Transcript
Page 1: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

MODULE 18:Management of Chemical, Cytotoxic,

Pharmaceutical and Radioactive Wastes

Page 2: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Module Overview

• Describe sources and types of chemical, cytotoxic, pharmaceutical, and radioactive wastes in a healthcare setting

• Discuss risks associated with exposure to these specific wastes

• Describe all aspects of management of these specific wastes

• Describe treatment and disposal methods

Page 3: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Learning Objectives

• Identify hazardous (non-infectious) wastes in a healthcare facility

• Identify key steps in collection, handling, storage, transport, treatment and disposal of these wastes

Page 4: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Sources & Examples of Hazardous (Non-Infectious) Wastes

• Examples of Sources – Chemicals from diagnostic and experimental work – Cleaning and disinfecting compounds– Agents used for chemotherapy– Drugs that are no longer required– Waste from nuclear medicine

• Examples of Wastes– Formaldehyde (Haemodialysis)– Photographic fixing and developing solutions (X-ray Department)– Solvents and fixatives (Pathology or Histology Labs)– Engine or vacuum pump oils, solvents, degreasers (Facility Engineering)– Disinfectants, pesticides, rodenticides (Housekeeping)– Acids, alkalis or reducing agents (Laboratory)– Mercury (thermometers), cadmium (batteries), lead (Radiology)– Gases stored under high pressure, in cans or cylinders (Surgical Theater)– Ethylene oxide gas (Central Sterile Supply)– Expired drugs, cytotoxic drugs (Pharmacy, Chemotherapy Ward)

Page 5: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Characteristics of Chemical Waste

Discarded solid, liquid and gaseous chemicals that are:•Toxic•Corrosive•Flammable•Reactive

- Explosive, water reactive, shock sensitive

•Oxidizing

Page 6: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

General Types of Chemical Wastes

Chemical Waste Examples

Halogenated solvents chloroform, methylene chloride, perchloroethylene, refrigerants, trichloroethylene

Non-halogenated solvents acetone, acetonitrile, ethanol, ethyl acetate, formaldehyde, isopropanol, methanol, toluene, xylenes

Halogenated disinfectants calcium hypochlorite, chlorine dioxide, iodine solutions, iodophors, sodium dichloroisocyanurate, sodium hypochlorite (bleach)

Aldehydes formaldehyde, glutaraldehydes, ortho-pthalaldehyde

Alcohols ethanol, isopropanol, phenols

Other disinfectants hydrogen peroxide, peroxyacetic acid, quarternary amines

Metals arsenic, cadmium, chromium, lead, mercury, silver

Acids acetic, chromic, hydrochloric, nitric, sulfuric

Bases ammonium hydroxide, potassium hydroxide, sodium hydroxide

Oxidizers bleach, hydrogen peroxide, potassium dichromate, potassium permanganate

ReducersPharmaceuticals

sodium bisulfate, sodium sulfiteexpired drugs, spilled drug, cytotoxic drugs

Miscellaneous anesthetic gases, asbestos, ethylene oxide, herbicides, paints, pesticides, waste oils

Page 7: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Examples of Chemical Waste Containing Heavy Metals

• Mercury– Thermometers, sphygmomanometers– Cantor tubes, esophageal dilators– Mercury switches, fluorescent lamps– Dental amalgam– Some formulations (e.g., Thimerosal)

• Cadmium– Dry cell batteries

• Lead– Radiation shielding

Page 8: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Health Impacts of Chemical Exposure

• Effects on the lungs– Cancer (asbestos, cadmium)– Asthma (formaldehyde)– Irritation (glutaraldehyde)

• Effects on the eyes and mucous membranes– Irritation (formaldehyde, xylene,

methyl ethyl ketone)– Conjunctivitis (glutaraldehyde)– Blurred vision (methyl alcohol)

Page 9: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

• Effects on the skin– Burns (concentrated acetic acid and

sodium hydroxide)– Rashes, irritation (methyl ethyl

ketone, other solvents)• Effects on the nervous system

– Mercury, ethylene oxide, xylene, lead, chloroform, other chlorinated solvents, various organochlorine insecticides

Health Impacts of Chemical Exposure

Page 10: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

• Effects on the liver and kidneys– Lead, cadmium, chloroform,

tetrachloroethylene and other chlorinated solvents

• Effects on the reproductive system– Various pesticides, lead, ethylene oxide

• Cancers – Ethylene oxide, benzene, various

pesticides, some chlorinated solvents, many cytotoxic agents

Health Impacts of Chemical Exposure

Page 11: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Segregation of Chemical Waste

• Chemical Waste

– Separate from infectious waste, radioactive waste, and general non-risk waste

– Segregate based on compatibility

• Toxic, Corrosive, Flammable, Reactive

Page 12: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Containers and Color Coding for Chemical Waste

• WHO recommendation

Waste Color and Markings Container Type

Chemical and pharmaceutical waste

Brown Plastic bag or container

Page 13: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Labeling of Chemical Wasteo Waste container label should have:

– Name, address, telephone of the generator

– Point of generation (if applicable)

– Start date of accumulation of waste

– Estimated quantity

– Description of contents

– Waste classification

– Hazard symbols

– Precautionary statement

– Emergency contact information

Page 14: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

International Chemical Waste Symbols

– Toxic

– Corrosive

– Flammable

– Explosive

– Oxidizer

Page 15: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Handling of Chemical Waste

• Proper personal protective equipment (PPE) should be used when handling hazardous chemicals

• Type of PPE required is specific for each chemical

Page 16: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Handling of Chemical Waste

• Appropriate transferring methods must be used

• Bonding, grounding, and explosion proof devices for flammable waste

• Spill kit accessible

• Different spill kits for different hazards

• All materials in the kit are hazardous after use

• Secondary containment

Page 17: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

On-Site Transport of Chemical Waste

• Use wheeled trolleys, containers, or carts designated for chemical waste transport with the following specifications

• Easy to load and unload• No sharp edges that could damage waste

bags or containers during loading and unloading

• Easy to clean• Leak proof

Page 18: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Storage of Chemical Waste

• Use a separate and enclosed area, room, or building

• Provide good ventilation

• Have easy access to safety shower and eyewash station

• Equip with a liquid or chemical proof sump (secondary containment in case of leaks)

Page 19: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Storage of Chemical Waste

• No mixing of chemical waste (according to manufacturers’ specifications)

• Incompatible wastes should be stored separately, e.g. acids and bases

• Temperature should be controlled or kept within the acceptable range based on manufacturers’ requirements

Page 20: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Sample Sketch of a Chemical Waste Storage Area

Page 21: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Storage of Chemical Waste

o Storage rooms and facilities should be labeled

on the exterior with a sign:

- NO ENTRY: Hazardous waste

o Other symbols if needed:

–No Smoking

–No Eating or Drinking

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Off-Site Transport

• Transport vehicles should meet basic requirements– E.g., well maintained, bulkhead to separate driver from

vehicle load, system to secure load, proper placards and markings including hazard symbol and emergency contacts, spill kit, easy to decontaminate, etc.

• Driver should be trained on:– Laws, risks, safe handling methods, labeling,

documentation and emergency procedures• Consignment or manifest system

Page 23: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Treatment of Chemical Waste• Chemical and Physical Treatment

– Neutralization– Detoxification– Chemical reduction or oxidation– Electrolytic oxidation– Hydrogenation, hydrolysis

• Biological Treatment– Biodegradation

• Thermal Treatment– High-temperature

incineration with air pollution control

Page 24: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Treatment of Chemical Waste in Low-Income Countries

• Encapsulation

• Inertization with cement

• Burial of encapsulated or inertized waste in engineered, controlled and secure landfills

• Return of chemicals to manufacturers

Page 25: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemical Wastes Containing Heavy Metals• Chemical Wastes containing toxic metals, in general

Should not be burned or disposed in dumpsites

Some heavy metals, like silver in x-ray processing, can be recovered

Return to supplier for reprocessing or disposal if possible

If no options currently exist, store the waste safely in a medium-term storage site

Refer to the Secretariat of the Basel Convention’s guidelines on the environmentally sound management or reclamation of metals including mercury and lead

• Mercury

Develop safe clean-up, handling and storage procedures

Sequester mercury waste safely in a long-term storage facility

Reduce unnecessary use of mercury equipment

Replace mercury-containing products with mercury-free alternatives

Develop plans to become a mercury-free facility

• Cadmium and Lead

Send to facilities that specialize in recovery of heavy metals

Return to suppliers if possible

Send to a treatment, storage and disposal facility for hazardous industrial waste

Page 26: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemical Waste Management

• Integrate chemical waste management into the HCWM plan, program and organization

• Identify chemical waste sources and hazards• Control hazards by using less hazardous materials,

modifying equipment to reduce exposures, implementing safe practices, PPE and administrative controls

• Train workers on the proper use of PPE• Provide workers with information such as material safety

data sheets (MSDS) and international chemical safety cards (ICSC)

• Comply with the country’s chemical waste regulations• Develop strategies for waste minimization

Page 27: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Workers’ Right to Know• Principle 10 of the Rio Declaration on Environment and

Development– “Each individual shall have appropriate access to information …

on hazardous materials and activities ….”

• Principle 10 is embodied in many national and regional laws on “Workers’ Right To Know” about the hazards of chemicals they are working with

• Facilities can provide chemical hazard information by making available or International Chemical Safety Cards or Safety Data Sheets (SDSs), which are also called Material Safety Data Sheets (MSDSs)

Page 28: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Safety Data Sheets

• Sections of a safety data sheet1. Identification

2. Hazard identification

3. First-aid measures

4. Fire-fighting measures

5. Accidental release measures

6. Handling and storage

7. Exposure controls/personal protection

8. Exposure controls/personal protection

9. Physical and chemical properties

10. Stability and reactivity

11. Toxicological information

12. Ecological information

13. Disposal considerations

14. Transport considerations

15. Regulatory information

16. Other information, including date

Page 29: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Example of an ICSC

ICSCs can be found at: http://www.ilo.org/dyn/icsc/showcard.home

Page 30: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Example of a Safety Data Sheet

MSDSs can be found on the Internet or obtained from manufacturers.

Page 31: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemical Waste Minimization

• Source Reduction (most desirable method of waste minimization)– Segregate hazardous chemical waste– Evaluate possible substitutions using less

hazardous or non-hazardous materials– Use steam cleaning or non-toxic cleaners– Control the inventory of chemicals– Minimize unnecessary dilution of wastes– Develop plans for a mercury phase-out

Page 32: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemical Waste Minimization

• Recycling– Select vendors that are willing to reprocess or

recycle their products– Use a silver recovery unit for photographic

waste– Use a distillation column to recover solvents– Purchase compressed gas cylinders from

manufacturers who accept return of empty or partially used cylinders

Page 33: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemotherapeutic Waste• Chemotherapeutic waste – waste generated from the

use of chemical agents for treatment, especially cancer therapy

• Cytotoxic agents – substances capable of killing or stopping the growth of cells

• Cytostatic agents – capable of suppressing growth and multiplication of cells

• Antineoplastic agents – inhibiting the development of abnormal tissue growth

• Genotoxic agents – capable of inducing genetic mutation

• Teratogenic agents – capable of causing defects in an embryo or fetus

Page 34: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Examples of Cytotoxic Waste

• Examples of sources– Contaminated materials from drug preparation including vials and

syringes

– Contaminated materials from drug administration including gloves, gauze, needles

• Examples of specific agents– Alkylating agents (e.g., mechlorethamine, chlorambucil,

cyclophosphamide, ifosfamide, melphalan, streptozocin, carmustine, busulfan, dacarbazine, thiotepa cisplatin)

– Antimetabolites (e.g., 5-fluorouracil, methotrexate)

– Anti-tumor antibiotics (daunorubicin, doxorubicin, bleomycin)

– Topoisomerase inhibitors (etoposide, teniposide)

– Mitotic inhibitors (paclitaxel, vinblastine, vincristine)

Page 35: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Segregation of Cytotoxic Waste

• Cytotoxic/Genotoxic Waste– Should be stored separately from other waste in

designated secure location– Collect in strong containers– Containers should be leak-proof– Clearly label containers “cytotoxic wastes”– Do not dispose in dumpsites or discharged into

sewerage systems

Page 36: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Treatment and Disposal of Chemotherapeutic Waste

Chemical degradation

– Convert chemo waste into non-toxic residues by alkaline hydrolysis, chemical oxidation with potassium permanganate or sulfuric acid, denitrosation with hydrobromic acid, or other effective methods for the particular type of cytotoxic waste

High-temperature incineration with air pollution control

Options for low-income countries:

UNDP GEF technology developed in Argentina www.gefmedwaste.org

Safely package and return to original supplier

Encapsulation as a last resort

Do not disposed in dumpsites nor discharged into sewer systems

Page 37: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Chemotherapeutic Waste Minimization

• Segregate chemotherapy wastes through worker training and separate waste containers

• Use degradable chemo agents instead of environmentally persistent agents

• Purchase drug volumes based on need• Return expired agents to manufacturer• Develop spill containment and clean-up

procedures that minimize waste clean-up volume

Page 38: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Characteristics of Radioactive Wastes

• Waste contaminated with radionuclides

• Produced as a result of: in-vitro analysis of body tissue and fluid in-vivo organ imaging and tumor localization investigative and therapeutic practices

• Can be sealed (encapsulated in pins, seeds or needles) or unsealed (liquids administered directly)

• Some have relatively short half-lives causing them to lose activity quickly (e.g., technitium-99m – 6 hours; iodine-123 – 13 hours; phosphorus-32 – 14 days)

• Others have long half-lives (carbon-14 – 5730 years)

Page 39: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Sources of Radioactive Wastes in Healthcare• Sealed sources

• Spent radionuclide generators

• Low-level solid waste, e.g. absorbent paper, swabs, glassware, syringes, vials

• Residues from shipments of radioactive material and unwanted solutions of radionuclides intended for diagnostic or therapeutic use

• Liquid immiscible with water, such as liquid scintillation-counting

• Residues used in radioimmunoassay, and contaminated pump oil

• Waste from spills and decontamination of radioactive spills

• Excreta from patients treated or tested with unsealed radionuclides

• Low-level liquid waste, e.g. from washing apparatus

• Gases and exhausts from stores and fume cupboards

Page 40: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Health Risks of Radioactive Waste

• Health impacts determined by type and extent of exposure to ionizing radiation– Chromosomal damage– Headaches, dizziness, vomiting– Tissue destruction, hemorrhage, hair loss,

diarrhea, death at high doses• An extreme case from Brazil (1988)

– Sealed radioactive source was removed from a radiotherapy institute and broken open – 249 people exposed, several died or suffered severe health problems

Page 41: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Containers for Radioactive Wastes

• Low-level radioactive infectious waste (swabs, syringes) may be collected in bags or containers

• There is no recommended color code for radioactive waste containers

• Containers should have the radioactive symbol

Page 42: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Segregation of Radioactive Waste

• Separate radioactive wastes based on• Half-life

– Short-lived (<60 days) versus long-lived (>60 days)

• Activity and radionuclide content

• Physical and chemical form

– Liquid: aqueous and organic

– Non-homogeneous (e.g. contain sludge or suspended solids)

– Solid: combustible/non-combustible and compactable/non-compactable

• Sealed versus non-sealed sources

– Spent sealed sources

• Waste content

– Waste containing hazardous (e.g. pathogenic, infectious, toxic) material

Page 43: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Labeling of Radioactive WasteRadioactive wastes

• “Radioactive waste” marking and symbol

• Identification number

• Radionuclide

• Activity and date of measurement

• Period of storage required

• Origin of the waste (room, lab, etc.)

• Potential/actual hazards

• Surface dose rate and date of measurement

• Quantity (weight or volume)

• Responsible person

Page 44: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Storage of Radioactive Waste• Secure cabinet, dedicated area, room or small building

• Waste segregated according to the time needed for storage

• Extremely short half lives (<5 days), short half lives (5 to 30 days), longer half lives (30 to 60 days)

• Restricted access for safety

• Radiation shielding depending on radiological hazard

• Radiation monitoring and surveillance

• Fire protection

• Periodic inspections for leakage

• Recordkeeping, inventory log

Page 45: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Disposal of Radioactive Waste• Return to supplier

• “Decay in Storage” or storage for decay

Store the waste for at least 10 times the half-life of

the longest lived radionuclide in the waste

Conduct a radiation survey to confirm that

radioactivity is below the clearance level

Disinfect mixed radioactive infectious waste before

discarding with regular waste

• Long-term storage at an authorized radioactive waste

disposal facility

Page 46: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Radioactive Waste Minimization

• Develop a radioactive waste management plan• Substitute long-lived radionuclides with short-lived

radionuclides• Substitute stable isotopes for radionuclides where

possible• Limit the quantity of radioactive items purchased• Improve procedures to avoid contamination and to

minimize the volume of waste generated

Page 47: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Sources of Pharmaceutical Waste

• Expired pharmaceuticals• Discontinued drugs • IV preparations• Partially used vials and syringes• Compounding of drugs• Breakage and spills of pharmaceuticals• Unused single-dose repackaged drugs• Patients’ personal medications

Page 48: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Characteristics of Pharmaceutical Waste

• Pharmaceuticals can be– Acutely hazardous (e.g., arsenic trioxide,

epinephrine, nitroglycerin, warfarin >0.3%)– Toxic (e.g., barium, chloral hydrate, chloroform,

chlorambucil, cyclophosphamide, mitomycin C, streptozotocin, lindane, phenol, thimerosal)

– Flammable or ignitable (e.g., isopropanol, paregoric, collodion-based preparations)

– Corrosive (e.g., acetic acid used for compounding)

Page 49: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Environmental Impact of Pharmaceutical Waste

• Pharmaceuticals are present in most hospital wastewater

• More than 100 different types of pharmaceuticals or their metabolites are found in water bodies in Europe and the U.S.

• Some pharmaceuticals can seep into the groundwater• Environmental concentrations could affect fish and

other wildlife• Antibiotics found in streams worldwide raise concerns

of the possible rise of antibiotic-resistant organisms

Page 50: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Segregation of Pharmaceutical Waste

• Pharmaceutical Waste– Should be segregated from other infectious

and radioactive wastes – National and local regulations must be

followed

Page 51: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Treatment and Disposal of Pharmaceutical Waste

• Chemical Treatment• Chemical Absorption• Denaturing (e.g., alkaline hydrolysis)• High Temperature Incineration• Recovery of active pharmaceutical ingredients

through solvent extraction, separation, distillation, filtration, etc.

Page 52: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Disposal of Pharmaceutical Waste in Low-Income Countries

• Reverse distribution (return to supplier)

• Safe burial on hospital premises

• Encapsulation or inertization

Solid, liquid, or semi-liquid waste can be encapsulated in metal drums

Solids ground up; mixed with cement, lime and water; made into pellets or blocks

• Landfill disposal

Landfilling large quantities of pharmaceuticals is not recommended, unless waste is encapsulated and disposed in a sanitary landfill where there is no risk of leaching into the groundwater

• Discharge to a sewer

Only for relatively mild liquid or semi-liquids (vitamins, cough syrups, eye drops, saline solution, glucose, electrolytes, etc.)

Discharge into a large flow of water and into municipal sanitary sewers

Antibiotics and cytotoxic drugs should not be discharged in a sewer

Page 53: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Pharmaceutical Waste Minimization

• Good inventory control– Increase inventory turnover– Apply inventory control strategies (e.g., ABC

classification, First In First Out, Just-In-Time management, etc.)

• Avoiding unnecessary prescriptions, especially antibiotics

• Reformulation of drugs

Page 54: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Discussion

• What are some sources of chemical, cytotoxic, and pharmaceutical wastes in your facility? What are some examples of these healthcare wastes that may occur both inside and outside of your facility? What are some major hazards and risks that are posed by these wastes?

• What are some sources of radioactive wastes in your facility? Give some examples, as well as their hazards and risks.

• How does your facility segregate chemical and pharmaceutical wastes? What about specific wastes that have cytotoxic and/or genotoxic properties? What handling and safety procedures are followed by those who deal directly with the wastes?

Page 55: MODULE 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes

Discussion

• How does your facility store chemical, cytotoxic, pharmaceutical, and radioactive wastes? What treatment and disposal methods does it use or has it used in the past for each category of waste?

• What are country/region-specific policies and guidelines for chemical and radioactive waste management? What about international guidelines specifically meant for radioactive wastes? Is your facility able to follow these guidelines?

• How does your facility regulate mercury? Are there plans to use alternative sources in place of mercury and to eventually phase out its use in most medical equipment?


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