DOEHealth Care Waste & Toxics Reduction Tips

for small and medium size health care facilities


Health care facilities conducting sterilization/ reprocessing on-site can benefit from waste reduction and resource efficiency efforts.


adminReasons for Change

          • Sterilization services may use ethylene oxide sterilizers (EtO).  Ethylene oxide is a known human carcinogen and has other acute and chronic health effects.  It is also extremely reactive and flammable. 

          • Chemiclaves may use formaldehyde or glutaraldehyde. Glutaraldehyde can cause throat and lung irritation, with exposure reported to cause asthma, nosebleed, headaches and nausea.  

          • Almost all sterilants used in chemical disinfection systems designate as dangerous waste. 

On average, reprocessed medical devices are 50 percent cheaper than new devices. Over 3,000 hospitals used reprocessed devices every day and their use is supported by the American Hospitals Association (AHA), the Association of periOperative Registered Nurses (AORN), the Center for Medicare and Medicaid Services (CMS) and the Joint Commision for the Accreditation Of Healthcare Organizations (JCAHO).

By assessing and implementing one or more of the practices described here and on the accompanying downloadable table, health care facilities can enjoy:

  • Reduced regulatory obligations and oversight

  • Increased safety and reduced risks for patients, staff, visitors and the community

  • Less waste in raw materials, by-products, work space, work flow, and staffing

  • Improved cost control at your health care facility.


Opportunities for Action

Specific tips on ways sterilization/reprocessing services can reduce and prevent toxic wastes and resource inefficiencies are listed in this fact sheet’s downloadable/printable table. A sampling of these tips is listed below. 

Basic Best Management Practices

  • Ethylene oxide sterilization systems should use scrubbers, combustion units or gas collection; keep area well ventilated and manage filters as dangerous waste.

  • Avoid spills; use and prepare only needed amount.

  • Manage all wastes containing formaldehyde or glutaraldehyde as dangerous waste.

  • Avoid using glutaraldehyde (inhalant hazard)use; use ventilation hood and personal protective gear.

  • Neutralize used cold sterilants and dispose to sewer (not septic system) if permitted by local public wastewater treatment authority.


Next Steps to Improve Sterilization/Reprocessing Practices

  • Keep costs down by separating packaging waste from biomedical waste.

  • Select a safer disinfectant, such as hydrogen peroxide or peracetic acid.

  • Replace chemical sterilization with less-toxic processes such as sonic sterilization, gas plasma, electron beam, microwave, or hydrogen peroxide whenever possible.

  • Use autoclaves or steam sterilizers if medical items are not moisture or heat-sensitive.

  • Use durable items such as, towels, instruments, and stainless steel products.




Additional Resources

This resource guide’s home page has links to additional fact sheets in this series, plus other useful tools and information from the Washington Department of Ecology and other experts.

The Minnesota Technical Assistance Program has an excellent clinic cleaning guideline. It includes tables listing levels of cleaning need for surfaces in patient rooms, exam rooms, operating rooms, dining areas and work stations.

EPA has a case study on reducing ethylene oxide and glutaraldehyde.

The Sustainable Hospitals website has a dedicated page listing a wide variety of alternative sterilization products.

PPRC has a list of sterilizer options, especially for replacing ethylene oxide.

Practice Greenhealth has more information about sterilants, including alternatives.

CDC Guideline for Disinfection and Sterilization in Healthcare Facilities.

CDC/NIOSH page on glutaraldehyde occupational hazards.

The CDC/NIOSH resource page on ethylene oxide.

General overview of reprocessing, including some cost-saving data.

Infection Control Today has a recent (04/26/2010) article on reprocessing.

The Association of Medical Device Reprocessors website has good information.



This information is brought to you by the Washington Department of Ecology/Toxics Reduction Unit with assistance from the Pacific Northwest Pollution Prevention Resource Center (PPRC) . June 2010