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JCAHPO Regional Meetings

2017

9/27/2016

1

Just Bag It ! RED BAG QUIZ – What Should

Go In The Red Bag ? 1. Half bag of leftover french fries from a boy with chickenpox.

2. Asthma inhaler from a 35-year-old man with allergies.

3. Single, uncapped syringe from a penicillin injection.

4. Broken mercury manometer.

5. Filled and securely closed reusable sharps container.

6. One adhesive bandage that is leaking blood from a playground accident.

7. Sealed vial with 2 tablets of acetominophen with codeine.

8. Visibly bloody gloves used in a digital exam of a 60-year-old man.

9. Leftover chemotherapy vial (90% empty) from leukemia patient.

10. Orthodontic wires from a 13-year-old girl who is apparently healthy.

ANSWERS

• Only #6 and #8 should go directly into the red bag, since red bags should be used for items capable of releasing blood or other potentially infectious materials. Food and other “regular” solid waste don’t belong in the red bag.

• An uncapped syringe (#3) should be placed in a sharps container, since it poses a biohazard if the needle should penetrate the red bag. Federal OSHA and most states also consider wires snipped from orthodontic appliances (#10) to be sharps waste.

• Although sealed “disposable” sharps containers can be added to the red bag, “reusable” sharps containers (#5) are “green” solutions that are rendered noninfectious and reused.

• Aerosol inhalers (#2), mercury (#4), and bulk chemotherapy (#9) are types of hazardous waste that must be separated from (“segregated”) and never permitted to commingle with red bag waste.

• Controlled substances, (i.e acetaminophen with codeine) are regulated by the Drug Enforcement Agency (DEA), and their disposal and destruction must be overseen by a DEA registrant.

What is “medical waste” or “potentially infectious” material?

The Medical Waste Tracking Act of 1988 broadly defined medical waste as any solid waste that is generated in the diagnosis, treatment, or immunization of human beings or animals. It excludes hazardous waste and household waste. The law states that medical waste included, but was not limited to, the following: items that are freely dripping liquid or semi-liquid blood, "potentially infectious materials" or could readily release infectious materials if compressed .

EPA.org

Medical waste is a subset of wastes generated at health care facilities (hospitals, physician’s offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories). Medical waste is health care waste that may be contaminated by blood, body fluids or other potentially infectious materials and is often referred to as regulated medical waste.

9/27/2016

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Examples Of Medical Waste

• blood-soaked bandages • culture dishes and other glassware • discarded surgical gloves • discarded surgical instruments • discarded needles used to give shots or draw blood (sharps) • cultures, stocks, swabs used to inoculate

cultures • removed body organs (ex: tonsils, limbs) • used lancets • Epi Pen after it has been used

www.sharpsdisposal.com

Which body fluids are considered infectious? * Amniotic fluids * Blood and its components * Cerebrospinal and synovial fluid * Dialysis waste * Pericardial and pleural fluid * Saliva in dental procedures * Semen * Vaginal secretions

docstoc.com

What Goes In The Red Bag ?

Always check your facility’s policies and procedures and adhere to your specific guidelines.

*Visibly bloody gloves

* Gauze, bandages or other

items saturated with blood .

How Do I Package My Red Bag ?

Medical waste generators are legally responsible for packaging their waste. Step 1: Line your container with the red bag prior to use. Step 2: Tie the bag when the container is full. Each bag must be hand-tied by gathering and twisting the neck of the bag. Step 3: Secure the lid on the container. -Make sure all closure and/or locking mechanisms are engaged. Red bags must not be visible once the container is closed. Step 4: Check the containers markings. Ensure that federal markings (biohazard symbol, this-side-up-arrows, regulated medical waste, N.O.S., and UN number) are present. Ensure you are complying with your individual state regulations. Step 5: Apply the bar code label (where available).

Stericyle.com Stericycle.com

9/27/2016

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What Should NOT Go In A Red

Bag? • Sharps such as needles, syringes,

scalpels, razors or Pasteur pipettes

• Chemical or radioactive waste

• Vomit, diapers, urine

• Medications

• Food

• General Trash

What Do I Do If I Have A Blood Spill In Clinic

OSHA’s Bloodborne Pathogen Cleanup Kit: • Disposable gloves • Absorbent materials (e.g., kitty litter, sand, etc.) • Disinfecting towelettes • Biohazard bag with zip tie • Scoop • Protective cap • Eye protection • Protective gown • Mask

Cover the spill area

with a paper towel and

then pour freshly

mixed 10% bleach and

water solution. Allow solution to soak into the contaminated material. Work from the outside edges of the spill inward when applying the bleach solution.

Wipe up bleached material with paper towels or absorbent pads. It may be necessary to use a scrub brush to remove the material if it impacted a hard porous surface such as concrete. If non-porous surfaces, such as a carpet have been contaminated, an outside vendor may be needed to clean the area.

Decontaminate with the bleach solution all potentially contaminated re-useable tools or protective equipment used in the cleanup. This includes: dustpans, brooms, forceps, and buckets. Anything that cannot be effectively cleaned must be disposed as waste. After the contaminated area has been cleaned, use fresh water to remove bleach residue from all surfaces.

9/27/2016

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Blood Spills On Non – Carpeted Floors

Non-carpeted surface blood spills is the most common setting for blood spills. This includes: tile, ceramic, vinyl, linoleum, metal, wood, cement, and any other non-absorbent flooring. Cleaning up blood and other bodily fluids off these surfaces is easier than absorbent surfaces, but there are still important steps for you to consider.

cultureofsafety.com

Spills on hard surfaces spread quickly so you need to contain the spill quickly. 1. Block off the area until cleanup and disinfection is complete. Keep unprotected staff and patients, from access to the area. 2. Put on disposable gloves. 3. Wipe up the spill as much as possible with paper towel or other absorbent material. 4. Gently pour bleach solution (1 part bleach to 9 parts water) onto all contaminated areas

• Let bleach solution remain on contaminated area for 20 minutes and then wipe up remaining bleach solution.

• All non-disposable cleaning materials such as mops, brushes and rags need to be disinfected by saturating with a bleach solution and then allowed to air dry.

• Remove gloves and place in a garbage bag with all other soiled cleaning materials.

• Double bag and securely tie up garbage bags and discard.

• Thoroughly wash hands with soap and water.

Blood Spills On Carpeted Floors

Blood spills on carpeted floors are very difficult to clean up. Many of the procedures for cleaning up blood on carpet will be the same as any other area, with a few additional concerns. There is no way to disinfect carpet completely so the best option is to clean as thoroughly as possible. Blood, or other bodily fluids, can harden or set up quickly on carpeting. This makes it more difficult to clean.

Steps For Carpet Disinfecting

• After completely disinfecting the area, allow the disinfectant to set and work for up to 20 minutes to make sure it has the full effect.

• Disinfect THREE times (20 minutes a time) • Rinse: Once the final round of disinfecting is complete, rinse the area one last time to remove any remaining detergent or disinfecting solution. After rinsing, wet- vacuum the area. • Dry the area thoroughly with rags to draw out any

remaining moisture and then place fans near the area to completely dry it

• After the area is clean, properly dispose of all rags and PPE contaminated by the spill.

• Bleach and other decontamination products can damage, or even destroy, carpet. The best way to clean these areas is to use manufacturer approved carpet shampoos and cleaners. You need a product with anti-microbial properties to help sanitize the area as thoroughly as possible.

• Steam Clean: Depending on the nature and size of the spill, it is advisable to perform a steam clean of the carpet. Steam cleaners will clean, remove debris, and sanitize carpeting more completely than

conventional washing. It is the best way to protect against bloodborne pathogens.

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Blood Spills On Furniture

Cloth furniture needs more treatment than wood or metal furniture. Depending on the type of cloth furniture and the degree of the spill, the best cleaning method is to remove the cloth covering, if possible, and launder it by itself on a warm wash cycle. If the cloth furniture does not have a removable cover, then it is best to treat the spot as you would a blood spill on carpet and disinfect, let sit, and repeat several times.

Professional cleaners can clean furniture more effectively. Blood spills on metal and wood furniture are not as difficult as those on cloth furniture, but it is important to point out that bloodborn pathogens are still a threat. Metal, wood and any other non-porous furniture should be cleaned just like a blood spill on a non-carpeted surface.

Sharps

Sharps is a medical term for devices with sharp points or edges that can puncture or cut skin. Used needles and other sharps are dangerous to people and pets if not disposed of safely because they can injure people and spread infections. The most common infections are: • Hepatitis B (HBV), • Hepatitis C (HCV), and • Human Immunodeficiency Virus (HIV).

www.sharpsdisposal.com

There Are (4) Kinds of Sharps

• Non-contaminated (except needles, syringes and lancets)

• Biohazardous (includes non-contaminated needles, syringes, and lancets)

• Chemically contaminated

• Radioactive

Never Re-Cap Needles (even with Safety devices) !!!!!

moodle.digital-campus.org

9/27/2016

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How Should Sharps Be Handled Per OSHA

Sharps containers need to either be labeled with the universal biohazard symbol and the word "biohazard" or be color-coded red. The containers must be maintained upright, replaced routinely, and not be allowed to overfill. Containers must be: • Closed immediately prior to removal, or replacement, to prevent

spillage or protrusion of contents during handling, storage, transport, or shipping

• Placed in a secondary container if leakage is possible. The second container must be: – Closable – Constructed to contain all contents and prevent leakage

during handling, storage, transport, or shipping; and

After closing, duct tape can be used to secure the lid of a sharps container, as long as the tape does not serve as the lid itself. Sharps containers must be easily accessible to employees and located as close as feasible to the immediate area where sharps are used (e.g., patient care areas).

• They always need to be labeled or color coded according to the standard.

• Reusable containers must not be opened, emptied, or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.

What Goes In The Sharps Disposal Container ?

• needles • lancets • syringes • broken glass • scalpels • culture slides & culture dishes • broken capillary tubes • broken rigid plastic • exposed ends of dental wires

Never place loose needles

and other sharps in

household or public trash

cans/recycling bins, and

never flush them down the

toilet!

Stericylcle.com

9/27/2016

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How Do I Package My Sharps ?

Step 1: Place sharps in a puncture resistant container designed for sharps waste. Do not allow loose sharps in any waste container other than the sharps container.

Step 2: Securely close the container.

What Are Pharmaceutical Wastes (RCRA) ?

“Hazardous” drugs in regard to drug waste, refers to pharmaceuticals that are identified by the Resource Conservation and Recovery Act (RCRA) as environmental hazards for people, animals, and the environment. RCRA (RICK-rah) is outlined by the EPA and gives guidance regarding medications that are known environmental hazards. By law, RCRA drug wastes must be disposed of by a company that specializes in hazardous waste management.

RCRA identifies the following as hazardous wastes: • P-listed drugs including nicotine and warfarin (Epi – Pen may be in this category as well ) * U-listed drugs including cyclophosphamide, lindane, melphalan, and mitomycin C ( a chemotherapeutic agent that aids in decrease scarring during the healing process after eye surgery) * Pharmaceuticals containing heavy metals and mercury, such as some vaccines, * eye and ear drops containing thimerosal (a preservative most commonly found in soft contact lens solutions )

total eye.org

Tips to Remember Regarding Pharmaceutical Waste

• Spilling or dropping a medication onto the floor doesn’t automatically render it harmless. If someone has a medication spill, it’s important to understand that the medication is still pharmaceutical waste that needs to be disposed of according to regulations.

• Patient forgets to bring their medication home with them. Personal medications are now your responsibility to be disposed of accordingly.

• Sometimes prepared medications aren’t fully administered, especially with IV bags

and injections. Residual medication should

be considered pharmaceutical waste.

What are Controlled or Scheduled Substances?

Controlled substances are defined by the Controlled Substances Act of 1970. These include: * Depressants * Hallucinogens, • Narcotics • Stimulants. Controlled substances are sometimes called scheduled substances, because of the DEA’s classification (CI-CV). This is based on each controlled substance’s theoretical potential for addiction and its medicinal purpose. The destruction of any of these scheduled substances must be witnessed as required by DEA. The Drug Enforcement Administration (DEA), an agency of the US Department of Justice, requires that controlled substances be destroyed as directed by the Agency. This type of disposal is called “witnessed destruction.”

What is “trace” chemotherapy ?

Trace chemotherapy is separated from other wastes and is incinerated.

Some types of chemotherapy (even in small amounts ) may not be disposed of as trace chemotherapy but are considered RCRA hazardous waste. All full bags, or bottles of chemotherapy, (those containing more than 3% of the original contents by weight are

considered RCRA hazardous waste

and must be disposed as such. )

When less than 3% of the original

content remains in total, the items may

be considered RCRA empty. It also

includes the medicine remaining in

needles, bags, tubing, containers, gloves,

and gowns used during injections.

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Be Aware of the LAW: State, Federal & Local

The EPA isn’t the only regulatory bodies with jurisdiction over pharmaceutical waste. The DOT, DEA, and OSHA also regulate the handling and disposal of pharmaceutical waste.

Your state, county, and municipality also may have more stringent requirements for specific types of pharmaceutical waste.

• The DOT, for example, requires

you to segregate pharmaceutical

waste according to chemical

compatibility to prevent reactions

from taking place inside waste containers during transportation.

• The DEA requires you to separately dispose of controlled substances. • OSHA is concerned about providing a safe work environment for those who work with pharmaceutical waste. For example, pregnant women should not be exposed to some pharmaceuticals or chemo meds (such as Mitomycin).

lynjyctrz.blogspot.com

weill.cornell.edu