Medical waste in the Death Care Industry


When people die, our society has rituals for disposing of their bodies. Bodies are not "waste" - they have too many emotional connotations associated with them among the living to be called waste. However, biological waste is generated during the processing of the body around death. Every step of corpse management generates waste.

The most common forms of disposition in the US are burial (interment) and cremation. Cremation is not exactly the same as incineration, but the processes are related. Liquid dissolution of bodies in alkaline baths is increasingly popular.

The institutions of the death care industry include morgues, mortuaries, funeral homes, and cemeteries. Morgues keep dead bodies until they can be identified or undergo an autopsy. Hospitals include morgues for the bodies of patients who have died until they can be taken away to a funeral home. The morgue keeps the body refrigerated to prevent biological decay. If a medical examiner needs to look at the body (as often happens in criminal cases), this happens at a morgue. Most dead bodies do not undergo autopsies if the patient has died under medical care.

Mortuaries and funeral homes prepare the body or process it. They also work with the family, religious ministers, and cemeteries and set up public viewings and receptions if needed. For bodies that will be buried, embalming happens at the mortuary, the body is dressed and fixed with makeup for the wake, and the body is placed in the coffin. Mortuaries may also transport the coffin to the cemetery. Bodies are also cremated at the mortuary. The cremation remains (sometimes called “ashes” although they are not strictly speaking ashes) are collected by mortuary attendants and put in a ceremonial container for delivery to the family or a cemetery.

Embalming

Embalming is not as popular as it once was. It involves pumping blood and lymph out of the body and replacing it with embalming fluid. The replacement fluid (about 2 or 3 gallons for an adult male body) is a formaldehyde solution with water and sometimes glutaraldehyde, methanol, ethanol, and phenol. Sometimes dyes are added, too. What happens to the blood and other fluid removed from the body? It is flushed down the drain! Yes, it enters the sewage system and is treated by the wastewater treatment system in whatever town you are in. The blood can be a substantial load to the BOD at the sewage plant so check with local officials.

Cremation

Cremation is increasingly popular and recently surpassed burial as the most common way for bodies to be disposed in the US. The body - with a garment and perhaps in a container - enters a chamber. Natural gas is used to heat the unit and exhaust goes through a scubber to ensure smoke does not exit the facility.

Mortuaries take x-rays of the body in preparation, so they can avoid putting mechanical devices in the chamber. Mechanical devices and pacemakers are removed from the body as are jewelry and watches. The crematory operator essentially performs surgery on the dead body, cutting it open to take out artificial devices.

Most of the human body - over 60 percent - is water. About 20 percent is protein, much of which is collagen in skin and bone. This is combustible. The inorganic part of the bone remains. It is often said the bones are “calcified” in the cremation - they lose organic material. The temperature in the chamber is over 1000 degrees F. Heating is by natural gas or propane, usually not electric. The process takes several hours. The remains are about 3 to 6 pounds. Most of the mass of the body is converted to carbon dioxide and water vapor and exits to the atmosphere.

Alkaline hydrolysis units

A few mortuaries now offer alkaline hydrolysis disposition of the body. They might have a different name for it (e.g. “flameless cremation”), but it uses a heated chemical (alkaline solution) to rapidly breakdown the body tissues. This process has been used to dispose of animal bodies for years and is becoming somewhat popular for humans, partly because it is more energy efficient and eco-friendly than cremation. For this reason, it is called “green cremation”. It has been used on the bodies of people who donate their bodies to science and several states have legalized it for disposal of dead bodies in general.

The body is put into a metal vessel with lye and water. The vessel is built to withstand pressure, and the temperature is increased to 300 degrees. After a period of time (3 hours to 12 hours, as specified by the manufacturer), the pressure and temperature are reduced to ambient levels. At this point the contents of the vessel are largely liquid and at high pH. Acid is added to neutralize the slurry. The slurry is then filtered and the filtrate sent down the drain to the municipal wastewater treatment system. As with embalming, check with local wastewater authorities before operating alkaline hydrolysis on a regular basis. The filtered solids are analogous to cremains and may be venerated or buried.

Both embalming and, even more so, alkaline hydrolysis result in biological fluids entering the sewage system.

Hazardous materials

Every mortuary or funeral home works with a waste management company that takes away problem waste for disposal. Having a contractual relationship with one does not absolve you of responsibility, though. You still have to follow good management practices to keep your customers and employees safe and to prevent the release of hazardous materials to the environment. In particular, pay attention to internal collection systems and how waste is stored until the management company picks it up.

The body itself

One problem is that the deceased body was often sick before expiration. While it is possible that an infectious disease could pass to a mortuary employee or visitor, it is not likely. The bigger risk is medical equipment or materials on the body. People who had been receiving chemotherapy might have ports on their bodies and trace chemotherapy agents could be present.

Embalming fluid

Embalming fluid waste that does not get into the body or leaks out of it would be considered RCRA hazardous waste in some contexts, but the industry usually flushes these liquids down the drain with the bodily fluids.

The CDC website states that: "No evidence indicates that bloodborne diseases have been transmitted from contact with raw or treated sewage. Many bloodborne pathogens, particularly bloodborne viruses, are not stable in the environment for long periods of time."

Other chemicals used on body

Chlorinated compounds trichloroethylene and perchloroethylene were once used in funeral homes, but funeral directors have gotten away from them because they can’t flush them down the drain and must dispose of them the same way dry cleaners do. If waste with these materials is produced, the waste must be classified as hazardous under RCRA.

Sharps

Sharps are scalpels, scissors, lancets, and any medical equipment that offers a piercing hazard. The mortuary uses cutting instruments in preparation of bodies for interment and cremation. Also, it is possible the body arrives at the facility with sharps attached. Sharps are not buried with the body and should not be included in the material sent to the cremation chamber. They should be placed in a dedicated sharps container. Medical waste contractors take sharps from many customers and they can take it from you for disposal.

Pharmaceutical and Chemotherapy Waste

See page on pharmaceutical waste.

RCRA waste

The US federal law that defines and regulates hazardous waste is the Resource Conservation and Recovery Act (RCRA). RCRA hazardous waste is produced in only small quantities at funeral homes, if at all. Keep it in a separate container and tell your waste management contractor. They should be able to take it away for you and arrange for treatment and disposal. The RCRA rules for small generators permit you to keep the waste for a time.

Biohazardous waste

Mortuaries end up with biohazardous waste that must be managed. The quantities are small compared with what is produced at hospitals or doctors offices. Materials such as gauze and bandages on the body that shows up at the funeral home, and some materials used in preparation of the body (e.g. disposable gloves, gauze, and tubing) qualify. Improper burial may contaminate the soil and ground water with leachates from the dead body.

Worker protection

Employees at mortuaries take precautions to avoid contact with hazardous materials. As part of getting their embalming license, operators must learn how to adhere to OSHA regulations for using personal protective equipment.

There is some chance of employees contracting a disease from working with a corpse, but if the medical industry does its job, the body should not be capable of communicating disease once it shows up to the mortuary. Employees use PPE as appropriate when working with bodies. The education for people to become funeral directors includes training on worker safety and mortuaries are subject to OSHA rules.

Resource: OSHA compliance guide for mortuaries from Georgia Tech

Waste management plan

The death care industry is regulated by states and there is always concern about consumer protection and respect for the dead. Environmental concerns do not get as much press, but regulators will look into the death care industry of a periodic basis.

Directors of funeral homes and mortuaries can reduce administrative and public relations headaches if they write and maintain a waste management plan. Developing the plan helps identify problems, makes sure you have accounted for all possible waste, and shows good faith. If asked by a regulator or a member of the general public you can show them your waste management plan. It doesn’t have to be long but it should show historic and projected rates of waste generation, and the plan for normally disposing of waste.

Nobody particularly wants to come after the death care industry, so if you follow regulations and don’t try to illegally dispose of waste you should be OK.