Managing Regulated Medical Waste in New Mexico

Transcription

1 Managing Regulated Medical Waste in New Mexico Prepared by: Dr. Joe King Camino Real Environmental Research Center Sunland Park, New Mexico

2 History of Medical Waste Regulations

3 1988 Legislation in response to medical waste washing up on several East Coast beaches

4 1988 Medical Waste Tracking Act

5 Medical Waste Tracking Act Defined medical waste and those waste to be regulated Established a cradle to grave tracking system Required management standards Established record keeping requirements and penalties for mismanagement

6 Medical Waste Tracking Act Expired June 21, 1999

7 Medical Waste Tracking Act Allowed the EPA to Gather Information Perform studies related to medical waste Information served as a potential model for state programs

8 Conclusion Disease causing potential is greatest at the point of generation and naturally tapers off at that point

9 Conclusion Risk to the public of disease caused by exposure to medical waste is likely to be much lower than the risk for occupationally exposed individuals

10 Medical Waste

11 Medical Waste Is Regulated at the State level

12 Medical Waste in New Mexico Is defined by The New Mexico Solid Waste Management Regulations

13 20 NMAC 9.1

14 20 NMAC 9.1 Regulates Generators of Medical Waste Transporters of Medical Waste, and Medical Waste Treatment Facilities

15 20 NMAC 9.1 Defines Regulated Medical Waste as Infectious Waste

16 Material rendered non-infectious May be handled as non-infectious waste, provided

17 provided It is not otherwise regulated

18 provided The operator of the disposal facility applies daily cover

19 provided Any person that treats infectious waste shall certify in writing, that the waste has been rendered noninfectious

20 Infectious Waste Includes but is not limited to a limited class of substances that carry a probable risk of transmitting disease to humans

21 infectious waste includes Microbiological Laboratory Waste

22 Microbiological Laboratory Waste disposable culture dishes and devices used to transfer, inoculate and mix cultures

23 Infectious waste means Pathological waste

24 Pathological Waste Human or animal tissue, organs and body parts, removed during surgery, autopsy or biopsy Note: Photo depicts non-compliance.

25 Infectious Waste means disposable equipment, instruments, utensils, and other disposable materials which require special precautions because of contamination by high contagious diseases Smallpox

26 Infectious waste means Human blood and blood products, including waste blood, blood serum, and plasma

27 Infectious waste means Used sharps, including used hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass

28 Microbiological Laboratory Waste Cultures and stocks of infectious agents from clinical research and industrial laboratories

29 Infectious waste means Contaminated animal carcasses, body parts, and bedding, especially those intentionally exposed to pathogens in research, in the production of biologicals or the in vivo testing of pharmaceuticals

30 Regulated Medical Waste Generators Includes but is not limited to: General Acute Care Hospitals Skilled Nursing Facilities or Convalescent Hospitals Intermediate Care Facilities In-Patient care Facilities for the Developmentally Disabled

31 generators continued. Dialysis Clinics Free Clinics Community Clinics Employee Clinics Health Maintenance Organizations Home Health Agencies Surgical Clinics Urgent Care Clinics

32 generators continued Acute Psychiatric Hospitals Blood/Plasma Centers Laboratories Medical Buildings Physicians Offices Veterinarians Acupuncturists Funeral Homes

33 and all infectious waste storage, treatment, and disposal facilities

34 Medical Waste Facilities generate: Recyclable materials Solid waste Liquid waste Hazardous waste Sharps (regulated medical waste) Radioactive waste Infectious medical waste

35 Recyclable Materials Paper Plastic Glass Cardboard Metal Etc.

36 Solid Waste Waste Management Hierarchy Reuse Recycle Waste to Energy Landfill

37 Liquid Waste If not hazardous or otherwise prohibited waste Must go to a permitted facility Not a Landfill

38 Liquid Waste Note: It is lawful to dispose of liquid infectious waste into a sewage treatment system after obtaining written approval of the sewage treatment system s operator

39 Hazardous Waste Must go to a permitted Hazardous Waste Treatment Facility

40 Used Sharps Must be handled, stored, transported, treated and disposed as infectious waste

41 Radioactive Waste Must go to a permitted Radioactive Waste Facility

42 Infectious Waste other than Sharps Must be segregated Disposed of as Regulated Medical Waste

43 Waste Management Plan Every person who generates, transports, stores, treats, or disposes of infectious waste shall prepare and maintain on file a management plan Camino Real Operating Records

44 Waste Management Plan Identifies The type of waste the person generates or handles The segregation Packaging Labeling Collection Storage Transportation procedures to be implemented Treatment or disposal method The Transporter Disposal Facility to be used The person responsible for the management of infectious waste

45 Manifest All infectious waste management facilities may only accept infectious waste that is accompanied by a manifest that contains the information required by Section 712

46 Manifest Requirements Name, address and phone number of the generator of special waste

47 Manifest Requirements Name, address and phone number of any and all commercial haulers in the order each will be transporting the waste

48 Manifest Requirements Type and proper name of waste being shipped

49 Manifest Requirements Total weight or volume of waste prior to shipment from generator

50 Manifest Requirements Total weight or volume of waste received at solid waste facility

51 Manifest Requirements Type and number of containers in shipment

52 Manifest Requirements Any special handling instructions

53 Manifest Requirements Date and location the waste was delivered

54 Manifest Requirements Date of receipt from the generator and total weight or volume of the special waste shall be provided by the transporter

55 Manifest Requirements If more than one commercial hauler is used, each commercial hauler shall provide the date of receipt and total weight or volume of said waste received from the previous commercial hauler

56 Manifest Requirements The manifest shall accurately reflect the information and be signed by the generator and each commercial hauler of the special waste, and by the solid waste facility owner or operator, acknowledging delivery, quantify, and receipt of the waste

57 Manifest Requirements All signatories shall be duly authorized agents of their organizations

58 Manifest Requirements Upon discovery of any significant discrepancy including, but not limited to, factual misrepresentation on the manifest, irregularities in transportation, discharges, or any unauthorized action in regard to the shipment, delivery, or disposal of the solid waste, the person discovering the discrepancy shall notify the Department, the generator, commercial hauler, and the solid waste facility within 24 hours

59 Manifest Requirements Upon receipt of special waste shipment at the solid waste facility, the owner or operator shall send a signed copy of the manifest back to the generator

60 Manifest Requirements A copy of the manifest shall be retained by the commercial hauler and the solid waste facility for their permanent records.

61 Manifest Requirements The generator shall retain both the original copy and the returned copy signed by the solid waste facility owner or operator for the generator s s permanent record

62 Manifest Requirements Copies of the manifest shall be made available to the Secretary upon request and shall be retained by the facility owner or operator throughout the post-closure period and any extended time period deemed necessary by the secretary

63 What is Infectious Waste in New Mexico? Gloves stained/smeared with blood

64 What is Infectious Waste in New Mexico? Gauze that is saturated, dripping, caking or flaking with blood or other potentially infectious substance

65 What is Infectious Waste in New Mexico? Dressing from patients that that are saturated, dripping, caking or flaking with blood or other potentially infectious agents

66 What is Infectious Waste in New Mexico? IV Bags used to give blood

67 What is Infectious Waste in New Mexico? IV bags for blood products

68 What is Infectious Waste in New Mexico? IV tubing with blood or evidence of blood contamination

69 What is Infectious Waste in New Mexico? Syringes with a used or attached needle or Syringes that are visibly contaminated with blood or OPIM

70 What is Infectious Waste in New Mexico? Ventilator tubing visibly contaminated with blood or OPIM

71 What is Infectious Waste in New Mexico? Suction tubing visibly contaminated with blood or OPIM

72 What is Infectious Waste in New Mexico? Suction Canisters visibly contaminated with blood or OPIM

73 Uncontaminated Canisters Are not regulated as infectious waste

74 Storage and Containment Requirements

75 Storage and Containment Requirements Shall be in a manner which affords protection from animal intrusion, does not provide a breeding place or a food source for insects and rodents, and minimizes exposure to the public

76 Storage and Containment Requirements Infectious waste shall be segregated by separate containment from other waste at the point of origin Note: Photo depicts an overfilled rigid container and is noncompliant.

77 Storage and Containment Requirements Except for sharps, shall be contained in plastic bags inside rigid containers

78 Storage and Containment Requirements The bags shall be securely tied to prevent leakage or expulsion of solid or liquid waste during storage, handling or transport

79 Storage and Containment Requirements Sharps, shall be contained for storage, transportation, treatment, and disposal in leak-proof, rigid, puncture resistant containers which are manufactured for the purpose of sharps containment and are taped closed or tightly lidded to preclude loss of contents

80 Storage and Containment Requirements All bags used for containment purposes shall be red or orange and clearly identified as specified in 29 CFR (f)(4) Note: This slide demonstrates the purpose behind high visibility bags.

81 Storage and Containment Requirements Rigid containers shall be labeled biomedical waste, or otherwise conspicuously labeled as holding infectious waste, or placed in disposal bags used for other infectious waste

82 Storage and Containment Requirements If other waste is placed in the same container as regulated infectious waste, then the generator shall package, label and mark the container and its entire contents as infectious waste

83 Storage and Containment Requirements Rigid infectious waste containers may be reused for infectious or non- infectious waste if they are thoroughly washed and decontaminated each time they are emptied and

84 Storage and Containment Requirements the surfaces or the containers have been completely protected from contamination by disposable, unpunctured or undamaged liners, bags, or other devices that are removed with the infectious waste, and the surface of the containers have not been damaged or punctured

85 Generators of medical waste Shall place an absorbent material inside the liner of the rigid container equal to one (1) cup of absorbent material per each six (6) cubic feet of box area if the rigid container is to hold any containers which had held free liquid

86 Absorbent material if the rigid container is to hold containers which do hold free liquids, then enough absorbent material shall be placed inside the liner of the rigid container sufficient to absorb 15% of the total volume of free liquid inside the rigid container 15%

87 Storage and containment areas Shall protect infectious waste from the elements Be ventilated to the outdoors Be only accessible to authorized persons Be marked with prominent warning signs on or adjacent to the exterior doors or gates

88 Storage and Containment Requirements Warning signs shall be easily read during daylight from a distance of 25 feet

89 Storage and Containment Compactors, grinders or similar devices shall not be used to reduce the volume of infectious waste before the waste has been rendered non- infectious unless prior approval has been obtained from the Department Requirements

90 Time - Storage Requirements Special waste shall not be stored for longer than 45 days, unless other wise approved by the Department.

91 Key to Successful Waste Management Identify Regulated Waste Segregate, Segregate, Segregate

92 Regulated Waste Hazardous/Toxic Waste PCB s Asbestos Liquid Waste Infectious Waste Radioactive Waste

93 Acceptable treatment of infectious waste

94 Incineration

95 Sterilization by heating in a steam sterilizer

96 Acceptable treatment of infectious waste Other methods approved by the Secretary

97 What happens when waste is mismanaged?

100 What happen when waste is mismanaged?

105 New Mexico Environment Department 1190 St. Francis Dr Suite N4050 Santa Fe, NM tel. (800)