medical waste management

Medical WasteCopyright Training 4 Today 2000 Published by EnvironWin Software LLC.
WELCOME
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Copyright Training 4 Today 2000 Published by EnvironWin Software LLC.
Define Medical Waste, Regulated Medical Waste and Infectious Waste.
Discuss the Regulations Applicable to Medical Waste.
Discuss the Components of an Infectious Waste Management Plan.
Outline an Exposure Control Plan.
Discuss Steps to take if Exposed to Infectious Waste.
Discuss the Problem of Mercury.
Discuss Records to Maintain.
Understand the Definition of Medical Waste, Regulated Medical Waste, and Infectious Waste.
Understand Why Medical Waste Compliance is Important.
Understand the Components of an Infectious Waste Management Plan.
Be Familiar with Exposure Control Plan.
Understand the Steps to Take if Exposed to Infectious Waste.
Understand the Problem of Mercury.
Be Familiar With Records to Maintain.
GOALS
BACKGROUND
In 1988, improperly disposed medical debris washed up on beaches in New Jersey. This spurred Congress to enact the Medical Waste Tracking Act.
EPA estimates that there are approximately 1 million medical waste generators in the United States who produce 4 million tons of medical waste each year.
Included in those 4 million tons of medical waste produced annually is 500,000 tons of “infectious” medical waste.
In August 2000, several beaches in Nassau County, New York were closed because of needles and other medical-related debris found along the shoreline.
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MEDICAL WASTE TRACKING ACT
Two-year demonstration program for the tracking of medical waste. Only four states and the Commonwealth of Puerto Rico participated in the tracking program.
This demonstration program began June 22, 1989 and ended June 22, 1991.
Currently the program is expired and there is no federal tracking regulations in effect.
Many states have developed programs based on the federal model.
Congress enacted the Medical Waste Tracking Act in November 1988, which added medical tracking provisions to RCRA Subtitle J. The Act directed the EPA Administrator to establish a two-year demonstration program for the tracking of medical waste. The States of Connecticut, New Jersey, New York, Rhode Island, and the Commonwealth of Puerto Rico all participated in the tracking program.
This demonstration program began June 22, 1989 and ended June 22, 1991. Currently the program is expired and there is no federal tracking regulations in effect.
States, however, have become active in managing medical waste and many have developed programs based on the federal model.
This training course is based on the federal model and EPA recommendations. You should consult your state’s regulations on specific medical waste management requirements.
Medical Waste Management */ 60
OTHER APPLICABLE REGULATIONS
29 CFR 1910.1030 – OSHA’s Bloodborne Pathogen Standard
49 CFR 173.196 Department of Transportation’s Packaging of Infectious Substances for Shipment
49 CFR 173.197 Department of Transportation’s Packaging of Regulated Medical Waste for Shipment.
Though EPA’s guidelines for Medical Waste tracking has expired, there are several federal regulations that you should be familiar.
29 CFR 1910.1030 – OSHA’s Bloodborne Pathogen Standard
49 CFR 173.196 Department of Transportation’s Packaging of Infectious Substances for Shipment
49 CFR 173.197 Department of Transportation’s Packaging of Regulated Medical Waste for Shipment.
WHAT IS A MEDICAL WASTE?
Definition of Medical Waste
In this course, medical waste includes all infectious waste, hazardous (including low-level radioactive wastes), and any other wastes that are generated from all types of health care institutions, including hospitals, clinics, doctor’s (including dental and veterinary) offices and medical laboratories.
Definition of Medical Waste
In this course, medical waste includes all infectious waste, hazardous (including low-level radioactive wastes), and any other wastes that are generated from all types of health care institutions, including hospitals, clinics, doctor’s (including dental and veterinary) offices and medical laboratories.
WHAT IS A REGULATED MEDICAL WASTE?
Definition of Regulated Medical Waste
Regulated Medical Waste is a subset of all medical wastes and include seven distinct categories:
Cultures and stocks of infectious agents.
Human pathological wastes (e.g. tissues, body parts)
Human blood and blood products
Sharps (e.g. hypodermic needles and syringes)
Certain animal wastes
Certain isolation wastes (e.g. wastes from patients with highly communicable diseases)
Unused sharps.
Definition of Regulated Medical Waste
Regulated Medical Waste is a subset of all medical wastes and include seven distinct categories:
Cultures and stocks of infectious agents.
Human pathological wastes (e.g. tissues, body parts)
Human blood and blood products
Sharps (e.g. hypodermic needles and syringes)
Certain animal wastes
Certain isolation wastes (e.g. wastes from patients with highly communicable diseases)
Unused sharps.
WHAT IS AN INFECTIOUS WASTE?
Definition of an Infectious Waste
EPA has provided the following guidance on what constitutes an infectious waste. These factors include:
Presence of a pathogen of sufficient virulence
Dose
Portal of entry
Resistance of host
Thus, for a waste to be infectious, it must contain a pathogen with sufficient virulence and quantity so that exposure to the waste by a person or animal could result in an infectious disease.
What is an infectious waste?
EPA has provided the following guidance on what constitutes an infectious waste. These factors include:
Presence of a pathogen of sufficient virulence
Dose
Portal of entry
Resistance of host
Thus, for a waste to be infectious, it must contain a pathogen with sufficient virulence and quantity so that exposure to the waste by a person or animal could result in an infectious disease.
EPA categorizes infectious wastes into the following seven categories:
1. Isolation wastes – wastes generated by hospitalized patients who are isolated to protect others from communicable diseases.
2. Cultures and stocks of infectious agents and associated biologicals – this category includes:
- Specimens from medical and biological laboratories
- Cultures and stocks of infectious agents from clinical, research, and industrial laboratories
3. Human blood and blood products – this includes waste blood, serum, plasma, and blood products.
The Seven Categories of infectious wastes
EPA categorizes infectious wastes into the following seven categories:
Isolation wastes – wastes generated by hospitalized patients who are isolated to protect others from communicable diseases.
Cultures and stocks of infectious agents and associated biologicals – this category includes:
- Specimens from medical and biological laboratories
- Cultures and stocks of infectious agents from clinical, research, and industrial laboratories, disposable culture dishes, and devices used to transfer, inoculate, and mix cultures; waste from production of biologicals; and discarded live and attended vaccines.
3. Human blood and blood products – this includes waste blood, serum, plasma, and blood products.
4. Pathological waste – tissues, organs, body parts, blood, and body fluids.
5. Contaminated sharps – contaminated hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass.
6. Contaminated animal carcasses, body parts, and animal bedding
7. Miscellaneous Contaminated Wastes – these include:
- Wastes from surgery and autopsy
- Miscellaneous laboratory wastes
- Dialysis unit wastes
- Contaminated equipment
4. Pathological waste – tissues, organs, body parts, blood, and body fluids removed during surgery, autopsy, and biopsy.
Contaminated sharps – contaminated hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass.
Contaminated animal carcasses, body parts, and animal bedding – these were known to have been exposed to infectious disease.
Miscellaneous Contaminated Wastes – these include:
- Wastes from surgery and autopsy such as soiled dressings, surgical gloves and lavage tubes.
- Miscellaneous laboratory wastes – specimen containers, slides and cover slips, disposable gloves, lab coats and aprons
- Dialysis unit wastes – tubing, filters, gloves, aprons, etc.
- Contaminated equipment – equipment used in patient care, medical laboratories, research, and in the production and testing of certain pharmaceuticals.
It should be noted that certain qualified person(s) can consider any item to be an infectious waste and part of the miscellaneous category.
INFECTIOUS WASTE MANAGEMENT PLANS
Components of an Infectious Waste Management Plan:
1. Designation of the waste that should be managed as infectious
2. Segregation of infectious waste from the noninfectious waste
3. Packaging
4. Storage
5. Treatment
6. Disposal
8. Staff training
Compliance with State and local regulations should be carefully considered when developing an infectious waste treatment plan. Each facility that has infectious waste should develop an infectious waste treatment plan. Each facility should develop an infectious waste management plan that provides for
Designation of the waste that should be managed as infectious,
Segregation of infectious waste from the noninfectious waste,
Packaging,
Storage,
Treatment,
Disposal,
Staff training.
DESIGNATION OF AN INFECTIOUS WASTE
The infectious waste plan for your facility should specify which wastes are to be managed as infectious wastes. The previous slides in this course can help determine what should be included. A responsible official or committee should determine any other miscellaneous wastes should be handled as an infectious waste.
Designation of infectious waste
The infectious waste plan for your facility should specify which wastes are to be managed as infectious wastes. The previous slides in this course can help determine what should be included. A responsible official or committee should determine any other miscellaneous wastes should be handled as an infectious waste.
SEGREGATING MEDICAL WASTES
Segregation of infectious waste with multiple hazards as necessary for management and treatment.
Use of distinctive, clearly marked containers or plastic bags for infectious wastes.
Use of the universal biological hazard symbol on infectious waste containers as appropriate.
Segregating Medical Waste
Segregating your wastes at the point of generation is one of the most important steps in properly managing your wastes. EPA recommends the following for segregating infectious wastes:
Segregation of infectious wastes at the point of origin.
Segregation of infectious waste with multiple hazards as necessary for management and treatment.
Use of distinctive, clearly marked containers or plastic bags for infectious wastes.
Use of the universal biological hazard symbol, as pictured in this slide, on infectious waste containers as appropriate.
Following these rules will help to ensure you are not producing undesirable mixtures that may be difficult or expensive to get rid of.
Whenever possible, do not combine medical waste with hazardous chemicals or radioactive waste.
Separate sharps waste from other medical wastes.
Separate pathology wastes from other medical wastes.
Separate chemotherapy wastes from other medical wastes.
If different types of waste are mixed, treat these mixtures as follows:
Mixtures of medical and radioactive waste--decontaminate the biohazardous component and manage as radioactive waste. See "Section K, Radiation Safety Logbook." .
Mixtures of medical and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as chemical waste. See the EH&S Help Sheet, Unwanted Hazardous Waste .
Mixtures of medical, radioactive, and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as radioactive waste. See Section K, Radiation Safety Logbook.
Separate sharps waste from other medical wastes. Sharps should be stored in puncture-proof containers.
Separate sharps waste from other medical wastes. Sharps should be stored in puncture-proof containers.
Mixtures of medical and radioactive waste--decontaminate the biohazardous component and manage as radioactive waste.
Mixtures of medical and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as chemical waste.
Mixtures of medical, radioactive, and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as radioactive waste.
If different types of waste are mixed, treat mixtures as follows:
Mixtures of medical and radioactive waste --decontaminate the biohazardous component and manage as radioactive waste.
Mixtures of medical and hazardous chemical waste -- if safe to do so, decontaminate the biohazardous component and manage as chemical waste.
Mixtures of medical, radioactive, and hazardous chemical waste -- if safe to do so, decontaminate the biohazardous component and manage as radioactive waste.
Mixtures of medical and radioactive waste--decontaminate the biohazardous component and manage as radioactive waste.
Mixtures of medical and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as chemical waste.
Mixtures of medical, radioactive, and hazardous chemical waste--if safe to do so, decontaminate the biohazardous component and manage as radioactive waste.
PACKAGING INFECTIOUS WASTE
Selection of packaging materials that are appropriate for the type of waste handled:
- Plastic bags for many types of solid or semisolid infectious waste.
- Bottles, flasks, or tanks for liquids.
Use of packaging that maintains its integrity during storage and transport,
Closing the top of each bag by folding or tying as appropriate for the treatment or transport
Place liquid wastes in capped/ tightly stopped bottles.
Do not compact infectious wastes before treatment.
Packaging infectious waste
Infectious waste should be packaged in order to protect waste haulers and the public from possible injury and disease that may result from exposure to the waste.
EPA recommends:
Selection of packaging materials that are appropriate for the type of waste handled:
- Plastic bags for many types of solid or semisolid infectious waste.
- Bottles, flasks, or tanks for liquids.
Use of packaging that maintains its integrity during storage and transport,
Closing the top of each bag by folding or tying as appropriate for the treatment or transport
Placement of liquid wastes in capped or tightly stopped bottles or flasks
Do not compact infectious wastes or packaged infectious wastes before treatment.
HANDLING SHARPS
Each year there are some 600,000 incidents where people are accidentally stuck by needles and sharps.
The most common times of risk for spreading bloodborne pathogens occurs:
Recapping needles
Failing to dispose of used needles properly in puncture-resistant sharps containers
Accidental breakage of the tubes used for collection of blood in a variety of health care settings. There are an estimated 2,800 injuries from these glass capillary tube breakage every year.
The transmission of bloodborne pathogens is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps. Each year there are some 600,000 incidents where people are accidentally stuck by needles and sharps.
The most common times of risk for spreading bloodborne pathogens occurs:
Recapping needles
Failing to dispose of used needles properly in puncture-resistant sharps containers
Accidental breakage of the tubes used for collection of blood in a variety of health care settings. There are an estimated 2,800 injuries from these glass capillary tube breakage every year.
HANDLING SHARPS
To protect against needlestick injuries, take the following precautions:
Avoid the use of needles where safe and effective alternatives are available.
Help your employer select and evaluate devices with safety features that reduce the risk of needlestick injury.
Use devices with safety features provided by your employer.
Avoid recapping needles.
Plan for safe handling and disposal of needles before using them.
To protect against needlestick injuries, take the following precautions:
Avoid the use of needles where safe and effective alternatives are available.
Help your employer select and evaluate devices with safety features that reduce the risk of needlestick injury.
Use devices with safety features provided by your employer.
Avoid recapping needles.
Plan for safe handling and disposal of needles before using them.
HANDLING SHARPS
Promptly dispose of used needles in appropriate sharps disposal containers.
Report all needlestick and sharps-related injuries promptly to ensure that you receive appropriate followup care.
Tell your employer about any needlestick hazards you observe.
Participate in training related to infection prevention.
Get a hepatitis B vaccination.
Promptly dispose of used needles in appropriate sharps disposal containers.
Report all needlestick and sharps-related injuries promptly to ensure that you receive appropriate followup care.
Tell your employer about any needlestick hazards you observe.
Participate in training related to infection prevention.
Get a hepatitis B vaccination.
PACKAGING OF SHARPS
Containers are rigid puncture-resistant containers that, when sealed, are leak resistant and cannot be reopened without great difficulty.
Must be red in color, have a biohazard label, be accessible to employees, and be located as close as feasible to the immediate area where sharps are used.
Must remain upright throughout use and be replaced routinely. Should not be overfilled to present a hazard.
Containers of contaminated sharps will be closed immediately.
Secondary containers must be closable and prevent leakage during handling, storage, transport, or shipping.
Sharps disposal containers are used to dispose of contaminated sharps (needles, scalpels, broken glass, broken capillary tubes) that can penetrate the skin.
These containers are rigid puncture-resistant containers that, when sealed, are leak resistant and cannot be reopened without great difficulty.
Must be red in color, have a biohazard label, be accessible to employees, and be located as close as feasible to the immediate area where sharps are used.
Must remain upright throughout use and be replaced routinely.
Should not be overfilled so as to present a hazard.
Containers of contaminated sharps will be closed immediately, prior to removal from the area of use, or placed in a secondary container to prevent accidental release of the contents.
Secondary containers must be closable and constructed in a manner such that they contain all the contents and prevent leakage during handling, storage, transport, or shipping.
These containers must also have a biohazard label.
Consult the Department of Transportation’s Regulations 49 CFR 173.196 for infectious substances and 49 CFR 173.197 for regulated medical waste packaging requirements prior to shipment.
STORAGE
Locating the storage area near the treatment site.
Minimizing storage time.
Proper packing that ensures containment of infectious waste and the exclusion of rodents and vermin.
Limited access to storage areas.
Prominently displaying the universal biological hazard symbol on storage area door, waste containers, etc.
Storage of infectious waste.
Locating the storage area near the treat site.
Minimizing storage time.
Proper packing that ensures containment of infectious waste and the exclusion of rodents and vermin.
Limited access to storage areas
Porting of universal biological hazard symbol on storage area door, waste containers, freezers, or refrigerators.
TRANSPORT
Avoidance of mechanical loading devices that may rupture packaged wastes.
Frequent disinfection of carts used to transfer wastes within the facility.
Placement of all infectious waste into rigid or semi-rigid containers before transport off site.
Transport of infectious waste in closed leakproof trucks or dumpsters.
Use of appropriate hazard symbols in accordance with local, state and federal regulations.
Transport of infectious waste
EPA recommends the following:
Avoidance of mechanical loading devices such as forklifts that may rupture packaged wastes.
Frequent disinfection of carts used to transfer wastes within the facility
Placement of all infectious waste into rigid or semi-rigid containers before transport off site.
The transportation of infectious waste in closed leakproof trucks or dumpsters.
Use of appropriate hazard symbols in accordance with local, state and federal regulations.
EPA does not consider trucks as a rigid containment system, but rather as a transport mechanism. Therefore, all infectious waste should be placed in rigid or semi-rigid, leakproof containers before loaded on a truck.
MEDICAL WASTE HAULING
There are three methods for transporting regulated medical waste, including sharps, to a permitted regulated medical waste treatment or storage facility.
By a healthcare professional employed by the facility.
By contract with a transporter registered with the state.
By mail, parcel post, or courier service (sharps only).
There are three methods for transporting regulated medical waste, including sharps, to a permitted regulated medical waste treatment or storage facility.
1) By a healthcare professional employed by the facility.
2) By contract with a transporter registered with the state.
3) By mail, parcel post, or courier service (sharps only).
MEDICAL WASTE HAULING
Transporting by the U.S. Postal Service may be arranged, provided the addressee is a treatment/disposal facility permitted by a state.
A mailed parcel of used sharps must be mailed as First Class or Priority Mail. No package may weigh more than 35 pounds, and the total liquid volume may not exceed 50 ml.
When using a facility healthcare professional or a state registered hauler, observe the transportation regulations particular to your state.
Transporting by the U.S. Postal Service may be arranged, provided the addressee is a treatment/disposal facility permitted by a state.
A mailed parcel of used sharps must be mailed as First Class or Priority Mail. No package may weigh more than 35 pounds, and the total liquid volume may not exceed 50 ml.
The primary sharps container must be placed inside a plastic biohazard bag, with a minimum thickness of 3.0 mils, and reinforced with a fiberboard sleeve.
There must be sufficient absorbent material within the plastic bag to absorb and retain three times the total liquid allowed within the primary container, i.e. 150 ml.
Seal the bag by lapping the gathered open end and binding with tape so that no liquid can escape.
Enclose the bagged sharps container within a DOT-approved outer shipping container constructed of 200-pound grade corrugated fiberboard or equivalent material of similar strength.
The box exterior must be marked with the words "Infectious Substance," "Medical Waste," or a label displaying the universal biohazard symbol.
ON-SITE TREATMENT
There are several methods that have been successful in the treatment of infectious waste. The following slides will discuss treatment that may be available at your facility. The methods discussed are:
Autoclaving (steam sterilization)
Sterilization by irradiation (radiofrequency and microwave)
There are several methods that have been successful in the treatment of infectious waste. The following slides will discuss treatment that may be available at your facility. The methods discussed are:
Autoclaving (steam sterilization)
AUTOCLAVING
Autoclaving (heating under high pressure) is widely accepted as an effective medical waste treatment technology.
Steam sterilization, autoclaving, involves the use of saturated steam within a pressure vessel at temperatures high enough to kill infectious agents in the waste. Sterilization is accomplished primarily by steam penetration.
Steam sterilization is most effective with low-density material such as plastics, metal pans, bottles, and flasks. High-density polyethylene and polypropylene plastic should not be used in this process because they do not facilitate steam penetration to the waste load.
Autoclaving (heating under high pressure) is widely accepted as an effective medical waste treatment technology. Steam sterilization, autoclaving, involves the use of saturated steam within a pressure vessel at temperatures high enough to kill infectious agents in the waste. Sterilization is accomplished primarily by steam penetration. Steam sterilization is most effective with low-density material such as plastics.
Containers that can be used effectively in steam sterilization are plastic bags, metal pans, bottles, and flasks. High-density polyethylene and polypropylene plastic should not be used in this process because they do not facilitate steam penetration to the waste load. Heat-labile plastic bags allow steam penetration of the waste, but they may crumble and melt. If heat-labile plastic bags are used, they should be placed in another heat-stable container that allows steam penetration, such as a strong paper bag, or they should be treated with gas/vapor sterilization.
AUTOCLAVING
Plastic bags should be placed in a rigid container before steam treatment to prevent spillage and drain clogging.
Bags should be opened and caps and stoppers should be loosened immediately before they are place in the steam sterilizer.
Care should be taken to separate infectious wastes from other hazardous wastes.
Infectious waste that contains noninfectious hazards should not be steam-sterilized.
Waste that contains antineoplastic drugs, toxic chemicals, or chemicals that would be volatilized by steam should not be steam-sterilized.
The following precautions should be taken when using steam sterilization:
Plastic bags should be placed in a rigid container before steam treatment to prevent spillage and drain clogging.
To facilitate steam penetration, bags should be opened and caps and stoppers should be loosened immediately before they are place in the steam sterilizer.
Care should be taken to separate infectious wastes from other hazardous wastes.
Infectious waste that contains noninfectious hazards should not be steam-sterilized because of the possibility that the equipment operator will be exposed to toxic, radioactive, or other hazardous chemicals.
Waste that contains antineoplastic drugs, toxic chemicals, or chemicals that would be volatilized by steam should not be steam-sterilized.
AUTOCLAVING
Persons involved in steam sterilizing should be trained in handling techniques to minimize exposure to hazards from these wastes. These should include:
Use of protective equipment
Minimization of aerosol formation
Prevention of burns from handling hot containers
Management of spills
Check autoclave temperature to ensure that the proper temperature is being maintained for a long enough period during the cycle.
Steam sterilizers should be routinely inspected.
Persons involved in steam sterilizing should be trained in handling techniques to minimize personal exposure to hazards from these wastes. Some of these techniques include:
Use of protective equipment
Minimization of aerosol formation
Prevention of burns from handling hot containers
Management of spills
The autoclave temperature should be checked with a recording thermometer to ensure that the proper temperature is being maintained for a long enough period during the cycle.
Steam sterilizers should be routinely inspected and serviced, and the process should be routinely monitored to ensure that the equipment is functioning properly.
INCINERATION
Particulate Matter
Carbon Monoxide
Cadmium
Lead
Mercury
Incineration, complete combustion by exposure of the waste to intense heat, has been used for several years to treat and destroy medical wastes. Stringent, new federal regulations under the Clean Air Act (40 CFR Part 60, Subparts Ec & Ce), however, may result in the decommissioning of these units to avoid the high costs of compliance.
The new EPA regulations restrict the following emissions from incinerators:
Particulate Matter
Carbon Monoxide
Cadmium
Lead
Mercury
It is believed that 85-90% of all current incinerators will NOT meet the new requirements.
THERMAL INACTIVATION
Thermal inactivation involves the treatment of waste with high temperatures to eliminate infectious agents.
This method is usually used for large volumes.
Liquid waste is collected in a vessel and heated by heat exchangers or a steam jacket surround the vessel.
The types of pathogens in the waste determine the temperature and duration of treatment.
After treatment, the contents can be discharged into the sanitary sewer in a manner that complies with State, Federal, and local requirements.
This method requires higher temperatures and longer treatment cycles than steam treatment.
Thermal inactivation involves the treatment of waste with high temperatures to eliminate the presence of infectious agents.
This method is usually used for large volumes of infectious waste.
Liquid waste is collected in a vessel and heated by heat exchangers or a steam jacket surround the vessel.
The types of pathogens in the waste determine the temperature and duration of treatment.
After treatment, the contents can be discharged into the sanitary sewer in a manner that complies with State, Federal, and local requirements.
Solid infectious waste is treated with dry heat in an oven, which is usually electric. This method requires higher temperatures and longer treatment cycles than steam treatment.
GAS/VAPOR STERILIZATION
Gas/vapor sterilization uses gaseous or vaporized chemicals as the sterilizing agents.
Ethylene oxide is the most commonly used agent, but should be used with caution since it is a suspected human carcinogen.
Because ethylene oxide may be adsorbed on the surface of treated materials, the potential exists for worker exposure when sterilized materials are handled.
Gas/vapor sterilization uses gaseous or vaporized chemicals as the sterilizing agents.
Ethylene oxide is the most commonly used agent, but should be used with caution since it is a suspected human carcinogen.
Because ethylene oxide may be adsorbed on the surface of treated materials, the potential exists for worker exposure when sterilized materials are handled.
CHEMICAL DISINFECTION
Chemical disinfection is the preferred treatment for liquid infectious wastes.
Consider the following:
Type of microorganism
Degree of contamination
Type of disinfectant
Contact time
Other relevant factors such as temperature, pH, mixing requirements, and the biology of the microorganism
Ultimate disposal of chemically treated waste should be in accordance with State and local requirements.
Chemical disinfection is the preferred treatment for liquid infectious wastes, but it can also be used in treating solid infectious waste. The following factors should be considered when using chemical disinfection:
Type of microorganism
Degree of contamination
Type of disinfectant
Contact time
Other relevant factors such as temperature, pH, mixing requirements, and the biology of the microorganism
Ultimate disposal of chemically treated waste should be in accordance with State and local requirements.
STERILIZATION BY IRRADIATION
Advantages of irradiation:
The principal disadvantages are as follows:
Capital costs are high.
Space requirements are great.
Worker exposure as a result of leaks in seals or poor work practices.
Disposal of the radiation source may pose problems.
Sterilization by irradiation is an emerging technology that uses ionizing radiation. Advantages over other treatment methods are as follows:
Electricity requirements are nominal.
Steam is not required.
The principal disadvantages are as follows:
Capital costs are high.
Space requirements are great.
The potential exists for worker exposure as a result of leaks in seals or poor work practices.
Ultimate disposal of the radiation source may pose problems.
There are two principle types: radiofrequency and microwave.
RADIOFREQUENCY IRRADIATION
Large radiofrequency irradiation medical waste treatment units include an initial destruction phase.
The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. The moist ground waste is then heated by exposure to radiofrequency irradiation. This process heats the waste to >90 C.
The factors which affect radiofrequency irradiation treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, temperature achieved throughout the waste load during treatment, and waste storage duration.
RADIOFREQUENCY IRRADIATION
Large radiofrequency irradiation medical waste treatment units include an initial destruction phase. The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. The moist ground waste is then heated by exposure to radiofrequency irradiation. This process heats the waste to >90 C.
The factors which affect radiofrequency irradiation treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, temperature achieved throughout the waste load during treatment, and waste storage duration.
Wastes suitable for treatment are most infectious waste with the exception of cytotoxic, hazardous, or radioactive wastes. Contaminated animal carcasses, body parts, human organs, and large metal items may also be unsuitable for treatment by RP irradiation.
MICROWAVE IRRADIATION
Large microwave irradiation medical waste treatment units include an initial destruction phase.
The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. The moist ground waste is then heated by exposure to six microwave irradiation units over a 2 hour period. This process heats the waste to > 90 C.
The factors which affect microwave treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, process temperature, and the mixing of waste during treatment.
MICROWAVE IRRADIATION
Large microwave irradiation medical waste treatment units include an initial destruction phase. The waste is automatically fed into a waste grinding device where it is shredded and sprayed with steam to increase the moisture content of the waste to approximately 10 percent. 'Ike moist ground waste is then heated by exposure to six microwave irradiation units over a 2 hour period. This process heats the waste to > 90 C.
The factors which affect microwave treatment of medical waste include the frequency and wavelength of the irradiation, the duration of the exposure, destruction and moisture content of the waste material, process temperature, and the mixing of the waste during treatment.
Wastes suitable for treatment by microwave irradiation include most infectious waste with the exception of cytotoxic, hazardous, or radioactive wastes. Contaminated animal carcasses, body parts, human organs, and large metal items may also be unsuitable for treatment by microwave irradiation.
DRAIN DISPOSAL
Some liquid medical wastes, such as human blood, may be disposed of in sinks if the waste is first autoclaved or brought to a final concentration of 1 percent bleach.
The following medical wastes may not be drain disposed:
Human or animal cultures suspected of containing infectious agents
Cultures and stocks of infectious agents
Wastes from the production of infectious bacteria, viruses, spores, discarded live and attenuated vaccines
Non-infectious medical waste disposal should only be made to sanitary sewers only.
Drain-Disposable Medical Waste
Some liquid medical wastes, such as human blood, may be disposed of in sinks if the waste is first autoclaved or brought to a final concentration of 1 percent bleach. The following medical wastes may not be drain disposed even if they have been treated with bleach or autoclaved:
Human or animal cultures suspected of containing infectious agents
Cultures and stocks of infectious agents
Wastes from the production of infectious bacteria, viruses, spores, discarded live and attenuated vaccines
Non-infectious medical waste disposal should only be made to sanitary sewers and NOT to storm drains or to septic tanks.
DISPOSAL OF TREATED WASTE
Infectious waste that has been effectively treated is no longer biologically hazardous and may be mixed with the disposed of as ordinary solid waste, provided the waste does not pose other hazards that are subject to federal or state regulations.
EPA recommends:
Contacting state and local governments to identify approved disposal options.
Discharge of treated liquids and pathological wastes (after grinding) to the sanitary sewer system. Approval of the local sewer authority must be obtained.
Disposal of treated waste
Infectious waste that has been effectively treated is no longer biologically hazardous and may be mixed with the disposed of as ordinary solid waste, provided the waste does not pose other hazards that are subject to federal or state regulations.
EPA recommends:
Contacting state and local governments to identify approved disposal options.
Discharge of treated liquids and pathological wastes (after grinding) to the sewer system. Approval of the local sanitary sewer authority must be obtained.
CONTINGENCY PLANNING
The infectious waste management plan should include a contingency plan to provide for emergency situations. The plan should include, but not limited to, procedures to be used under the following circumstances:
Spills of liquid infectious waste – cleanup procedures,
Protection of personnel, and disposal of spill residue
Rupture of plastic bags (or other loss of containment) – cleanup procedures, protection of personnel, and repackaging of waste
Equipment failure – alternative arrangements for waste storage and treatment (e.g. offsite treatment).
Contingency Planning
The infectious waste management plan should include a contingency plan to provide for emergency situations. The plan should include, but not limited to, procedures to be used under the following circumstances:
Spills of liquid infectious waste – cleanup procedures, protection of personnel, and disposal of spill residue
Rupture of plastic bags (or other loss of containment) – cleanup procedures, protection of personnel, and repackaging of waste
Equipment failure – alternative arrangements for waste storage and treatment (e.g. offsite treatment).
DECONTAMINATION
All surfaces, tools, and other objects in contact with potentially infectious materials must be decontaminated and as soon as possible.
Equipment and tools must be cleaned and decontaminated before servicing or being put back to use.
Decontamination should be accomplished by using
A solution of 5.25% sodium hypochlorite (household bleach / Clorox) diluted between 1:10 and 1:100 with water.
Lysol or some other EPA-registered tuberculocidal disinfectant.
Decontamination
All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible.
Equipment and tools must be cleaned and decontaminated before servicing or being put back to use.
Decontamination should be accomplished by using
A solution of 5.25% sodium hypochlorite (household bleach / Clorox) diluted between 1:10 and 1:100 with water. The standard recommendation is to use at least a quarter cup of bleach per one gallon of water.
Lysol or some other EPA-registered tuberculocidal disinfectant. Check the label of all disinfectants to make sure they meet this requirement.
DECONTAMINATION
To clean up spilled blood, you can carefully cover the spill with paper towels or rags, then gently pour your 10% solution of bleach over the towels or rags, and leave it for at least 10 minutes.
To decontaminate equipment or other objects (be it scalpels, microscope slides, broken glass, saw blades, tweezers, mechanical equipment upon which someone has been cut, first aid boxes, or whatever) you should leave your disinfectant in place for at least 10 minutes before continuing the cleaning process.
Cleanup materials must be decontaminated.
Decontamination
If you are cleaning up a spill of blood, you can carefully cover the spill with paper towels or rags, then gently pour your 10% solution of bleach over the towels or rags, and leave it for at least 10 minutes. This will help ensure that the bloodborne pathogens are killed before you actually begin cleaning or wiping the material up. By covering the spill with paper towels or rags, you decrease the chances of causing a splash when you pour the bleach on it.
If you are decontaminating equipment or other objects (be it scalpels, microscope slides, broken glass, saw blades, tweezers, mechanical equipment upon which someone has been cut, first aid boxes, or whatever) you should leave your disinfectant in place for at least 10 minutes before continuing the cleaning process.
Of course, any materials you use to clean up a spill of blood or potentially infectious materials must be decontaminated immediately, as well. This would include mops, sponges, re-usable gloves, buckets, pails, etc.
DECONTAMINATION
Steps to Clean Up a Spill of Human Blood
Wear gloves and lab coat to clean up spill.
If broken glass is present, use forceps to pick up and place in sharps container.
Absorb blood with paper towels and discard in biohazard waste container.
Using a detergent solution, clean the spill site of all visible blood.
Wipe the spill site with paper towels soaked in a disinfectant such as bleach diluted 1:10
Discard all contaminated materials into biohazard waste container.
Wash hands with soap and water.
Decontamination
Steps to Clean Up a Spill of Human Blood
Wear gloves and lab coat to clean up spill.
If broken glass is present, use forceps to pick up and place in sharps container.
Absorb blood with paper towels and discard in biohazard waste container.
Using a detergent solution, clean the spill site of all visible blood.
Wipe the spill site with paper towels soaked in a disinfectant such as bleach diluted 1:10 (vol/vol).
Discard all contaminated materials into biohazard waste container.
Wash hands with soap and water.
EXPOSURE CONTROL PLAN
This plan should include:
Determination of employee exposure
- Universal precautions
- Personal protective equipment
Record keeping
Procedures for evaluating the exposure incident.
OSHA requires facilities to have an Exposure Control Plan whenever there is a chance an employee may be exposed to Bloodborne Pathogens such as Hepatitis B or C and HIV virus.
This plan should include:
*Determination of employee exposure
- Universal precautions
- Personal protective equipment
*Recordkeeping
OSHA has provided a model plan at their website.
EXPOSURE STEPS
Despite the best precautions, exposure still can occur. If a person is exposed to potentially infectious materials try to minimize the exposure to that person and others.
If a person is exposed, they should:
Wash the exposed area thoroughly with soap and running water (use non-abrasive, antibacterial soap if possible).
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for at least 15 minutes.
See a physician immediately.
Exposure
Despite the best precautions, exposure still can occur. If a person is exposed to potentially infectious materials try to minimize the exposure to that person and others.
If a person is exposed, they should:
Wash the exposed area thoroughly with soap and running
water (use non-abrasive, antibacterial soap if possible).
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for at least 15 minutes.
See a physician immediately.
EXPOSURE STEPS
Report the Incident — Employees should immediately report exposure incidents to the employer to permit timely medical follow-up.
Exposure
The first step after washing is to
Report the Incident — Employees should immediately report exposure incidents to the employer to permit timely medical follow-up. If exposed to the bloodborne pathogen HIV, postexposure prophylaxis should be initiated promptly, preferably within 1-2 hours after the exposure incident. Immediate reporting also enables the employer to evaluate the circumstances surrounding the exposure incident to try to find ways to prevent such a situation from occurring again.
EXPOSURE STEPS
Referral to a a Health Care Professional (HCP) — Following a report of an exposure incident of a bloodborne pathogen, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up at no cost to the employee.
Exposure
The second step is to be referred to a Health Care Professional (HCP) — Following a report of an exposure incident of a bloodborne pathogen, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow-up at no cost to the employee. The employer is responsible for providing follow-up, but is not required to perform the follow-up. The employer must refer the exposed employee to a licensed health care professional who will perform all medical evaluations and procedures in accordance with the most current recommendations of the U.S. Public Health Service.
If the infectious exposure is not a bloodborne pathogen, the employer is not required by law to refer the employee to a HCP, however it is a recommended best management practice.
EXPOSURE STEPS
Documentation — The employer must prepare a report of the exposure incident of a bloodborne pathogen, including the route(s) of exposure, the circumstances under which the exposure incident occurred, and the identity of the source patient — if known, and if permitted by law.
Exposure
The third step is Documentation — The employer must prepare a report of the exposure incident of a bloodborne pathogen, including the route(s) of exposure, the circumstances under which the exposure incident occurred, and the identity of the source patient — if known, and if permitted by law. This report must be placed in the employee's confidential medical record. A copy also must be provided to the evaluating health care professional.
Though documentation is not required for other infectious exposures, it is a recommended best management practice.
STAFF TRAINING
Training should include an explanation of the infectious waste management plan and assignment of roles and responsibilities for implementation of the plan.
Training programs should be implemented:
When the infectious waste management plan are first developed and instituted.
When new employees are hired, and
When infectious waste management practices change.
Continuous education is also an important part of staff training.
Training
Facilities that generate infectious waste should provide employees with infectious waste management training. This training should include an explanation of the infectious waste management plan and assignment of roles and responsibilities for implementation of the plan. Such education is important for all employees who generate or handle infectious wastes regardless of the employee’s role or type of work.
Training programs should be implemented:
When the infectious waste management plan are first developed and instituted.
When new employees are hired, and
When infectious waste management practices change.
Continuous education is also an important part of staff training. Refresher training aids in maintaining awareness of the potential hazards posed by infectious waste. Training also serves to reinforce waste management policies and procedures that are detailed in the infectious waste management plan.
MERCURY
Lessons learned about mercury:
· The risk of mercury spills is high. The cost to remedy spills has proven to be very expensive.
· Ninety-nine percent of a typical hospital’s mercury is contained in esophageal dilators, sphygmomanometer services kits, and barometers.
· Total cost to replace mercury devices is modest, especially in light of the cost of spills.
· Non-mercury replacements are usually no more expensive than their mercury counterparts.
Mercury is not a medical waste. However, it is an extremely hazardous waste that is commonly found in hospitals and clinics. The U. S. Environmental Protection Agency (EPA) and the American Hospital Association (AHA) signed a Memorandum of Understanding (MOU) in 1998 implementing pollution prevention actions within hospitals. One of the goals of the MOU was to virtually eliminate mercury-containing waste from hospital waste streams by 2005. The following are lessons learned from the study of mercury in hospitals and clinics.
LESSONS LEARNED
· The risk of mercury spills is high. The cost to remedy spills has proven to be very expensive.
· Ninety-nine percent of a typical hospital’s mercury is contained in esophageal dilators (a tube that is placed down a person’s esophagus) , sphygmomanometer services kits (to monitor blood pressure contains mercury), and barometers.
· Total cost to replace mercury devices is modest, especially in light of the cost of spills.
· Non-mercury replacements are usually no more expensive than their mercury counterparts.
MERCURY
Removal of a mercury device must mean “get it out of the hospital”, not merely out of service.
Purchasing Departments and associated staff must be vigilant in purchasing and accepting shipments of supplies. Vendor substitution could bring mercury back into the facility.
Training for mercury auditing is best done on a one-on-one basis, large groups make the process difficult.
Mercury assessments must be performed in a safe and open atmosphere, which encourages the discovery of all sources of mercury.
Lessons Learned (continued):
Removal of a mercury device must mean “get it out of the hospital”, not merely out of service.
· Purchasing Departments and associated staff must be vigilant in purchasing and accepting shipments of supplies. Vendor substitution could bring mercury back into the facility.
· Training for mercury auditing is best done on a one-on-one basis, large groups make the process difficult.
· Mercury assessments must be performed in a safe and open atmosphere, which encourages the discovery of all sources of mercury.
RECORDS
Medical records of exposure to bloodborne pathogens.
Any training records on medical waste management.
Any state or local requirements for shipping manifests of medical wastes.
Any state or local requirements for logs of equipment used to treat medical wastes.
WHAT RECORDS MUST YOU KEEP?
The only federally mandated records to keep are medical records of those personnel exposed to bloodborne pathogens. You must keep those medical records up to 30 years after the employment of the employee.
Other records that you should keep include:
Any training records on medical waste management.
Any state or local requirements for shipping manifests of medical wastes.
Any state or local requirements for logs of equipment used to treat medical wastes.
You should check with your state on specific medical waste record keeping requirements.
THE IMPORTANCE OF A
CLEAN ENVIRONMENT
“I would ask all of us to remember that protecting our environment is about protecting where we live and how we live. Let us join together to protect our health, our economy, and our communities -- so all of us and our children and our grandchildren can enjoy a healthy and a prosperous life.”
Carol Browner Former EPA Administrator
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In closing, it is important to remember the words of Carol Browner, EPA Administrator during the Clinton Administration. She said:

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