module 18: management of chemical, cytotoxic, pharmaceutical and radioactive wastes

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

  • Module OverviewDescribe sources and types of chemical, cytotoxic, pharmaceutical, and radioactive wastes in a healthcare settingDiscuss risks associated with exposure to these specific wastesDescribe all aspects of management of these specific wastesDescribe treatment and disposal methods

  • Learning ObjectivesIdentify hazardous (non-infectious) wastes in a healthcare facilityIdentify key steps in collection, handling, storage, transport, treatment and disposal of these wastes

  • Sources & Examples of Hazardous (Non-Infectious) WastesExamples of Sources Chemicals from diagnostic and experimental work Cleaning and disinfecting compoundsAgents used for chemotherapyDrugs that are no longer requiredWaste from nuclear medicine

    Examples of WastesFormaldehyde (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)

  • Characteristics of Chemical WasteDiscarded solid, liquid and gaseous chemicals that are:ToxicCorrosiveFlammableReactive -Explosive, water reactive, shock sensitiveOxidizing

  • General Types of Chemical Wastes

    Chemical WasteExamplesHalogenated solventschloroform, methylene chloride, perchloroethylene, refrigerants, trichloroethyleneNon-halogenated solventsacetone, acetonitrile, ethanol, ethyl acetate, formaldehyde, isopropanol, methanol, toluene, xylenesHalogenated disinfectantscalcium hypochlorite, chlorine dioxide, iodine solutions, iodophors, sodium dichloroisocyanurate, sodium hypochlorite (bleach)Aldehydesformaldehyde, glutaraldehydes, ortho-pthalaldehydeAlcoholsethanol, isopropanol, phenolsOther disinfectantshydrogen peroxide, peroxyacetic acid, quarternary aminesMetalsarsenic, cadmium, chromium, lead, mercury, silverAcidsacetic, chromic, hydrochloric, nitric, sulfuric Basesammonium hydroxide, potassium hydroxide, sodium hydroxideOxidizersbleach, hydrogen peroxide, potassium dichromate, potassium permanganateReducersPharmaceuticalssodium bisulfate, sodium sulfiteexpired drugs, spilled drug, cytotoxic drugsMiscellaneousanesthetic gases, asbestos, ethylene oxide, herbicides, paints, pesticides, waste oils

  • Examples of Chemical Waste Containing Heavy MetalsMercuryThermometers, sphygmomanometersCantor tubes, esophageal dilatorsMercury switches, fluorescent lampsDental amalgamSome formulations (e.g., Thimerosal)CadmiumDry cell batteriesLeadRadiation shielding

  • Health Impacts of Chemical ExposureEffects on the lungsCancer (asbestos, cadmium)Asthma (formaldehyde)Irritation (glutaraldehyde)Effects on the eyes and mucous membranesIrritation (formaldehyde, xylene, methyl ethyl ketone)Conjunctivitis (glutaraldehyde)Blurred vision (methyl alcohol)

  • Effects on the skinBurns (concentrated acetic acid and sodium hydroxide)Rashes, irritation (methyl ethyl ketone, other solvents)Effects on the nervous systemMercury, ethylene oxide, xylene, lead, chloroform, other chlorinated solvents, various organochlorine insecticidesHealth Impacts of Chemical Exposure

  • Effects on the liver and kidneysLead, cadmium, chloroform, tetrachloroethylene and other chlorinated solventsEffects on the reproductive systemVarious pesticides, lead, ethylene oxideCancers Ethylene oxide, benzene, various pesticides, some chlorinated solvents, many cytotoxic agentsHealth Impacts of Chemical Exposure

  • Segregation of Chemical WasteChemical WasteSeparate from infectious waste, radioactive waste, and general non-risk wasteSegregate based on compatibilityToxic, Corrosive, Flammable, Reactive

  • Containers and Color Coding for Chemical Waste

    WHO recommendation

    WasteColor and MarkingsContainer TypeChemical and pharmaceutical wasteBrownPlastic bag or container

  • Labeling of Chemical WasteWaste container label should have:Name, address, telephone of the generatorPoint of generation (if applicable)Start date of accumulation of wasteEstimated quantityDescription of contentsWaste classificationHazard symbolsPrecautionary statementEmergency contact information

  • International Chemical Waste Symbols

    ToxicCorrosiveFlammable

    ExplosiveOxidizer

  • Handling of Chemical Waste

    Proper personal protective equipment (PPE) should be used when handling hazardous chemicalsType of PPE required is specific for each chemical

  • Handling of Chemical Waste

    Appropriate transferring methods must be usedBonding, grounding, and explosion proof devices for flammable wasteSpill kit accessibleDifferent spill kits for different hazardsAll materials in the kit are hazardous after useSecondary containment

  • On-Site Transport of Chemical Waste

    Use wheeled trolleys, containers, or carts designated for chemical waste transport with the following specificationsEasy to load and unloadNo sharp edges that could damage waste bags or containers during loading and unloadingEasy to cleanLeak proof

  • Storage of Chemical WasteUse a separate and enclosed area, room, or buildingProvide good ventilationHave easy access to safety shower and eyewash stationEquip with a liquid or chemical proof sump (secondary containment in case of leaks)

  • Storage of Chemical WasteNo mixing of chemical waste (according to manufacturers specifications)Incompatible wastes should be stored separately, e.g. acids and basesTemperature should be controlled or kept within the acceptable range based on manufacturers requirements

  • Sample Sketch of a Chemical Waste Storage Area

  • Storage of Chemical WasteStorage rooms and facilities should be labeled on the exterior with a sign: - NO ENTRY: Hazardous waste

    Other symbols if needed:No SmokingNo Eating or Drinking

  • Off-Site TransportTransport vehicles should meet basic requirementsE.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 proceduresConsignment or manifest system

  • Treatment of Chemical WasteChemical and Physical TreatmentNeutralizationDetoxificationChemical reduction or oxidationElectrolytic oxidationHydrogenation, hydrolysisBiological TreatmentBiodegradationThermal TreatmentHigh-temperature incineration with air pollution control

  • Treatment of Chemical Waste in Low-Income CountriesEncapsulation Inertization with cementBurial of encapsulated or inertized waste in engineered, controlled and secure landfillsReturn of chemicals to manufacturers

  • Chemical Wastes Containing Heavy MetalsChemical Wastes containing toxic metals, in generalShould not be burned or disposed in dumpsitesSome heavy metals, like silver in x-ray processing, can be recoveredReturn to supplier for reprocessing or disposal if possibleIf no options currently exist, store the waste safely in a medium-term storage siteRefer to the Secretariat of the Basel Conventions guidelines on the environmentally sound management or reclamation of metals including mercury and leadMercuryDevelop safe clean-up, handling and storage proceduresSequester mercury waste safely in a long-term storage facility Reduce unnecessary use of mercury equipmentReplace mercury-containing products with mercury-free alternativesDevelop plans to become a mercury-free facilityCadmium and LeadSend to facilities that specialize in recovery of heavy metalsReturn to suppliers if possibleSend to a treatment, storage and disposal facility for hazardous industrial waste

  • Chemical Waste ManagementIntegrate chemical waste management into the HCWM plan, program and organizationIdentify chemical waste sources and hazardsControl hazards by using less hazardous materials, modifying equipment to reduce exposures, implementing safe practices, PPE and administrative controlsTrain workers on the proper use of PPEProvide workers with information such as material safety data sheets (MSDS) and international chemical safety cards (ICSC)Comply with the countrys chemical waste regulationsDevelop strategies for waste minimization

  • Workers Right to KnowPrinciple 10 of the Rio Declaration on Environment and DevelopmentEach 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 withFacilities 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)

  • Safety Data SheetsSections of a safety data sheetIdentificationHazard identificationFirst-aid measuresFire-fighting measuresAccidental release measuresHandling and storageExposure controls/personal protectionExposure controls/personal protection

    Physical and chemical propertiesStability and reactivityToxicological informationEcological informationDisposal considerationsTransport considerationsRegulatory informationOther information, including date

  • Example of an ICSCICSCs can be found at: http://www.ilo.org/dyn/icsc/showcard.home

  • Example of a Safety Data

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