INSTITUTIONAL POLICY AND PROCEDURE (IPP)

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1 HOSPITAL NAME INSTITUTIONAL POLICY AND PROCEDURE (IPP) Department: Manual: Section: TITLE/DESCRIPTION POLICY NUMBER HAZARDOUS WASTE: HANDLING AND DISPOSAL EFFECTIVE DATE REVIEW DUE REPLACES NUMBER NO. OF PAGES APPROVED BY APPLIES TO PURPOSE To provide guidelines for the handling or disposal of hazardous waste, including infectious waste, radioactive waste, chemical waste, and chemotherapy waste. DEFINITION infectious waste Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a suspectable host could result in an infectious disease. RESPONSIBILITY CROSS REFERENCES POLICY Medical Center staff shall use the following procedures in the safe handling or disposal of hazardous waste. The guidelines of the Environmental Protection Agency (EPA), Centers for Disease Control and Prevention, and other agencies are used in the development of these procedures. Specific Information: A. Infectious Waste 1. The Infection Control Committee/Office is responsible for the definition of infectious waste (See Attachment A) and is responsible for developing guidelines concerning the handling or disposal of infectious waste. 2. Waste items considered infectious include, but are not limited to, needles and sharps, items contaminated with Blood or body fluids, isolation room waste, all microbiological waste, anatomical pathology, and surgical waste (See Attachment A). 3. Handling, Storage, and Transport a. All items defined as infectious waste are segregated from noninfectious waste at the point of generation and handled separately. b. Red bagged waste are placed in secondary containers that will prevent leakage of contents. c. The rooms where potentially infectious waste is stored are identified by signage with the symbol. d. Infectious waste discarded in red bags is transported by Environmental Services or other designated housekeeping services to the autoclave in closed leak-proof containers with tight fitting covers. e. Sharps containers, pathological waste, and body fluid collection devices which cannot be emptied are managed by incineration or autoclaving according to applicable state and federal regulations by a commercial medical waste vendor. Standards Page 1 of 8

2 f. For the offsite practices, infectious waste discarded in red bags, sharps containers, pathological waste, and Body collection devices which cannot be emptied are managed by incineration or autoclaving according to applicable state and federal regulations by a commercial medical waste vendor. 4. All needles and sharps are placed in color coded or labeled, puncture-resistant Sharps containers. Sharps containers must be checked and replaced as needed to prevent overfilling. They are then sealed when full. (NOTE: Sharps containers are not reusable.) 5. Blood and body fluids in easily emptied containers, such as suction canisters, may be carefully emptied into hoppers, utility sinks, or commodes in a manner that minimizes splashing and splattering. Personal protective equipment is used since there is a reasonable likelihood for exposure. The containers are then discarded in red infectious waste bags. 6. Closed systems containing blood, such as pleura-vacs and blood collection/administration systems, cannot be emptied. A solidifying agent (e.g., Isolyzer gel) is added to these blood and body fluid collection systems and single use suction containers, causing blood and body fluids to gel prior to being placed in the ous waste container. These containers of blood or body fluids which have not been decanted into the Municipal sewer system are not placed in red bags, but are placed in Red bins for disposal and removal by Environmental Services or other designated housekeeping services. 7. Pathologic waste includes tissues, placentas, organs, body parts that are removed during the surgery and autopsy. Pathologic wastes must be incinerated by an offsite contracted waste disposal company. Pathologic Waste is not placed in any regular red bag disposal container. Pathologic waste bagged and placed in a designated yellow waste container. 8. Laboratory infectious waste is autoclaved prior to transport to the landfill. B. Radioactive and Chemical Waste 1. Environmental Health and Safety is responsible for developing guidelines concerning the handling or disposal of radioactive and chemical waste. Detailed procedures are available from the web site. For areas that do not have access to the internet, a hard copy of the procedures may be obtained by contacting the Environmental Health and Safety. 2. Faculty and staff in areas that generate chemical and radioactive waste follow the procedure below: a. All waste is properly packaged for transport. All liquid waste must be in a chemically compatible Container (such as the container it came in), sealed with a screw-on cap, and free of any residue on the Outer surface of the container. Environmental Health and Safety will not accept any waste in water bottles, milk jugs, household detergent container, etc. All solid waste must be in an approved Environmental Health and Safety bag or box and sealed tape. The bag or box should not be leaking or have any residue on the surface. (NOTE: If unsure of proper container for transport, contact Environmental Health and Safety). Standards Page 2 of 8

3 b. Items containing lead are packaged separately from all waste. c. Chemical waste is stored by compatibility in secondary containment until collection. Waste containers are closed at all times except when adding waste. d. Waste is tagged for disposal with the appropriate tag. These tags can be ordered free of charge through the Environmental Waste Collection Program. Available tag types are as follows: i. Chemical waste ii. Radioactive waste (solid) iii. Radioactive waste (liquid) iv. Radioactive waste (biowaste) Note: Radioactive liquid waste requires both the Radioactive waste (liquid) tag and the Chemical waste tag. e. Request a hazardous waste pick-up through the Environmental Health and Safety website. For areas that do not have internet access, complete the attached chemical waste or radioactive waste collection form and fax to Environmental Health and Safety. C. Cytotoxic Waste 1. Trace contaminated cytotoxic drug waste includes: a. Items used to prepare drugs b. Items used to clean areas and waste from patient rooms where drug is administered c. Empty bags, vials, IV tubing, etc. These items are placed in a securely closed cytotoxic bucket or cytotoxic waste bag prior to transport. Cytotoxic waste is picked up by Environmental Services or other designated housekeeping service and transported to an offsite medical waste incinerator. (Note: Sharps may be discarded in cytotoxic waste liners). Bulk contaminated cytotoxic drug waste (unsused Ivs and vials of drugs) is returned to the pharmacy For disposal. 2. Faculty/staff who have regular contact with preparing, administering, removing, and destroying cytotoxic drugs are oriented to the hazards of handling cytotoxic drugs. Special instructions are given on the disposal of designated cytotoxic drug waste and cleaning of areas where these medications are in use. 3. Cytotoxic waste containers are available on units for disposal of waste from patients receiving cytotoxixc drugs. 4. Faculty/staff must wear appropriate personal protective equipment when handling cytotoxic drug waste containers. PROCEDURE FORMS EQUIPMENT REFERENCES Standards Page 3 of 8

4 Garner JS, Simmons. CDC Guidelines for Isolation Precautions in Hospitals. Atlanta, GA: US 1997 Web References: Centers for Disease Control and Prevention website Clinical Policy Manual Cytotoxic Drugs (Chemotherapy) Administration and Management Blood Product Administration From Manual/Hpolicy.nsf?OpenDatabase Comprehensive Accreditation Manual for Hospitals Management of the Environment of Care standard from Rules of the Tennessee Department of Health and Tennessee Department of Environment and Conservation Safety Policy Manual Handling of Cytotoxic Drugs Tennessee Department of Environment and Conservation website. Tennessee Department of Transportation website. U.S. Environmental Protection Agency website. Vanderbilt Environmental Health and Safety website. APPROVAL: Prepared by Reviewed by Approved By Approved By Latest Revision Approved By Name Signature Date ATTACHMENT A Standards Page 4 of 8

5 INFECTIOUS WASTE POLICY DEFINITION OF INFECTIOUS WASTE The Department of Health and Environment, Chapter of the hospital rules and regulations, defines infectious waste as follows: Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a suspectable host could result in an infectious disease. The following categories of waste are classified as infectious: 1. Cultures and stocks of infectious agents; including specimen cultures collected from medical and pathological laboratories, cultures, and stocks agents from clinical and research labs, wastes from the production of biological agents, discarded live and attenuated vaccines, and culture dishes and devices used to transfer inoculate, and mix cultures. 2. Human blood, blood products, serum, plasma, and waste blood. Any medical device or item (blood bags and corresponding tubing, dialysis lines, wound dressings, and the like) that are contaminated with blood. 3. Pathological wastes, tissues, organs, body parts, and body fluids removed during surgery or autopsy. 4. Discarded sharps (e.g., needles, syringes, scalpels, pipettes, broken glass, scalpel blade, capillary tubes) used in clinical or research areas. All sharps, including those not contaminated with blood or body fluids, shall be placed in a sharps container. 5. All solid waste contaminated with body fluids from isolation rooms, or labor and delivery rooms, the emergency department, and all intensive units. 6. Contaminated animal carcasses. Body parts, animal bedding from animals exposed to pathogens in research, production of biological agents, or in vitro testing, or pharmaceutical vaccines. Other medical devices are summarized in the following table. In general, medical waste contaminated by blood or other body fluids is incinerated or autoclaved to destroy all pathogens prior to deposits in the landfill. MEDICAL CENTER HAZARDOUS WASTE DISPOSAL GUIDELIES Standards Page 5 of 8

6 TYPE OF WASTE Sharps EXAMPLES Needles, Syringes,scalpels,lancets, capillary tubes, etc. CONTAINER USED Sharps container DISPOSAL METHODS Autoclave,For offsite practices: COMMENTS Check and replace container as needed to prevent overfilling. Pathological Waste Human tissue (placenta, OR tissue, etc.) Red Bag may need to double bag if leaks are possible; place pathologic waste in special yellow path waste container All path waste is incinerated offsite by Biohazard Small, unrecognizable pieces of tissue or parts of organs are autoclaved or disposed of as regular red bag waste. Chemotherapy Waste Contaminated patient care services that cannot be emptied Contaminated patient care Chemotherapy bags, etc.* See sharps section above for disposal Pleuravacs, vacuum bottles, blood bags, etc Suction canisters, wound drainage systems, Cytotoxic waste bucket or container lined with cytotoxix waste bags Red bin; do not place within red bag. A solidifying agent (i.e. Isolyzer) is added to containers to cause secretions to solidify prior to being discarded in the ous waste container. Red bin; do not place Incinaration Service, For Offsite practices: Incineration or autoclave Service, For Offsite practices: Incineration or autoclave Return unused drug to pharmacy Pleuravacs must clamped before discarding. Note: For patients with transfusion reactions, send blood bag with bag copy of tag and administration tubing to the Blood Bank Carefully empty into a hopper, clinical sink, Standards Page 6 of 8

7 devices that can be emptied Isolation Grossly contaminated items Patient care devices (not contaminated with blood) General Waste Recyclable Soda cans, paper (hemovacs, JP drains), dialysis lines etc. Any waste from an isolation room that contains any blood/body fluids or from a VRE isolation room 4x4 saturated sponges all saturated dressings, saturated items from ED, OR, L&D, all ICUs etc. Foley bags, IV bags and tubing, blue pads, (Chux) urine cup (if no blood), vaginal speculums, etc. Pizza boxes, soda cans, fast food wrappers, flowers, newspapers, magazines, paper wrappings from sterile items, paper towels, etc. Clear, tan bag or none within red bag. A solidifying agent (i.e. Isolyzer) is added to containers to cause secretions to solidifying prior to being discarded in the ous waste container. Red bag may need to double bag if leakage is possible Red bag may need to double bag if leakage is possible Clear or tan bag Clear or tan bag Recycled Service, For Offisite practices: Autoclave for Offsite Practices: Autoclave For Offsite Practices: Landfill Landfill or commode. Use personal protective equipment if there is a reasonable likelihood for exposure due to splashing/splattering. Double bagging is no longer recommended except in VRE cases. For human tissue (placenta, OR tissue) see pathological waste. Any patient item that is not contaminated with blood. Do not place these items in red bags even if they are from an isolation room. Radioactive Radioactive isotopes Yellow bag with special markings Licensed disposal service Collection managed by EHS. Submit online collection request via website. Spills should be Standards Page 7 of 8

8 Chemical Collodion, xylene, toluene, formalin, etc. Liquid Waste chemically compatible container (such container it came in) Solid Waste Approved EHS sealed bag or box Licensed disposal service reported to tel. No. Collection managed by EHS. Submit online collection request via website. Spills should be reported to tel. No. Standards Page 8 of 8

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