Into the Jaws of a Giant
The new rotoclave turns red-bag medical waste green

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Ever wonder where those red bags of medical waste wind up when they leave the hospital floor? You probably blocked that thought, right?

Well, recently, Hopkins Hospital introduced a whole new method of disposing of infectious waste without harming the environment. A new machine known as a rotoclave, a new vendor to manage the process, and in-house programs designed to minimize medical waste all are raising the profile of this once-verboten topic. Now, everyone’s talking trash.

The rotoclave, cylindrical and resembling a small submarine, the biggest of its type and the only one of its kind in Maryland, is situated on the loading dock in back of the Orleans Garage. It can process 2,600 pounds of medical waste in one hour. For now, it’s handling waste exclusively from Hopkins Hospital and the Outpatient Center, but, says Todd Gartrell, director of Environmental Services, “It’s so big that we could eventually bring on Howard County General Hospital, Bayview and our major ambulatory care centers like Green Spring Station.”

A type of autoclave in that it uses steam at high pressure to sterilize the waste, the rotoclave adds a rotating drum. The waste is dumped into the machine. Steam, heatedto 275 F, is injected inside as the drum begins to rotate. The agitation, combined with the steam treatment, breaks up and sterilizes the waste. The process takes about 30 minutes. After the rotoclave cools down, its gigantic door swings slowly open to the ceiling.

Inside, the decontaminated waste, now reduced in volume by about 80 percent, looks a bit like mulch. It is dropped onto a conveyer belt. Before being trucked to a landfill, it is examined for recognizable objects, like metal instruments and devices that might have been thrown into a red bag by mistake. (If such objects are discovered, Environmental Services visits the offending hospital unit to review protocol.)

The rotoclave makes Hopkins Hospital a good neighbor, says Gartrell. “All emissions are vented to a sewer below; none go into the atmosphere. A carbon filter removes odors. It’s not noisy. You would never know that all this was going on here.”

Hospitals have to be extremely careful about how they dispose of medical waste. In a heavily regulated field, they are legally liable for any infractions, like a syringe on a beach. In the late 1990s, faced with new regulations and increasing public opposition to incinerators, which release harmful pollutants into the environment, hospitals began experimenting with alternative technologies.

Beginning in 1999, when Hopkins’ waste disposal operation was based on Wolfe Street in the recently demolished Maryland Hospital Laundry, Environmental Services tried irradiative and then chemical processes. All too often, though, the machinery broke down and the trash backed up due to problems with the waste hauler, an outside vendor.

In January, Environmental Services moved the operation to the new loading docks just off Fayette Street, brought in a new vendor, Stericycle, the largest certified medical waste disposal company in the country, and settled on another alternative technology—steam treatment. The rotoclave was fired up for the first time on Jan.18.

Meanwhile, inside the hospital, Environmental Services began substituting reclyclable products for disposable ones. The added space the new loading docks provide will make more recycling possible, says Gartrell. He’ll soon launch a hospital-wide recycling campaign.

Environmental Services also will begin working with staff to minimize and better segregate medical waste, particularly in the operating rooms, where large volumes are generated. On patient units, infectious waste has already been reduced by 30 percent, Gartrell says. “Red bags now stay exclusively in patient rooms.”

Still, there is more work to be done. Hopkins Hospital currently generates about 15 million pounds of trash annually. That’s about 40 pounds of trash per bed, per day. About 45 percent to 50 percent of it is infectious waste. “That’s far too much,” says Gartrell. “We’re aiming to get it down to 20 percent. If we can do that, we would be very happy.”

—Anne Bennett Swingle

The Rotoclave being readied for shipping to Johns Hopkins. 

Rotoclave installed at Hopkins.  This system is the largest medical waste treatment equipment that we have built to date.  It consists of a 7 foot by 20 foot vessel and generally processes approximately 30 - 1 cubic yard carts.