Journal of Environmental Management 80 (2006) 107–115

www.elsevier.com/locate/jenvman

Medical waste management in Korea*

Yong-Chul Jang a,*, Cargro Lee a, Oh-Sub Yoon b, Hwidong Kim c
a
Department of Environmental Engineering, Chungnam National University, Daejeon 305-764, South Korea
b
Department of Environmental Engineering. Hanbat National University, Daejeon 305-719, South Korea
c
Department of Environmental Engineering Sciences, University of Florida, Gainesville, FL 32603, USA

Received 7 December 2004; received in revised form 7 June 2005; accepted 18 August 2005
Available online 9 December 2005

Abstract
The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past medical
waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities (e.g. inadequately
controlled incinerators) in Korea. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to
better manage the waste from healthcare facilities. This paper presents an overview of the current management practices of medical waste in
Korea. Information regarding generation, composition, segregation, transportation, and disposal of medical wastes is provided and discussed.
Medical waste incineration is identified as the most preferred disposal method and will be the only available treatment option in late 2005. Faced
with increased regulations over toxic air emissions (e.g. dioxins and furans), all existing small incineration facilities that do not have air pollution
control devices will cease operation in the next few years. Large-scale medical waste incinerators would be responsible for the treatment of
medical waste generated by most healthcare facilities in Korea. It is important to point out that there is a great potential to emit air toxic pollutants
from such incinerators if improperly operated and managed, because medical waste typically contains a variety of plastic materials such as
polyvinyl chloride (PVC). Waste minimization and recycling, control of toxic air emissions at medical waste incinerators, and alternative
treatment methods to incineration are regarded to be the major challenges in the future.
q 2006 Elsevier Ltd. All rights reserved.

Keywords: Medical waste; Hospital waste; Infectious waste; Incineration; Sterilization

1. Introduction infectious agents, and contamination of the environment by

In Korea, generation of medical waste from the healthcare
industry has rapidly increased over the past decade. This type
of waste results from the treatment, diagnosis, or immunization
of humans and/or animals at healthcare facilities, veterinary
and health-related research centers, and medical laboratories.
Although medical waste represents a small portion of the total
solid waste stream in Korea, such waste must be handled with
care because of the potentially infectious and hazardous
materials contained in it. Improper disposal of medical waste
may pose a significant risk to human health and the
environment. Some of the problems arising from poor
management of medical waste may include damage to humans
by sharp instruments, diseases transmitted to humans by
*
This paper presents an overview of the state-of-the-art knowledge on the
management of medical waste in Korea.
* Corresponding author. Tel.: C82 42 821 6674; fax: C82 42 822 5610.
E-mail address: gogator@cnu.ac.kr (Y.-C. Jang).
0301-4797/$ - see front matter q 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jenvman.2005.08.018
toxic and hazardous chemicals. Thus, the management of
medical waste is a subject of major concern for any regulatory
agency.
In Korea, medical wastes had been regulated by the Medical
Law under the Ministry of Health and Welfare until 1999. These
wastes were often mixed with municipal solid waste (MSW) and
commonly disposed of in municipal landfill sites or improper
treatment facilities. In addition, information on handling and
disposal of medical waste from healthcare institutions was very
limited and unknown. Facing the management problems of
medical wastes, the Korea National Assembly modified the
Waste Management Act in 1999 to better control medical waste
from the point of generation to its final destination. The Korea
Ministry of Environment (MOE) was responsible for imple-
menting the Act. Medical waste is classified as designated (or
hazardous) wastes and subject to hazardous waste regulations
under the Waste Management Act. The Korea MOE promul-
gated several regulations for definition, segregation, packaging,
tracking, and disposal of medical waste.
Under the Act, medical waste is defined as any solid waste
that is generated by medical treatment facilities and laboratory
108 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115

Table 1
Classification of medical waste

Waste category Components

(1) Tissue Human or animal pathological wastes, including tissues, organs, blood, pus, and body parts and fluids that are removed
during autopsy or surgery
(2) Absorbent cotton Items (e.g. cotton pads, bandages, disposable diapers, or bedding) saturated or stained with human or animal blood, pus,
discharge, or secretion
(3) Discarded medical plastics Disposable syringe, IV bag, blood bag or waste from blood dialysis
(4) Pathological waste Culture and stocks of infectious agents from test or examination, culture dishes, discarded blood fluids and containers;
items that were in contact with infectious agents, such as used slides and cover glass
(5) Waste sharps Discarded sharps, hypodermic needles, syringes, surgical blades and blood lancets
(6) Waste mixed with infectious waste Wastes that are not classified into the above categories but mixed or in contact with waste class (1) through (5) above

facilities operating in a hospital setting and is considered to be
potentially hazardous to health. The waste includes animal
carcasses, human body and animal parts, excretion and
secretion from humans or animals, discarded plastic materials
contaminated with blood, culture and stocks of infectious
agents, discarded medical equipment, and other waste mixed
with infectious agents. Specifically, the waste is classified into
six major categories (Table 1).
It is important to point out that the term ‘medical waste’ has
often been used interchangeably with other terms such as
‘hospital waste’ and ‘infectious waste’ around the world.
Hospital waste is a more broad definition and refers to all
wastes generated by hospitals including infectious and non-
infectious waste materials, hazardous wastes and chemicals,
and other non-hazardous wastes. Medical waste is often
considered to be a subcategory of hospital waste and indicates
‘potentially’ infectious waste that is produced from healthcare
facilities (Klangsin and Harding, 1998; Levendis et al., 2001;
Lee et al., 2002a). In this paper, ‘medical waste’ refers to any
potentially infectious wastes that are generated in the
diagnosis, treatment, examination, or research by general
hospitals, clinics, veterinary, and research centers, as listed in
Table 1. Radioactive materials that have been used in medical
examination and activities in a hospital setting (e.g. X-ray
examination laboratory, X-ray treatment room) should be
properly stored, transported, and treated to avoid any
environmental and health hazards via beta and gamma ray
emission. Wastes containing radioisotopes, such as P32, H3, or
C14, are separately regulated by the Atomic Energy Act in
Korea.
This paper presents an overview of medical waste manage-
ment in Korea. The generation rates and characteristics of
Table 2
Quantities of medical waste in Korea
medical wastes are discussed in the following section. It also
addresses the fundamentals of the actual situation in medical
waste management and current disposal methods of the waste.
Several suggestions are made to improve medical waste
management practices in Korea. Data regarding the generation
rates and composition of medical wastes from hospitals and air
emissions of dioxins from medical waste incineration facilities
were gathered from survey letters, hospital visits, conversa-
tions with hospital authorities, and available literature. We then
evaluated the data obtained in this study to present an overview
of the-state-of-the-art knowledge on the medical waste
management in Korea.
2. Generation and composition of medical waste in Korea
In order to develop proper waste management strategies, it
is important to characterize the volumes and composition of the
waste stream. The quantity of medical waste depends upon
several factors such as the size of healthcare facility, the
segregation program of medical wastes, and the medical
activities. According to the Korea MOE, approximately 33,
980 tons of regulated medical waste were generated from 44,
478 healthcare facilities in 2002 (Korea MOE, 2003). Table 2
presents the quantities of medical waste generated from 1996
through 2002. In recent years, increased amounts of medical
waste have been generated partly due to the stringent
regulations for the waste and the wide acceptance of single-
use disposable materials (Table 2). It is important to note that
medical waste has been classified into two major categories
since 1999: tissues and others. Tissues are stored in a
refrigerator, and all other wastes are placed and mixed in a
large container at room temperature before waste treatment.

Waste components Unit: ton /year

‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02
Tissues 605 652 790 887 1624 993 919
Absorbent cotton 4746 5287 5027 17,512a 20,726a 26,784a 33,062a
Discarded medical plastics 6598 7180 7386
Pathological waste 834 1430 1654
Waste sharps 737 1070 947
Total 13,520 15,619 15,804 18,399 22,350 27,777 33,981

Source: Korea Ministry of Health and Welfare (1998), Korea MOE (1998 and 2003).
a
The numbers indicate all medical waste other than human and animal tissues.
 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115 109

Table 3 Table 4
Sources and quantities of medical waste in Korea in 2002 Quantities and composition of medical waste in general hospitals in Daejeon
metropolitan city
Waste No. of Waste % Contri- Waste
components generators generated bution by generated per Waste Unit: kg/year
all facilities type of facility (ton components
(ton/year) facility per year) Hospital A Hospital B Hospital C Hospital D
Veterinary 13 23 0.1 1.73 Tissues 301 41.8 76.8 10.3
institute Placentas 416 369 249 13.1
Animal 1912 217 0.6 0.11 Absorbent 70,239 35,040 20,433 8790
hospital cotton
Multi-speci- 919 4523 13.3 4.92 Discarded 39,217 39,461 7972 5171
alty hospital medical
Local public 2684 374 1.1 0.14 plastics
healthcare Pathological 13,953 26,136 3586 2664
unit wastes
Medical 263 826 2.4 3.14 Waste sharps 4513 1334 754 817
research Mixture with 23,239 5,595
institute infectious
Clinics 38,238 7663 22.5 0.20 waste
Midwife 66 9 0.03 0.13 Total 128,639 102,382 56,310 23,060
unit No. of bed 736 568 522 450
General 292 19,990 58.8 68.46 Generation 0.48 0.49 0.30 0.14
hospital rate (kg/
Blood banks 17 353 1.0 20.78 bed$day)
Others 74 3 0.01 0.04
(Crematory)
Total 44,478 33,981 100.0 absorbent cottons, and pathological wastes. Although data
regarding the quantities of medical wastes generated from
Source: Adopted from Korea MOE (2003).
healthcare facilities have been available, little is known about
Sources and quantities of medical waste in Korea are shown the detailed mass composition of medical wastes generated by
in Table 3. National data show that medical waste generation is this type of healthcare facility.
skewed toward the largest generators, which are general Table 4 presents the quantities and mass compositions of
hospitals containing more than 100 beds. Approximately 60% medical waste produced by four general hospitals in Daejeon
of medical waste came from general hospitals, which account Metropolitan City in Korea based on a survey conducted during
for only less than 0.7% of all generators. This indicates that this study. Daejeon Metropolitan City is located in the middle
such facilities are the largest source of medical waste when of South Korea and has a population of more than 1.2 million.
compared to other healthcare facilities. The average amount of Major components of the wastes in the hospitals are absorbent
waste generated per general hospital in 2002 was 68.5 ton. cotton, discarded medical plastics, and pathological wastes. It
was found that the generation rates of medical waste in the
Taking into consideration that the total number of beds in
hospitals ranged from 0.14 to 0.49 kg/bed$day, assuming
general hospitals in Korea is 114,000 (Korea Association of
100% bed-occupancy. While the generation rates from
Hospitals, 2003) and assuming that a bed-occupancy rate is
Hospitals A and B were comparable to the average value
100%, the estimated generation rate of medical waste from
(0.48 kg/bed day) estimated by the national statistical data, a
general hospitals is 0.48 kg/(bed$day). This generation rate is
wide difference between the two hospitals and Hospital D was
comparable to those observed by other studies (Monreal, 1993;
noted. Hospital D offers medical services mainly related to
Pruss et al., 1999; Da Silva et al., (2005)). The amount of waste
industrial work accidents. Inpatients at the hospital are
generated per clinic (e.g. physician, dental, and other outpatient
generally admitted for a longer period of time, resulting in
clinics) is significantly lower (0.2 ton/year), although they
relatively lower turnover rate of patients. This indicates that a
represent more than 85% of all medical waste generators. This
lower proportion of patients is treated on a day-care basis
results partly from less intensive and routine medical care for
resulting in less medical waste produced by the hospital
outpatients provided by such clinics (e.g. single use materials
compared to the other hospitals. Another possible reason for
for diagnosis). Therefore, they are often classified as ‘minor the lower generation rate is that the healthcare services
and scattered sources’ of health-care waste according to the provided by Hospital D require less disposable plastics,
quantities produced (Pruss et al., 1999). pathological items, and absorbent cotton than the other three
Medical waste generally consists of many different types of general hospitals due to different hospital specializations.
materials. While the relative proportion of the components of
medical wastes produced from hospitals depends upon the
types of healthcare facilities, the management practices of 3. Medical waste management in Korea
waste (e.g. handling, segregation and disposal), and the
regulations of waste, as a whole, the major components of The best medical waste management practice for medical
medical waste include tissues, single-use disposable plastics, facilities is to prevent and minimize the generation of waste.
110 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115

Medical waste

Recycling
Source Separation
(Placentas)

On-Site Off-Site
(Manifest and On-line Tracking System)

Incineration Incineration
Steam Sterilization Steam Sterilization
with Shredding

Ash Disposal in Landfills

Fig. 1. Current pathways for the management of medical waste in Korea.

However, the potential for waste prevention and reduction at
the point of generation are known to be somewhat limited
because of the nature of the waste stream (e.g. the infectious
characteristics) and the increased use of single-use disposable
items. Fig. 1 illustrates the current pathways for the manage-
ment of medical waste in Korea. The following section
discusses each pathway of medical waste management.
3.1. Source separation and collection
The segregation of medical waste is done at the point of
generation and is commonly practiced in the majority of
healthcare facilities in Korea. Human and animal tissues are
placed in a red container (plastic, paper board, or metal
container), while pathological waste and discarded sharps are
stored in a yellow container. All other wastes are placed in an
orange container before shipment. All containers exhibit the
universal biohazard sign that is commonly used in many
countries. In many cases, all segregated wastes other than
tissues are then transferred to a larger medical waste container
in a storage area before transportation to off-site treatment
facilities for final disposal. Placentas are commonly separated
in a red container and then used for raw materials in
pharmaceutical products. Recycling of any segregated wastes
other than placentas is not currently being practiced on-site.
3.2. Off-site transportation: manifest system and on-line
tracking manifest
created to track and better manage hazardous waste. The
manifest form contains information on waste generator,
transporter, and treatment facility, along with a characteriz-
ation of hazardous waste being transported. Six copies (or four
copies for small-size hospitals) of the form are initially
completed and signed by generators before transportation.
The generator retains one copy (Part #6) of the manifest and
gives the remaining parts to the transporter. Upon arrival, the
transporter retains one copy (Part #5) of the manifest and gives
the remaining parts to the treatment facility. The treatment
facility sends one copy (Part #3) to the original generator
within 3 days, two copies (Parts #1 and #2) to local
environmental agencies and retains one copy (Part #4).
Manifests are not required for generators who treat the waste
at their own on-site facilities. By using this manifest system,
the generator and the local environmental agency can track the
movement of medical waste from the point of generation and to
the point of final destination.
In 2002, an on-line manifest system was established to
manage medical waste with a high degree of reliability and in
real time. All of the parties (i.e. generators, transporters, and
operators at medical waste treatment facilities as well as
national and local regulatory agencies) who register with the
on-line manifest system can track the movement of the waste
and find out the status of the waste in real time, saving energy,
cost, and time to manage the waste.
3.3. Medical waste treatment

Since medical waste is designated as hazardous waste, a Several medical waste treatment methods, including
manifest system is required for the management of medical incineration, steam sterilization (or sanitation), microwave
waste. The uniform hazardous waste manifest system was sanitation, chemical disinfection, dry heat disinfection, and
 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115
Fig. 2. Treatment methods of medical waste in 2002 in Korea (Source: Korea MOE, 2003).
disinfection with superheated steam, may be used. As shown in
Fig. 2, incineration and steam sterilization are currently being
used as major treatment methods of medical waste.
The major disposal option of medical waste from most
healthcare facilities is to pay a licensed transporter to transport
the waste to a medical waste incineration facility. As shown in
Table 5, the most common method of medical waste disposal is
off-site treatment, which accounts for approximately 90% of
the total waste stream. The remaining waste (less than 10%) is
treated by on-site incinerators or steam sterilization facilities at
some general hospitals where incinerators or steam sterilization
is available (Table 5). A total of 12 out of 292 general hospitals
treat their own medical waste on-site by incineration, while two
general hospitals employ steam sterilization with shredding of
their medical wastes. Table 6 presents a list of on-site and off-
site medical waste treatment facilities and shows the type of
treatment and capacity of each.
3.4. Incineration
In Korea, incineration has been a traditional treatment
method to handle medical waste that typically contains
infectious and hazardous materials. It has several advantages
when used to treat medical waste, including a reduction in the
waste volume, the sterilization and detoxification of the waste
materials, and the recovery of heat or electricity during
incineration. However, incineration has also some disadvan-
tages, including the potential emission of toxic substances into
the surrounding area, high operation and maintenance costs,
and the requirement of ash disposal.
The major type of incinerator used for the treatment of
medical waste in Korea is a starved air incinerator. The starved
air incinerator typically consists of two furnace chambers. In
the first chamber, the waste is combusted with less than the
stoichiometric air required, resulting in an effluent rich in
organics. The off-gas is then burned out in the secondary
Table 5
On-site and off-site treatment of medical waste by in 2002 in Korea
Unit: ton/year
On-site treatment
Incineration Steam sterilization
Tissues 45 – 575
Others 1774 1110
Total 1819 1110
Source: Korea MOE, 2003.
111
chamber where more than the required (stoichiometric) amount
of air (or oxygen) is provided for complete combustion.
Operating conditions for incinerators required by the Korea
MOE guidelines are greater than 850 8C within the secondary
combustion chamber and at least 2 s of retention time of flue
gas. All medical waste incinerators should also follow air
emission standards for industrial settings to reduce air pollution
potential.
Medical waste incinerators can emit various toxic pollutants
if the incinerators are improperly operated. Emissions from
medical waste incinerators may include carbon monoxide (as a
result of incomplete combustion), particulate matter, hydrogen
chloride, metals (e.g. mercury, lead, arsenic, and cadmium)
(Segura-Munoz et al., 2004), poly-cyclic aromatic hydro-
carbons (PAHs) (Levendis et al., 2001; Lee et al., 2002b), and
dioxins (polychlorodibenzo-p-dioxin (PCDD)) and furans
(polychlorodibenzofuran (PCDF)) (Lee et al., 1995; Brent
and Rogers, 2002; Fritsky et al., 2001; Matsui et al., 2003; Lee
et al., 2004). In recent years, many general hospitals have
stopped operating their on-site incinerators because of the
stringent regulations of air pollutant emissions, especially
dioxins, and the typical hospital’s proximity to cities. The
incinerators in the hospitals were often old with minimal
emission control systems for air pollutants.
Table 7 shows the emission standard for dioxins at
incinerators set by the Korea MOE. Under the modified
Waste Management Act, medical waste incinerators must
measure dioxins more than once every year since 2001.
Although the incinerators are required to measure PCDD and
PCDF, limited data regarding the concentrations of PCDD and
PCDF in air emissions from medical waste incinerators are
available. Table 8 presents what data are available for dioxins
and furans concentrations measured at several medical waste
incinerators, which was provided by the Korea MOE. The
results show that the dioxin concentrations notably vary among
the incinerators. Average dioxin concentrations of air
Off-site treatment
Incineration Steam sterilization Recycling Others (crematory)
226 76
15,533 14,659 – 19
16,108 14,659 226 95
112 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115

Table 6
Current medical waste treatment facilities versus their treatment type and capacity (2003)

On-site treatment Off-site treatment

Facility Capacity (kg/h) Treatment type Facility Capacity (kg/h) Treatment type
A 50 Ia 1 900 I
B 150 I 2 300 I
C 30 I 3 500 I
D 400 I 4 350, 1000 I, Sb
E 190 I 5 710, 350 I, S
F 190 I 6 250 I
G 100 I 7 300 S
H 190 I 8 320, 500 I, S
I 190 I 9 300 S
J 25 I 10 3400 I
K 700 S 11 1900 I
L 250 S 12 1400 S
M 170 S 13 1500 S
N 30 I 14 440 S
O 120 I
P 50 I
Total 1715, 1120 I, S Total 8630, 5790 I, S
a
I, Incineration.
b
S, Steam sterilization (Source: Korea MOE, 2003).

emissions from the medical waste incinerators were 9.23 ng-
TEQ/Nm3 in 2003 and 6.85 ng-TEQ/Nm3 in 2004. The average
levels are clearly lower than the current dioxin standards (e.g.
20 or 40 ng-TEQ/Nm3), but some incinerators have the
potential to exceed the new standard (e.g. 1 or 10 ng-TEQ/
Nm3) coming in 2006. Thus, they will need to better control
dioxin emissions. Further studies should be conducted to
determine whether a number of the current medical waste
incinerators are capable of complying with the new dioxin
standard which is coming at the beginning of 2006.
Many small-size on-site and off-site treatment facilities
(Table 6) are likely to discontinue the use of existing
incinerators in the near future, largely due to the stricter dioxin
emission standards. Thus, only a limited number of large-size
medical waste treatment facilities will remain, where advanced
air pollution control devices can be used to control toxic
pollutant emissions. However, some of the on-site incinerators
may still treat their wastes at a rate of slightly less than 0.2 ton/
h (e.g. 190 kg/h) to avoid the increased regulations for dioxin
emissions for large scale incinerators (10 ng-TEQ/Nm3 for
0.2–2 ton/h capacity) (see Tables 6 and 7).
Many air pollutants in emissions from medical waste
incinerators can be significantly reduced by modern air
pollution control devices if properly designed and operated.
Typical air pollution control devices used at many medical
waste incinerators in Korea include cyclones, semi-dry
scrubbers, and baghouse filters (or fabric dust removers).
Many devices can be modified to effectively control dioxins
and furans. After incineration, the fly ash is disposed of in a
hazardous waste landfill, while the bottom ash is characterized
by the Korea Leaching Test to determine appropriate final
disposal methods (hazardous or non-hazardous).
3.5. Steam sterilization
Steam sterilization (or sanitation) has also been commonly
used for treating medical waste in Korea. Under the Waste
Management Act, the medical waste collected in a plastic bag

Table 7
Emission standards for dioxins at incinerators in Korea

Capacity Emission standard (ng-TEQ/Nm3) Frequency of testing

New Existing
Medical waste incinerator 4 ton/h 0.1 20a or 1b At least twice a year
2–4 ton/h 1 40a or 5b At least twice a year
0.2–2 ton/h 5 40a or 10b At least twice a year
25–200 kg/h 5b 10b
!25 kg/h –c –c
Municipal solid waste 2 ton/h 0.1 0.5 (until June 30, 2003) 0.1 At least twice a year
incinerator (July 1, 2003)
a
Until Dec. 31, 2005.
b
Beginning Jan. 1, 2006.
c
Incinerators no longer in use.
 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115 113

Table 8 Alternative (and currently less developed) treatment methods

Dioxins in air emissions at several medical waste incinerators in Korea to be used in the future depend upon the physical and chemical
Medical waste Capacity (kg/h) Dioxins and furans in air emission characteristics of medical waste. A certain component in the
incinerator (ng-TEQ/Nm3) medical waste stream may require a different method of
Year 2003 Year 2004 treatment, destruction, and disposal suitable to its own
Site 1 1700 –a 0.09 peculiarities. Thus, the development of alternative treatment
Site 2 (a) 300 11.4 57.6, 1.31 technologies for medical waste (e.g. microwave sanitation,
(b) 600 –a 1.25 chemical disinfection, pyrolysis, and gasification) should be
Site 3 350 0.70 0.46
encouraged, replacing unnecessary incineration by potentially
Site 4 250 6.59 4.91
Site 5 (a) 210 17.1 1.91 more environmentally friendly treatment methods. While
(b) 500 22.0 1.43, 2.92 incineration is a suitable treatment for most types of medical
Site 6 320 3.67 1.92 waste and has several advantages (especially volume reduction
Site 7 500 3.15 1.57 of medical waste, destruction of pathogens and hazardous
Average con- 9.23 6.85 (1.78b)
organic matter), it is still an expensive method and may result
centration
in the production of many toxic emissions. For instance,
a
Not measured. dioxins and furans from medical waste incinerators may be
b
Average concentration without outlier (57.6). easily formed and emitted to the atmosphere because the
medical waste stream typically consists of a significant fraction
or in a steel or plastic container should be shredded to less than of plastic materials containing polyvinyl chloride (PVC)
2 cm using appropriate shredding equipment prior to steriliza- products. It has been widely known that the incineration of
tion. The purpose of shredding is to convert medical wastes medical waste is one of the major sources of dioxins and furans
into a more homogenous form that can be easily handled and pollution partly due to the presence of PVC products (Walker
efficiently sterilized. After shredding, the waste is loaded into and Cooper, 1992; Lerner, 1997; Vesilind et al., 2002).
an autoclave for sterilization. This method is known to be very Medical plastic wastes include those associated with sharps
efficient when used for infectious waste and can be applied to (e.g. syringes), IV bags, IV solution containers, blood bags,
most types of microorganisms, if the time and temperature of tubing, gloves/lab ware, and medical packaging. Some of the
the reaction and contact between steam and waste are materials (e.g. IV bags, IV solution containers, and blood bags)
sufficiently provided to kill microbial spores (Ostler and are typically made of PVC plastics that can serve as dioxin
Nielsen, 1998). Operating conditions for sterilization required precursors. Concerns about dioxin air emissions are driving
by the Korea MOE are processing for more than 30 min. in some efforts to reduce the use of PVC materials in medical
contact with steam at 121 8C and above 1 atm. After steam products in the healthcare industry in some developed
sterilization, the final products are often incinerated at medical countries. Some researchers developed chlorine-free blood
waste treatment facilities because many communities are and IV fluid bags as an alternative to PVC to reduce dioxin air
reluctant to accept and dispose of the sterilized products in their emissions when incinerated (Anderson et al., 1999; McCally,
MSW landfills. This results in a double treatment of medical 1999). Therefore, in order to reduce the release of dioxins from
waste, which becomes a less cost-effective approach for incineration of medical waste, it is necessary to make efforts to
treating the waste. As a result, the Korean National Assembly recycle medical PVC plastics, study material substitution of the
recently passed new legislations eliminating the use of all PVC products, and examine effective treatment methods for
existing steam sterilization units for medical waste treatment medical plastic wastes.
by August 8, 2005. This means that incineration will be the Recycling of medical waste, especially discarded PVC
only available treatment option of medical waste in Korea in products, is not currently practiced in most of the hospitals in
the near future. Korea except for the use of placentas as raw materials in the
manufacturing of pharmaceutical products. In addition, no
efforts have been made to examine safer alternatives that exist
4. Suggestions and future challenges for virtually all uses of PVC plastic products. In order to
increase recycling of non-infected medical plastics such as
In the past few years many efforts have been made in Korea medical plastic packages and IV solution bags, proper source
to better manage waste produced from medical institutions. A separation should be undertaken after the modification of the
number of regulations and guidelines have been issued in current medical waste regulations. However, some arguments
order to establish an integrated medical waste management suggest that single-use disposable plastic products reduce
system. Since many of the measures initiated by the Korea liability, control infection, and minimize human exposure to
MOE have only recently started, the outcome may still be hazardous or infectious chemicals.
difficult to evaluate. However, several suggestions can be made Second, waste minimization through reuse, recycling, and
to improve current medical waste management practices in source reduction has to be promoted, which results in a
Korea. decrease of medical waste to be disposed of. Programs for
First, as stated earlier, the only available treatment option medical waste components separation at the source of
for medical waste after August 8, 2005 will be incineration. production have not been successful in healthcare facilities to
114 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115
promote material recycling (e.g. glass, plastic) because of a
major concern over the infectious characteristics of the waste
and the regulations that do not allow recycling and reuse of any
of the medical waste components. However, many waste
components produced in hospitals might be recyclable if they
are not infected, contaminated, and not used for medical
activities. The components include the plastics and metals in
syringes, infusion tubing and bags, and the glass in tubes and
vials. Purchasing easily recyclable, less hazardous, or reusable
items will expedite waste minimization efforts in the
subsequent waste management process.
Third, although medical wastes are defined and classified
into six major categories, composition data of medical waste in
national statistics have been divided into only two major
categories (i.e. tissues and others). Thus, proper medical waste
management strategies to be applied are very limited. More
detailed categories are needed to better understand the physical
and chemical characteristics of medical waste and to develop
best waste management practices, rather than relying solely on
incineration.
Finally, dioxins and furans data at medical waste
incinerators are not readily available, although the toxic
pollutant measurements have been required by the regulations
in recent years. Considering the fact that incineration is the
dominant disposal method of medical waste in Korea, more
dioxin data are needed to assess potential risks to humans and
the environment near medical waste incinerators. In addition,
characteristics of incinerated medical waste ash should be
closely investigated prior to final disposal since it too may
contain a variety of toxic substances.
5. Conclusion
The generation of medical waste in Korea has been
increasing in quantity and variety, due to the wide acceptance
of single-use disposalable items (e.g. gloves, plastic syringes,
medical packages, bedding, tubing, IV bad and containers). The
management of medical waste has been of major concern due to
potentially high risks to human health and the environment. In
the past, medical waste was often mixed with household waste
and disposed of in municipal solid waste landfills. In recent
years, increased public concerns over the improper disposal of
medical waste have led to a movement to regulate the waste
more systematically and stringently by the Korea Ministry of
Environment. Waste minimization and recycling are still not
well-promoted, which results in significant amounts of medical
waste to be disposed of. Efforts have to be made for
minimization and recycling of medical waste prior to final
disposal, especially many medical PVC wastes and plastics, if
not infected or contaminated. Incineration will be dominant as
a medical waste treatment in Korea because another common
treatment method, steam sterilization, will no longer be
available in the near future. Therefore, toxic substances such
as dioxin emissions at medical waste incinerators should be
closely monitored to reduce potential risks to humans and the
surrounding environment. Other potential treatment technol-
ogies, such as pyrolysis and microwave disinfection, should be
examined as alternatives to incineration in order to better
manage medical waste in Korea.
Acknowledgements
This study was funded by the research grant (#2004-0650) at
the Chungnam National University. The authors gratefully
acknowledge the assistance of Dr Jae-Hyuk Hyun from
Chungnam National University and Dr Jenna R. Jambeck,
Post-doctoral associate, Office of Research and Development,
Air Pollution Prevention and Control Division, US Environ-
mental Protection Agency at Research Triangle Park, NC.
during the preparation of the manuscript. The authors also wish
to thank several anonymous reviewers for providing helpful
comments on the manuscript.
References
Anderson, J., Curmen, R., Miripori, J., 1999. Alternatives to Current Blood Bag
Plastic and Plasticizer Materials. US Department of Health and Human
Services Workshop on Plastcizers, SAG Corp., Washington, DC, pp. 164–
204.
Brent, A., Rogers, D., 2002. Establishing the propensity for dioxin formation
using a plume temperature model for medical waste incinerator emissions
in developing countries. J. Air Waste Manage. Assoc. 52, 811–821.
Da Silva, C., Hoppe, A., Ravanello, M., Mello, N., 2005. Medical waste
management in the South of Brazil. Waste Manage. 25, 600–605.
Fritsky, K., Kumm, J., Wilken, M., 2001. Combined PCDD/F destruction and
particulate control in a baghouse: experience with a catalytic filter system at
a medical waste incineration plant. J. Air Waste Manage. Assoc. 51, 1642–
1649.
Klangsin, P., Harding, A., 1998. Medical waste treatment and disposal methods
used by hospitals in Oregon, Washington and Idaho. J. Air Waste Manage.
Assoc. 48, 516–526.
Korea Association of Hospitals, 2003. Statistical Data of Hospitals (In Korean).
Korea Ministry of Environment, 1998. Improved Methods of Medical Waste
Management, Korea (In Korean).
Korea Ministry of Environment, 2003. National Statistics of Solid Waste
Production, Korea (In Korean).
Korea Ministry of Health and Welfare, 1998. Medical Waste Production and
Treatment, Korea (In Korean).
Lee, B., Moure-Eraso, R., Ellenbecker, M., 1995. Potential dioxin and furan
sources from hospital solid waste streams: a pilot study. J. Korea Air Pollut.
Res. Assoc. 11 (E), 13–21.
Lee, B., Ellenbecker, M., Moure-Eraso, R., 2002a. Analyses of the recycling
potential of medical plastic wastes. Waste Manage. 22, 461–470.
Lee, W., Liow, M., Tsai, P., Hsieh, L., 2002b. Emission of polycyclic aromatic
hydrocarbons from medical waste incinerators. Atmos. Environ. 36, 781–
790.
Lee, B., Ellenbecker, M., Moure-Eraso, R., 2004. Alternatives for treatment
and disposal cost reduction of regulated medical wastes. Waste Manage. 24,
143–151.
Lerner, B., 1997. Prevention of Dioxin Formation in Medical Waste
Incineration, 90th Annual Meeting and Exhibition, Air & Waste Manage.
Assoc., Paper No. 97-FA 166.01, Toronto, Ontario, Canada, June 8–13.
Levendis, Y., Atal, A., Carlson, J., Quintana, M., 2001. PAH and soot
emissions from burning components of medical waste: examination/surgi-
cal gloves and cotton pads. Chemosphere 42, 775–783.
Matsui, M., Kashima, Y., Kawano, M., 2003. Dioxin-like potencies and
extractable organohalogens (EOX) in medical, municipal and domestic
waste incinerator ashes in Japan. Chemosphere 53, 971–980.
McCally, M., 1999. Perspectives on Vinyl in Medical Products: How Risky is
Vinyl? Medicine Should Err on Side of Caution with IV Fluid Bags, San
Francisco Chronicle 12 March, pp. 1–2.
 Y.-C. Jang et al. / Journal of Environmental Management 80 (2006) 107–115 115

Monreal, J., 1993. Consideration of medical waste management in Latin
America. In: Proceedings of International Seminar on Medical Wastes,
Curitiba, PR, Brazil.
Ostler, N., Nielsen, J., 1998. Waste Management Concepts, Environmental
Technology Series, vol. 5. Prentice-Hall, New Jersey.
Pruss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Wastes from
Health-care Activities. WHO, Geneva.
Segura-Munoz, S., Takayanagui, A., Trevilato, T., 2004. Trace Metal Distribution
in Surface Soil in the Area of a Municipal Solid Waste Landfill and a Medical
Waste Incinerator. Bull. Environ. Contam. Toxicol. 72, 157–164.
Vesilind, P., Worrell, W., Reinhart, D., 2002. Solid Waste Engineering.
Thompson Learning Inc., California, CA.
Walker, B., Cooper, C., 1992. Air pollution emission factors for medical waste
incinerators. J. Air Waste Manage. Assoc. 42, 784–789.