Dive Brief:
- A new report from the Environmental Research & Education Foundation follows the “profound regulatory and structural transformation” of the medical waste incineration sector in the United States over the last 30 years that has prompted 99% of facilities to close since the early 1990s.
- That’s because stricter federal emissions standards, introduced in the mid-1990s and further tightened over the years, required existing facilities to either drastically update pollution control technologies or close their doors, the report says.
- Of the estimated 2,300 medical waste incineration units operating in the 1990s, only between 12 to 13 are active today, according to the report. Emissions of hazardous pollutants, such as mercury and dioxins, have also decreased by over 99% in that time frame, the report states.
Dive Insight:
The EREF report aims to highlight and contextualize available data on facilities that incinerate hospital, medical, and infectious waste, noting that some “academic and public discourse” may still rely on outdated data from before the establishment of stricter standards. That can lead to miscommunications about how the sector operates today, according to the report.
The report comes as environmental activists and environmental justice communities continue to protest incinerator operations — both medical waste and municipal waste projects — due to concerns that certain operators are not complying with required environmental standards.
The EREF report’s scope covers trends in medical waste incinerator regulations from the last few decades, but it does not offer commentary on how specific modern incinerator projects operate today. In general, the report notes that the medical waste incineration sector operates under strict federal oversight, especially compared to its incineration predecessors from the 1990s.
The report focuses on facilities that incinerate regulated medical waste, such as pharmaceutical, pathological and chemotherapy waste as well as sharps. These kinds of waste are often incinerated as a way “to ensure complete destruction and effective risk mitigation,” and the process is subject to specific federal and state regulations for handling and treatment, according to the report.
Other types of waste generated in healthcare settings, such as cafeteria, office and packaging waste, are typically managed as municipal solid waste and aren’t covered in the report.
In the ‘90s, there were “thousands” of small, hospital-based units that incinerated waste under “variable oversight” and routinely mixed MSW with regulated medical waste, the EREF report says.
But the advent of certain federal regulations under the Clean Air Act, set in the mid-90s, imposed much stricter emissions limits and operational requirements such as more stringent monitoring.
The U.S. EPA’s New Source Performance Standards for medical waste incinerators had a pronounced effect on this process because it prompted facilities to adopt modern pollution control technologies, the EREF report says. The NSPS rule for such facilities was first adopted in 1997 and most recently updated in 2013.
These regulations imposed strict, federally enforceable emission limits on pollutants such as carbon monoxide, lead, cadmium, mercury, dioxins and furans, hydrogen chloride, nitrogen oxides and sulfur dioxide.
Many of the smaller incinerators couldn’t afford to implement the rigorous compliance programs needed to filter out and monitor for these pollutants, prompting them to close or shift their medical waste management focus toward non-incineration treatment technologies such as autoclaving and chemical disinfection, the report said.
That shift defined how the medical waste incineration industry works today, with a “small number of centralized facilities operating under uniform federal performance standards” handling the majority of regulated medical waste incineration.
Due to this dramatic change, the report cautions researchers to pay attention to how data on regulated medical waste incineration is being used in research reports. Older data from before the NSPS is still being used today despite it being decades out of date, it said.
The EREF report gathered information from Freedom of Information Act requests to determine how modern-day medical waste incinerators are operating, and found that most “function under modern federal standards and permitting requirements.”
Yet high-profile violations in recent years underscore how communities may be impacted when operators don’t meet the required standards. For example, the Curtis Bay Energy medical waste facility in Baltimore in 2023 was fined $1.75 million after admitting to improperly incinerating medical waste.
Stericycle’s Utah medical waste incineration facility, which closed in 2022, faced years of community protests due to alleged pollution violations. In 2021, the company agreed to a settlement with the U.S. EPA and the Justice Department, which alleged that the facility exceeded regulatory limits for nitrogen oxide and failed to properly conduct stack tests.
Stericycle, now owned by WM and known as WM Healthcare Solutions, opened a $110 million medical waste facility in McCarran, Nevada, in 2024. The company stressed that the facility was designed to exceed certain environmental standards.
The company has said there’s growing demand for medical waste incineration services in the West.
The EREF report, which did not address the larger medical waste incineration market, noted that it expects incineration to continue in the U.S. due to the technology’s ability to eliminate certain pathogens compared with some other methods.
“Incineration remains a necessary and deliberate component of the medical waste management system, even as the overall scale of medical waste incineration has declined substantially over time,” the report states.
