Medical waste management

Medical Waste Management 1/ 60 © Copyright Training 4 Today 2000 Published by EnvironWin Software LLC.

WELCOME

MEDICAL WASTE MANAGEMENT

CUSTOMIZED ENVIRONMENTAL TRAINING


INSTRUCTOR

Insert Instructor Name Here


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.

Recommend Inspection Items.

Discuss Use of Contractors.

OBJECTIVES


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 Your Facilities 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.


Supervisors

Facility Engineers

Maintenance Personnel

Department Managers

Building Occupants

Process Specialists

Environmental and Safety Committees

LEARNERS


The goal of this course is to provide supervisors with the tools needed to properly manage medical waste. It recommends practical, actions that can be carried out by facility management, maintenance personnel and building occupants. The course will help you to integrate good medical waste management activities into your existing organization and identify which of your staff have the necessary skills to carry out those activities.

OVERVIEW


WHAT THIS COURSE DOES NOT DO

The course is not intended to provide information to operate medical waste treatment equipment. These specialties required training beyond the intended scope of this course. Where this expertise is needed, outside assistance should be solicited.


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.


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.


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.


WHAT IS A REGULATED MEDICAL WASTE?

Definition of Regulated Medical WasteRegulated Medical Waste is a subset of all medical wastes and include seven distinct categories:1. Cultures and stocks of infectious agents.2. Human pathological wastes (e.g. tissues, body parts)3. Human blood and blood products4. Sharps (e.g. hypodermic needles and syringes)5. Certain animal wastes6. Certain isolation wastes (e.g. wastes from patients with highly communicable diseases)7. Unused sharps.


WHAT IS AN INFECTIOUS WASTE?

Definition of an Infectious WasteEPA has provided the following guidance on what constitutes an infectious waste. These factors include:1. Presence of a pathogen of sufficient virulence2. Dose3. Portal of entry 4. Resistance of hostThus, 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 laboratories3. 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


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

7. Contingency measures for emergency situations

8. 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.


SEGREGATING MEDICAL 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 on infectious waste containers as appropriate.



Whenever possible, do not combine medical waste with hazardous chemicals or radioactive waste. Separate sharps waste from other medical wastes. Sharps should be stored in puncture-proof containers. Separate pathology wastes from other medical wastes. Separate chemotherapy wastes from other medical wastes.



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.


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.


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.


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.


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.


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.


STORAGE

Storage temperature and duration are important considerations. Warmer temperatures cause higher rates of microbial growth and putrefaction, resulting in odor problems. EPA recommends: 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.


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.


MEDICAL WASTE HAULING

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.


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:1. Autoclaving (steam sterilization)2. Incineration3. Thermal inactivation4. Gas/Vapor Sterilization5. Chemical Disinfection6. Sterilization by irradiation (radiofrequency and microwave)


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

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.


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 spillage during autoclave loading/unloading •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.


INCINERATION

Newly Regulated Emissions from Medical Waste Incineration: 1. Particulate Matter2. Carbon Monoxide3. Dioxin4. Sulfur Dioxide5. Hydrogen Chloride6. Nitrogen Oxides7. Cadmium8. Lead9. Mercury


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.


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.


CHEMICAL DISINFECTION

Chemical disinfection is the preferred treatment for liquid infectious wastes. Consider the following:

– Type of microorganism – Degree of contamination – Amount of proteinaceous material present – 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: Electricity requirements are nominal. Steam is not required. No heat or chemicals remain the treated waste.The principal disadvantages are as follows: Capital costs are high. Highly trained personnel are required. 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.


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.


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.


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.


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.


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

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

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.


EXPOSURE CONTROL PLAN

Required when employees may be exposed to bloodborne pathogens. This plan should include:

Determination of employee exposure Implementation of methods of exposure control, including:

- Universal precautions- Engineering and work practice controls- Personal protective equipment- Housekeeping

Hepatitis B vaccination Post-exposure evaluation and follow-up Communication of hazards to employees and training Record keeping Procedures for evaluating the exposure incident.


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 STEPS

Report the Incident — Employees should immediately report exposure incidents to the employer to permit timely medical follow-up.


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 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.


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.


MERCURY

EPA and AHA signed a Memorandum of Understanding (MOU). 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

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.


CHECKLIST

A. SPILL PLAN EQUIPMENT & PROCEDURES Disinfectant Absorbent Shovel Gloves Public protection Bags and boxes Notification procedures Protective clothing

B. CONTINGENCY PLANS Alternate treatment site Other storage sites Exposure Control Plan


CHECKLIST

C. HANDLING & STORAGE Handling procedures followed Packaging procedures followed Packages are transferred properly Storage areas marked and locked Storage areas disinfected

D. HEALTH & SAFETY TRAINING Risks associated with infectious waste Spill plan procedures Personal protective gear (gloves, aprons, goggles) Schedule of training Proof of training


RECORDS

What Records Must You Keep?

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.


Remember, You Control Your Facility or Area!

Review Procedures With Them Before Starting the

Job!

Ensure They Are Properly Trained!

Determine Their Environmental Compliance Record!

Determine Who Is in Charge of Their People!

Determine How They Will Affect Your Facility’s

Environmental Compliance!

TIPS FOR USING CONTRACTORS


ELEMENTS OF A SUCCESSFUL MEDICAL WASTE PROGRAM

1. DETAILED WRITTEN MEDICAL WASTE INSPECTION

GUIDELINES.

2. DETAILED WRITTEN MEDICAL BEST MANAGEMENT

PRACTICES.

3. EXTENSIVE EMPLOYEE TRAINING PROGRAMS

4. PERIODIC REINFORCEMENT OF TRAINING

5. SUFFICIENT DISCIPLINE REGARDING IMPLEMENTATION

6. PERIODIC FOLLOW-UP


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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Medical waste management

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Transcript of Medical waste management