A Stericycle trainer explains to a clinical team the importance of properly identifying and segregating pharmaceutical waste.
With an increasingly complex web of state and federal legislation emerging on handling of pharmaceutical waste, more and more hospitals are turning to medical-waste management firms to help them in this effort.

Desi Kotis, Pharm. D., pharmacy director, Northwestern Memorial Hospital, Chicago, says there is a lot more focus on pharmaceutical-waste disposal since a 1999-2000 U.S. Geological Survey (USGS) study revealed pharmaceuticals in streams it tested in Minnesota and elsewhere.

She says that complying with disposal regulations is a big job made significantly easier since her hospital partnered with medical-waste disposal company Stericycle, Lake Forest, Ill., which offers an array of services for the hospital.

Kotis says Stericycle offers training for staff on how to segregate pharmaceutical waste, tests drugs to determine if they are hazardous or nonhazardous, and takes care of labeling and documentation of materials it hauls away for disposal.

Other companies offer similar services as more hospitals seek help with the issue. A 2008 investigation by the Associated Press (AP) showed that a wide range of pharmaceuticals exist in the drinking water supplies of at least 41 million Americans in 24 major metropolitan areas.

AP also reported in 2008 that most unused pharmaceuticals from health care facilities are dumped down sinks or toilets, usually without violating state or federal regulations.

Wastewater treatment technology does not completely remove these compounds.

While only trace amounts of pharmaceuticals were found in the drinking water, the risks posed by the pollutants deposited or leaching into the water supply are largely unknown. The Environmental Protection Agency (EPA) says there are no known human health effects from low-level exposures in drinking water, but questions remain.

Besides the health factor, it's an issue that has caused confusion for hospitals because of the growing complexity and number of pharmaceuticals in question, and the legislation that impacts their disposal.

For example, the federal Resource Conservation and Recovery Act (RCRA) of 1976 regulates the disposal of hazardous pharmaceuticals, but not nonhazardous medicines and drugs. Minnesota, New York, New Jersey and California have laws regulating nonhazardous pharmaceutical disposal, but other states are just now proposing them.

To simplify the matter for hospitals, the EPA has proposed a rule that would call for unused hazardous pharmaceutical waste to be handled under its current Universal Waste Rule rather than under RCRA. EPA also proposes that nonhazardous pharmaceutical waste be treated as universal waste.

The wide range of pharmaceuticals, the number of locations where pharmaceutical waste is generated internally, the number of medical staff involved, and varied legislation make proper handling and disposal complicated. That's why a growing number of hospitals are turning to medical-waste management companies to help them deal with the issue.

Michael Burke, director of environmental service, North Memorial, Robbinsdale, Minn., deals with regulators on a county, state and federal level but has also turned to outside help as well.

"Stericycle helps with the entire process — everything from the identification of the waste, evaluation, education, segregation and policing of the waste containers every day," he says.

He says workforce reductions at his facility have made hiring a vendor critical to help keep North Memorial in compliance with waste-disposal regulations. "That's who's been keeping me in compliance for the last three years," he says of Stericycle.

While there is a cost at­tached to hiring a vendor to manage medical-waste disposal, there's a potentially higher price not to be in compliance. The EPA and some state regulators are getting tougher on medical-waste disposal. Burke says he knows of a hospital that was fined in excess of $40,000 for noncompliance of RCRA regulations.

Kotis agrees that the cost related to hiring a company to help the staff at 900-bed Northwestern Memorial comply with pharmaceutical waste-disposal regulations is money well spent. "If you've got a process in place at a large institution like ours, staff puts the waste in the right spot. These steps save money in the long run," she says.