for permits and licenses to open the facility, many area residents expressed concern about seeing recognizable body parts. This kind of waste is called “pathological waste,” Perez explained, and as of yet Mediwaste does not have the equipment to appropriately process it.

However, those capabilities are forthcoming. Squeamish readers may want to proceed with caution – the company will be getting a shredder within the next month. True to its name, the shredder will allow them to render body parts “unrecognizable” before the pulp is treated along with the usual regulated medical waste. This is partly done on the behalf of landfill operators, who may not only get freaked out by finding an intact foot but would have to shut down operations in case the remains are evidence of a murder.

The homegrown company kicked off its operations when it picked up its first load from a pediatrician’s office in 2015 and is considering branching off into other unpleasant territories when the time is right, such as treating asbestos and chemical waste. Perez is as surprised as anyone that he finds himself running such a strange operation, but he is glad he is. In addition to appreciating the company’s success, Perez takes pride in the fact that the company can offer something positive to the community he grew up in. The facility is the first located in El Paso County, which means that tax revenue stays local and that trucks carrying hazardous waste don’t have to drive for hours to the next closest location to dispose of it.

“We took a chance and rolled the dice,” Perez said. “It’s not every a mom and pop operation shows up and says ‘Hey, I’m here to take your medical waste.'”

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Sidebar: What happens to pharmaceuticals and similar waste?

Mediwaste is able to collect and process most pharmaceuticals for disposal. “As long as it’s non-hazardous, it can be run through the autoclave and taken to the landfill,” Perez said.

“Non-hazardous” in this context refers to pharmaceuticals whose components will be rendered inert in the autoclave process and thus won’t leach into groundwater or soil. However, certain medications must be incinerated in order to fully destroy them, as do items such as asthma inhalers, which can explode in the autoclave, and medications like warfarin, which contain explosive chemicals. Chemotherapy waste, such as canisters and related supplies, likewise must be incinerated.

Other options for disposing of pharmaceutical waste include treating it with chemicals, or in the case of pills, encasing them in concrete and burying them in a landfill.

Sidebar redux: How can I properly dispose of my household medications?

According to the El Paso Department of Health, disposing of most household medications is a fairly easy process. First, take an old plastic container with a screw-on lid and fill it with an unappetizing substance, such as dirt, coffee grounds, or kitty litter. Next, take pills, patches, syrups, etc. and put them in the plastic container. Put the lid back on and shake the contents. The moisture that collects in the container will dissolve the pills safely. The container and its contents can then be put out with the regular trash. Disposing of medications in this capacity instead of dumping them down the toilet reduces the amount of chemicals that pollute waterways and ecosystems.

However, such a method won’t work for items like syringes, home medical tools, and asthma inhalers (the latter of which can explode if punctured or heated). These items can be taken to hazardous waste collections sites around town. Some medical facilities or pharmacies are also equipped to take this waste as well as unused and expired medication. Fort Bliss also has collection points.