Disposing of Disposables

Hospitals that once had horrendous difficulties in washing and sterilizing mountains of linen and equipment now have that problem largely solved. They use disposable supplies, which reduce the risk of infections spreading within the hospital: presterilized bed pads, sheets, pillowcases, blanket covers, examination gowns, surgical masks and drapes, oxygen canopies, water carafes, dishes and drinking cups, transfusion tubing and fittings, thermometers, and perhaps most important of all, hypodermic syringes and needles. But the hospitals, as well as doctors in their private offices, are finding that they have replaced one problem with another: how to dispose of the disposables.

Use all these items once and throw them away, the manufacturers say. The majority of American hospitals are now doing just that--and running into two problems: the sheer bulk of the garbage and its nature. In the early 1960s, the average hospital patient "generated" (in hospitalese) probably no more than 5 pounds and certainly no more than 10 pounds of garbage daily. Much of this was paper or food remains. Not so today. The average patient in a modern hospital that makes full use of disposables is now responsible for 15 to 18 pounds of garbage a day. Much of it consists of a dozen or more varieties of plastics that can be burned, provided the local air-pollution code allows the hospital to use an incinerator. But the PVC (polyvinyl chloride) plastics may generate lethal fumes containing hydrochloric acid and phosgene, a poisonous gas once used in chemical warfare. Other plastics melt and clog the incinerators.

Unsterile Needles. Metals are still harder to deal with, especially the 1.2 billion disposable stainless steel needles attached to plastic syringes that are now used each year in the U.S. Of this total, nearly 800 million are used in hospitals, almost 200 million by diabetics giving themselves insulin, as many more by doctors and nurses in their offices, and the remainder by nursing homes, researchers and veterinarians.

Only ten years ago, most patients dreaded the needle because it was likely to be blunt and painful. Doctors were concerned because re-used needles were not always truly sterile and transmitted serum hepatitis to untold numbers of patients. The disposable hypodermics virtually eliminated both the discomfort and the risk to patients.

But how to get rid of the disposable hypodermic? If the doctor just drops it into a trash can, his nurses or the cleaning staff might snag themselves on the needle and perhaps get an infection. Or the trash cans could be rifled,and the discarded needles supplied to dope addicts. Despite the precautions now taken in hospitals and most doctors' offices, the needles that wind up in the hands of junkies constitute a serious problem.

Tip Destroyer. All the manufacturers of hypodermics have tried to supply their customers with easy ways of getting rid of the needles. One of the simplest: "Destructip," a 10-c- device for bending and breaking needles offered by Becton, Dickinson & Co. for individual users such as diabetics. For hospitals and doctors' offices, some manufacturers build a tip destroyer into the wall of the carton. Once the needle has been used, the nurse or technician inserts it in a metal slot in the side of the carton and bends it to break off the point.

That still does not get rid of the plastic syringe. For hospitals and clinics that use large numbers of hypos, Becton. Dickinson offers a furnace that mel the plastic into a compact mass and embeds the needles. If 1,000 disposable hypos are dropped into this furnace, all that is left after two hours are four multicolored plastic bricks, each less than 8 1/2 in. by 8 1/2 in. by 3 in. Already sterilized at 400DEG F., they need no further safety treatment before they are dropped into the garbage.

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