Seanad Éireann debate -
Wednesday, 22 Jan 1992

Vol. 131 No. 1

Adjournment Matter. - Disposal of Clinical Waste.

Mr. Costello

I welcome the Minister to the House. I did not expect to meet him again so soon.

The disposal of clinical waste is a very serious matter. This waste emanates from hospitals — I refer particularly to Dublin — and has to be disposed of in residential and densely populated areas. There are two ways of disposing of it, one by landfill disposal and the other by incineration. Landfill disposal is a very dangerous and limited method because segregation of the material is required and that means no infectious material can be put into a landfill site. Obviously this requries a high level of segregation and segregation facilities are not in place in the hospitals. Consequently the normal method of disposal of clinical waste is through incineration. If you go to any hospital in Dublin you will see a tall chimney puffing black sooty smoke into surrounding residential areas a number of times a day.

It is ironic that a hospital which is a place for healing pollutes and causes illnesses. This soot falls on clothes lines and an enormous amount of pollution is caused. Residents complain about this pollution all the time. It is ironic that while we have disposed of the problem of smog from burning bituminous fuel in the city of Dublin we still have pollution from clinical waste, particularly from hospitals. It is a contradictory situation and cannot be tolerated. The situation is worse in that while we have an air pollution Act we do not have any specific Irish standards for the incineration of and disposal of hospital waste. We cannot adhere to the British or the German standards because of the antiquated incinerators operating in our hospitals. That is very serious.

The Department of the Environment recommend adhering to British standards but we do not have the facilities to do so. The level of heat requried under the British and German standards cannot be matched by our antiquated incinerators. It appears there are no guidelines covering private incinerator operations and when inspection of them was carried out, some were found to be in breach of the recommended standards of the Department of the Environment. That is very serious. The incinerators were not designed for the temperatures now required. The equipment is not adequate for the volume of waste. Maintenance either does not take place or is neglected. The personnel manning the incinerators have little or no training for the job and, consequently, their efficiency of the incinerators is extremely poor. The monitoring of the incineration of clinical waste is virtually nil.

We operate almost in a vacuum. We do not know how the radioactive waste emanating from our hospitals is being treated or disposed of. There seems to be no firm evidence about it. That is extremely serious. Is radioactive waste being dumped in landfill sites? How does one incinerate and dispose of radioactive waste properly? Are infectious materials being dumped in landfill sites? Nobody seems to know.

We have reached the stage where we have an optimum of two years or thereabouts remaining in the existing corporation sites in Dublin. We will be faced with a bigger problem in disposing of waste whether of a general or a clinical nature later. We do not have systems for separating waste, whether radioactive material, infectious material or other waste that may not be dangerous. That is why I am asking the Minister for Health if some better procedure can be put in place. A better procedure should be developed. We need to look at the question of waste in the national as distinct from the Dublin context. We must look at the question of the management of hospital waste and develop a coherent approach so that we are simply not relying on the hospital authorities to make a decision on incineration, the use of private operators or landfill sites for waste disposal.

There are no regulations, no standards and no procedures for disposing of waste. It is incredible in this day and age that we are operating a system that has not been updated since Victorian times. Waste disposal is not subject to surveillance or to any Irish standards and regulations. We do not know the dangers of the material that may be emanating from hospitals. We express concern about the nuclear threat from across the water yet we have not taken precautions to ensure that our hospitals do not dispose of radioactive material.

How can we deal with this? We must get an alternative to on-site incineration. Hospitals by their nature deal with large numbers of people, and are, therefore, located in urban areas. Generally hospitals are surrounded by large residential areas. Dublin has 37 hospitals, and many people live adjacent to these hospitals. If we are to protect the health of the people who reside in those areas we must have an alternative system to on-site incineration. We must choose another location and another method of waste disposal. I am not sure incineration is the solution. It may well be but the incinerator should not be sited near a hospital.

I wish to bring to the attention of the Minister the serious nature of the matter, the volume of complaints on a daily basis from people who expect hospitals to deal with and protect their health. The Minister, and the Department of Health, should have a policy on this and develop a plan that will ensure the present unsatisfactory situation is discontinued. We should have emission control levels, and methods of dealing with clinical waste. Above all, we must ensure that there is no detrimental effect on the population in the vicinity of a hospital from which clinical waste material emanates.

Minister of State at the Department of Health (Mr. Flood)

I am pleased to have an opportunity to respond to this important issue and I thank Senator Costello for raising it.

First, I should explain that my Department's technical officers have been examining for some time a number of options for the disposal of hospital waste, including clinical waste, with a view to arriving at the most economic and environmentally acceptable solution. The policy of the hospital authorities is that hospital waste should be segregated into infected and non-infected categories, the infected waste being incinerated and the non-infected waste being sent for disposal by deep burial at tipheads. The two main current methods of disposal are, therefore, incineration and burying at tipheads. Other technologies which are under investigation include steam sterilisation and a grinding and chemical sterilisation process.

It must be recognised that hospitals, by the nature of the medical treatments which are performed in them, will produce waste which is bacteriologically dangerous and must be made safe.

Infectious waste contains pathogens in sufficient concentration or quantity that exposure to it could result in disease. This category includes cultures and stocks of infectious agents from laboratory work, waste from surgery and autopsies on patients with infectious diseases, waste from infected patients in isolation wards, waste that has been in contact with infected patients undergoing haemodialysis, for example dialysis equipment such as tubing and filters, disposable towels, gowns, aprons, gloves and laboratory coats and waste that has been in contact with animals inoculated with an infectious agent or suffering from an infectious disease.

The best method of rendering such infectious waste harmless is to raise it to a temperature which will destroy all living organisms. This has traditinally been done in the hospital incinerator. Unfortunately, the incineration of hospital waste gives rise to the production of products of combustion which must be discharged into the atmosphere. With the present generation of incinerators, these products will frequently include visible smoke and can cause atmospheric pollution. There is no way of avoiding the production of infectious waste from hospitals and so the challenge is to render it safe while not causing pollution. This can be done but it cannot be done cheaply and it cannot be done overnight.

This whole area involves complex economic and technical considerations and one conclusion which has emerged is that incineration is the preferred method of disposal. However, hospital waste is difficult to incinerate in a smokeless fashion and the equipment required to meet the current stringent environmental standards is tending to become more and more expensive and sophisticated. Within the incineration option there are a number of alternatives including incineration on each hospital site using incinerators manufactured to an acceptable standard; on-site incineration of biologically hazadous material with off-site disposal of other waste; central or group incineration on selected hospital sites serving a number of hospitals; and contract incineration off site. The high cost of the chemical scrubbing and filtration equipment required to meet environmental standards rules out incineration on each hospital site.

I am aware that criticisms have been made from time to time in relation to the arrangements currently in force for the disposal of hospital waste. Some of these criticisms relate to the use of incinerators that are alleged to be defective or, indeed, inadequate. Many of the hospital incinerators currently in use have been stated to be incapable of reaching the required temperatures for efficient operation.

While the implementation of waste disposal procedures is a matter for the health agencies concerned in the first instance, I do accept that many of these criticisms are justified. The fact is that many of our hospital incinerators are not geared to the level of performance required to meet today's rigorous standards on a continuous basis. These standards are becoming more demanding year by year in response to society's increasing concern for the environment.

Because of the inability of many of our individual hospital incinerators to meet the required standard, my Department consider that the most cost-effective and environmentally acceptable solution to the problem appears to be the provision of large centralised incinerators to cater for more than one hospital. A proposal to establish a central incinerator to cater for the clinical waste from all Dublin hospitals is well advanced. I am determined that this proposal, and any other proposal for the disposal of clinical waste, will be subject to the fullest scrutiny to ensure compliance with today's environmental standards. That scrutiny will involve the completion of an environmental impact study by EOLAS, and the seeking of planning permission and a licence under the Air Pollution Act.

The question arises whether it is better to locate a central incinerator on a hospital site or in a separate location. One advantage of locating a central incinerator on a hospital site is that the heat produced by incineration can be recovered and used to heat the hospital. The recommended temperature for incineration of hospital waste varies from one country to another. A survey of emission rules in seven countries, published some time ago in the Journal of the Institute of Hospital Engineering, shows recommended temperatures of 800ºC to 1,000ºC and I am taking the steps necessary to ensure that all waste will be incinerated in conditions which comply with these requirements.

As I have already mentioned, this whole question is extremely complicated and my Department are in constant touch with the Department of the Environment in relation to the central incineration arrangements envisaged and in relation to an EC proposal to include hospital and other clinical wastes in a new and extended definition of hazardous waste.

In relation to the disposal of hospital waste by incineration, the Air Pollution Act, 1987, obliges the occupiers of non-domestic premises, including premises belonging to the State, to use the best practicable means to prevent or limit air pollution. Hospital incinerators are within the scope of this Act and are subject therefore to its general provisions. The Minister for the Environment has made regulations establishing a licensing system for new plant to which the Act applies and it is the intention that, in due course, all existing plant, including existing hospital incinerators, will be brought within the scope of the licensing system.

I should like to thank the Senator again for raising this important question and I assure the House that every effort is being made by my Department to implement a hospital waste disposal policy that will overcome the difficulties associated with current practices and comply fully with the demanding requirements of modern environmental and other standards.

The Seanad adjourned at 8.30 p.m. until 2.30 p.m. on Thursday, 23 January 1992.