J Mater Cycles Waste Manag (2003) 5:9–12
SPECIAL FEATURE: CONFERENCE REPORT
Ira F. Salkin
Conventional and alternative technologies for the treatment of
infectious waste
Received: April 22, 2002 / Accepted: October 14, 2002
Abstract The limited scientific information about infec-
tious waste, and the heightened public awareness of this
special component of the waste stream, have contributed
to the implementation or strengthening of the regulations
in this area. This paper proposes a general working defini-
tion of infectious waste, and describes the systems used to
limit its potential occupational and public health impacts.
Although incineration and autoclaving are the most widely
used methods of treating infectious waste, the introduction
of more stringent air-quality standards for incinerators, and
the inherent limitations to the application of autoclaves,
have created a demand for other methods of processing
this segment of the solid and liquid waste streams. These
alternative technologies use one or more of the following
methods: (1) heating the waste to a minimum of 90–95°C;
(2) exposing the waste to suitable chemicals; (3) subjecting
the waste to heated chemicals; (4) irradiating the infectious
waste with ionizing sources. The advantages and disadvan-
tages of each of these alternative forms of treatment are dis-
cussed in this paper.
Key words Infections waste · Incineration · Autoclaves ·
Alternative systems
Introduction
A significant component of the response to the potential
risks associated with infectious waste and increasing public
awareness has been the implementation or strengthening of
regulations in many parts of the world. One of the key
factors in these statutes and rules is the requirement that
this waste be appropriately treated in order to diminish or
I.F. Salkin (*)
Information From Science, PO Box 408, West Sand Lake, New York,
USA
Tel./Fax 518-674-1713
e-mail: irasalkin@aol.com
© Springer-Verlag 2003
Integrated Management for Hazardous Waste
eliminate its possible affect as an occupational or public
health hazard. This paper describes a general working def-
inition of infectious waste, as well as the conventional and
alternative methods used in the treatment of the compo-
nents of the infectious waste stream.
While healthcare facilities, microbiological research,
diagnostic laboratories, pharmaceutical firms, funeral
homes, and the like have always generated infectious waste,
the occupational and public health risks associated with
these components of the solid waste stream have not been
fully appreciated. The literature on the role of infectious
waste as a reservoir of disease is extremely limited. There
have been a few reports that have documented the poten-
tial for, or the actual direct transmission of, diseases to
workers exposed to infectious waste. However, there is no
scientifically substantiated evidence of transmission to the
general public. Furthermore, the discussion or position
papers and the few scientific investigations have not, for the
most part, taken the following factors into consideration:
– the limited availability of hard data from controlled sci-
entific investigations of the consequences of occupational
or accidental exposure to infectious waste;
– the available information is restricted to developed
country, and therefore does not reflect the exposure, prac-
tices, and risk situations in low-income countries;
– the actual content of microorganisms, including path-
ogens, in municipal and infectious waste, and the survival
of microorganisms in such waste;
– the survival of microorganisms in landfill sites;
– airborne transmission of microorganisms at waste sites
and during the handling of wastes.
The absence of information on the risks posed by infec-
tious waste has only fueled the public’s concerns about
these special components of the solid waste stream. They
were first made aware of infectious waste when it was found
along the beaches of several northeastern US states. Their
fears were heightened by numerous reports in the popular
press, almost all anecdotal in nature, of many needle-stick
injuries having occurred to children playing around landfills
or even in playgrounds. Recently, children playing in
10
garbage bins near a healthcare center in Russia found dis-
carded smallpox vaccine ampoules and became infected
with the live vaccine strain of the virus.
Definitions of infectious waste
There is no uniform international standard which defines
the components that comprise the infectious waste stream.
In addition, there is no generally accepted term or phrase
to denote and differentiate the liquid and solid elements of
this special form of waste. Furthermore, there is not even
agreement on the types of facilities that generate infectious
waste. Consequently, for the purposes of this paper, we will
employ the term infectious waste to describe all liquid and
solid materials which may serve as reservoirs of disease
which are generated by any type of facility.
It therefore follows that to develop a working definition
of the components of the infectious waste stream we must
recognized the elements necessary for the transmission of
such diseases, e.g. (1) the type, virulence, and concentration
of the pathogen, (2) the susceptibility of the the host, (3) the
method of transmitting the organism to the host, (4) the
infective dose of the pathogen, and (5) the portal of entry
into the host. Based on these elements, the following broad
categories of waste would be included in our working
definition of infectious waste.
Cultures and stocks of infectious agents and associated
biological material
Cultures and stocks of infectious agents and associated bio-
logical material such as specimens from medical and pathol-
ogy laboratories, cultures and stocks of infectious agents
from clinical, research, and industrial laboratories, dispos-
able culture dishes, and devices used to transfer, inoculate,
and mix cultures and wastes from the production of
biological material.
Sharps waste
Sharps waste includes items such as hypodermic needles,
syringes, Pasteur pipettes, and scalpel blades that have been
used in animal or human patient care, treatment, or
research. Sharps present safety and disease-transmission
hazards because of their ability to create a portal of entry
through the skin, and to carry potentially infectious agents.
Waste human blood and blood components
This category encompasses liquid waste human blood and
blood products, items saturated and/or dripping with human
blood, and other blood components such as serum or
plasma. This category may also include other body fluids,
e.g., cerebrospinal fluid, which have the potential to serve
as sources of transmission of infectious agents.
Human pathological waste
This waste includes tissues, organs, and body parts that are
removed during surgery or autopsy. Although pathological
waste has not been implicated in disease transmission in the
scientific literature, both the Center for Disease Control and
Prevention and the Environmental Protection Agency of
the United States designate this waste as having potentially
infective qualities, and recommend special handling and
treatment prior to disposal.
Animal waste
This category involves animal carcasses, body parts, and
bedding of animals that were known to have been exposed
to infectious agents during research, including research in
veterinary settings. Although this waste stream has not been
implicated in disease transmission to humans, the waste
results from the artificial inoculation of animals with etio-
logical agents infectious to humans, and warrants special
disposal considerations.
Treatment of infectious waste
Having established the components of the infectious waste
stream, we can now consider the various methods that are
used in its treatment. The numerous advantages associated
with incineration (Table 1), and its long history as an effec-
tive method of waste management, have led to its world-
wide use as the preferred means of treating and disposing
of infectious waste. The process converts combustible waste
into residual ash and gases, the latter being vented to the
atmosphere. This time-tested method inactivates all biolog-
ical materials, and is particularly useful in the treatment of
pathological waste and sharps, as these components of the
waste stream are rendered unrecognizable and unusable.
However, new emission standards to reduce the potential
air pollution from incinerators have resulted in an enor-
mous increase in their operating costs. As a result, many
infectious waste generators are turning to alternative treat-
ment technologies and/or simply discontinuing the use
of on-site incinerators. For example, in 1990, there were
approximately 150 infectious waste incinerators in opera-
tion at hospitals, nursing homes, laboratories, and commer-
cial facilities in New York State. However, by 2000, there
were only eight incinerators in use at healthcare sites within
the state.
Since 1876, when Charles Chamberland built the first
pressurized steam sterilizer, autoclaves have been used for
the sterilization of surgical instruments, medical devices,
and heat-stable liquids, as well as their numerous applica-
tions in clinical laboratories and private industry. Therefore,
it was a natural progression to utilize autoclaves to decrease
or eliminate the potential bioburden contained in infectious
waste. While autoclaving offers several advantages over
incineration, there is a downside to its application in pro-
 11

Table 1. Advantages and disadvantages of common clinical waste treatment systems

Type Factors Advantages Disadvantages

Incineration Turbulence and mixing
Moisture content of waste
Filling combustion chamber
Temperature and residence time
Maintenance and repair
Steam Temperature and pressure
autoclave Steam penetration
Size of waste load
Length of treatment cycles
Chamber air removed
Microwave Waste characteristics
Moisture content of waste
Microwave strength
Duration of exposure
Extent of waste mixture
Chemical Concerns about chemicals,
temperature, pH
Chemical contact time
Waste and chemical mixing
Recirculation vs. flow-through
Pyrolysis Waste characteristics
Temperature
Length of treatment cycle
Volume and weight reduction
Unrecognizable waste
Acceptable for all waste types
Heat recovery potential
Low investment cost
Low operating cost
Ease of biological tests
Low hazard residue
Unrecognizable waste
Significant volume reduction
Absence of liquid discharge
Significant volume reduction
Unrecognizable waste
Rapid processing
Waste deodorization
Almost no waste remains
Unrecognizable waste
Heat recovery potential
Public opposition
High investment and operation costs
High maintenance costs
Future restrictive emissions laws
Appearance, volume unchanged
Not suitable for all waste types
Air emissions
Ergonomic concerns
High investment costs
Increased waste weight
Not suitable for all waste types
Air emissions
Ergonomic concerns
High investment costs
Not suitable for all waste types
Air emissions
Need for chemical storage
Ergonomic concerns
Novel technology
Air emissions must be treated
Skilled operator needed

cessing both liquid and solid forms of this waste (see Table
1). One major concern associated with the use of autoclaves,
which has been overlooked until relatively recently, has
been the generation of potentially hazardous chemicals.
Pressurized steam is an excellent method of volatilizing
organic compounds, and many organic reactions are accel-
erated at elevated temperatures. Therefore, a wide variety
of organic species may be emitted depending on the quan-
tity and composition of the hazardous chemicals contained
in the waste. Furthermore, autoclaves cannot be used to
treat a wide variety of waste, e.g., radioactive, chemothera-
peutic, and pathological waste. Finally, even with the newer
vacuum systems, effective treatment of this very narrow
range of waste in an autoclave requires 1–1.5 h.
The reduction in the use of incinerators and the limita-
tions on the application of autoclaves have created a new
industry – alternative medical waste treatment systems.
While these systems vary in their treatment capacity, the
extent of automation, and overall volume reduction, all
alternative technologies utilize one or more of the follow-
ing methods: (1) heating the waste to a minimum of 90–95°C
by means of microwaves, radio waves, hot oil, hot water,
steam, or superheated gases; (2) exposing the waste to
chemicals such as sodium hypochlorite (household bleach)
or chlorine dioxide; (3) subjecting the waste to heated
chemicals; (4) irradiating the infectious waste with ionizing
sources. Each of these methods has its own advantages and
disadvantages, which must be considered when selecting a
treatment system for use by any generator of infectious
waste (see Table 1).
Thermal systems which use heat to inactivate pathogenic
microorganisms are the most common alternative tech-
nologies for the treatment of medical waste. These systems
can be broadly divided into those using low temperatures,
i.e., between 95°C (for example the moist heat generated
through microwaving) and 250°C (dry heat), and those
that use high temperatures, i.e., approximately 500°C to
over 6000°C, as occurs during pyrolysis. The latter systems
combust and destroy the waste as part of the treatment
process. However, many of these thermal technologies have
extremely high initial investment costs, and may not be suit-
able for the treatment of all components of the infectious
waste stream (see Table 1).
Chemical systems employ high concentrations of disin-
fectants to treat both solid and liquid infectious waste. Solid
components are initially shredded to allow the chemicals,
such as chlorine dioxide or peracetic acid, to come into
contact with all surface areas. The resulting slurry may be
discharged directly into a sanitary sewerage system, or the
solid components may be separated from the liquids, with
only the latter being released as part of the facility’s general
sewer effluents. In the latter situation, the unrecognizable
solids are collected in disposable sacks to be transported as
part of the municipal solid waste stream to landfills. While
such systems render the waste unrecognizable and require
far less processing time than thermal technologies, they also
have high capital costs, and their use may be restricted as
they are not suitable for the treatment of all types of infec-
tious waste (see Table 1).
Summary
In the absence of internationally recognized standards as to
the components of the infectious waste stream, this paper
12

has proposed five categories of such waste on the basis of

their potential to act as reservoirs for the transmission of
Reference
infectious diseases. In addition, the paper has discussed
1. Salkin IF, Krisiunas E, Turnberg WL (2000). Medical and infection
the advantages and disadvantages of the more commonly
waste management. In: Richmond JR (ed) Anthology of biosafety.
employed conventional and alternative methods of treating II. Facility design considerations. American Biological Safety Asso-
the various components of the infectious waste stream. ciation, Mudelein, pp 140–160
More detailed information on the treatment of infectious
waste may be obtained from the report by Salkin et al.1

Acknowledgment Portions of the texts were reprinted with permission

of the American Biological Safety Association (ABSA). These sections
of text were originally published in Ref. 1, Chap. 10.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.