Medical Waste Management

MEDICAL WASTE MANAGEMENT
CPE655 SOLID WASTE MANAGEMENT

DR. AZIL BAHARI BIN ALIAS
WELCOME
Medical Waste Management 1/ 60
Copyright Training 4 Today 2000 Published by EnvironWin Software LLC.
OBJECTIVES
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.
GOALS
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.
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.
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 OSHAs Bloodborne Pathogen
Standard
49 CFR 173.196 Department of Transportations
Packaging of Infectious Substances for Shipment
49 CFR 173.197 Department of Transportations
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, doctors
(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:
1. Cultures and stocks of infectious agents.
2. Human pathological wastes (e.g. tissues, body parts)
3. Human blood and blood products
4. Sharps (e.g. hypodermic needles and syringes)
5. Certain animal wastes
6. Certain isolation wastes (e.g. wastes from patients with
highly communicable diseases)
7. 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:
1. Presence of a pathogen of sufficient virulence
2. Dose
3. Portal of entry
4. 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.

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 punctureresistant 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 semirigid 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. Incineration
3. Thermal inactivation
4. Gas/Vapor Sterilization
5. Chemical Disinfection
6. 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 Matter
2. Carbon Monoxide
3. Dioxin
4. Sulfur Dioxide
5. Hydrogen Chloride
6. Nitrogen Oxides
7. Cadmium
8. Lead
9. 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 hospitals 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 oneon-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
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.
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

Medical Waste Management

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MEDICAL WASTE MANAGEMENT

CPE655 SOLID WASTE MANAGEMENT

Copyright Training 4 Today 2000 Published by EnvironWin Software LLC.